Spinal Cord Injury
Spinal cord injury (SCI) is a major health problem. The vertebrae involved in this type of injury frequently involves the 6th and 7th cervical (neck) vertebrae (C5-C7), the 12th thoracic vertebra (T12) and the first lumbar vertebra (L1). These vertebrae are most susceptible because there is a greater range of mobility in the vertebral column in these areas. Furthermore, these are the least likely portions of the human vertebra that are subjected to the most amount of force as they are the most vulnerable in most cases.
The predominant risk factors of a spinal cord injury include age, gender, alcohol and drug use. The frequency with which these risk factors area associated with spinal cord injuries serves to emphasize the importance of primary intervention and prevention. It is therefore imperative that healthcare workers must know the basic, intermediate and advance skills in caring for individuals with spinal cord injuries as they are prone to several physical and psychological stresses throughout the acute all the way to their post recovery phase.
Pathophysiology of a spinal cord injury
A spinal cord injury can range from transient concussions (from which the patient fully recovers) to contusion, laceration and compression of the cord substance (either alone or in combination), to a total and complete transection (severing) of the spinal cord which renders the patient paralyzed below the level of the injury.
Generally, spinal cord injuries can be separated into two distinct categories: primary injuries and secondary injuries. Primary injuries are the result of the initial trauma and usually have permanent effects following the injury. Secondary injuries are usually the result of a contusion or a tear injury, in which the nerve fibers begin to swell or disintegrate. A secondary chain of events produces ischemia, hypoxia, edema and hemorrhagic lesions which in turn result in the destruction of myelin and axons.
Clinical manifestations of a spinal cord injury
Manifestations of SCI depend on the type and level of injury. The type of injury refers to the extent of injury to the spinal cord itself. In an incomplete spinal cord lesion, depending on the level of injury can result in loss of bladder and bowel control, loss of sweating and vasomotor tone, marked reduction in blood pressure and loss of peripheral vascular resistance. A complete spinal cord lesion ultimately results in the total loss of sensation and voluntary muscle control below the level of injury.
Emergency management of a spinal cord injury
The immediate management at the scene of the injury is very critical because improper handling of the patient can cause further damage and loss of neurologic function. Any patient who is involved in a motor vehicular crash, a diving or contact sports injury, a fall or any direct trauma to the head and neck must be presumed and considered have SCI until such injury can be ruled out. Initial care must include a rapid physical assessment, immobilization, extrication, stabilization or control of life-threatening injuries and transportation to the most appropriate medical facility.
At the scene of the injury, the patient must be immobilized on a
spinal board with the head and neck in neutral position in order to prevent an incomplete injury from becoming completely severed. If possible, at least four people should work as a team in immobilizing and transferring the individual to the nearest health care facility for further management in order to begin appropriate care or rule out a spinal cord injury.