4. Anatomy :
On the surface :
Deep anterior median fissure.
Shallower posterior median sulcus.
Spinal cord segment :
Section of the cord from which a pair of spinal
nerves are given off.
5.
6. Anatomy :
Dorsal root – sensory fibres
Ventral root – motor fibres
Dorsal and ventral roots join at intervertebral
foramen to form the spinal nerve
7.
8. Physiology and function
Grey matter - sensory and motor nerve cells
White matter - ascending and descending
tracts
Divided into - dorsal
- lateral
- ventral
9. Dermatomes
Area of skin innervated by sensory axons within a
particular segmental nerve root
Knowledge is essential in determining level of injury
Useful in assessing improvement or deterioration
10. Myotomes :
Segmental nerve root innervating a muscle
Again important in determining level of injury
Upper limbs:
C5 - Deltoid
C 6 - Wrist extensors
C 7 - Elbow extensors
C 8 - Long finger flexors
T 1 - Small hand muscles
12. SPINAL CORD INJURY
DEFINITION:
Spinal cord injury is damage to the spinal cord that
results in a loss of function such as mobility or
feeling.
The cervical and lumbar vertebrae are the most
common sites of injury.
15. Classification
Complete
absence of sensory & motor function in lowest
sacral segment after resolution of spinal shock
Incomplete
presence of sensory & motor function in lowest
sacral segment (indicates preserved function below
the defined neurological level)
16. Types of incomplete injuries
i) Anterior Cord Syndrome
ii) Central Cord Syndrome
iii) Brown – Sequard Syndrome
iv) Herniated disc Syndrome
19. Classification
Incomplete SCI syndromes
Central Cord Syndrome
Motor loss UE>LE
Hands affected
Common in elderly w/
pre-existing spondylosis
and cervical stenosis.
Substantial recovery can
be expected.
20. Classification
Incomplete SCI syndromes
Brown Sequard
Ipsilateral motor,
proprioception loss.
Contralateral pain,
temperature loss.
Penetrating injuries.
Good prognosis for
ambulation.
21. Types of Spinal Cord Paralysis
1.Monoplegia:paralysis of one limb
2.Diplegia:paralysis of both upper or lower limbs
3.Paraplegia:paralysis of both lower extremities
4.Hemiplegia:paralysis of upper limb,torso and
lower leg on one side of the body.
5.Quadriplegia:paralysis of all four limbs.
22.
23. SIGNS AND SYMPTOMS:
1.Impaired breathing.
2.Extreme back pain or pressure in the neck,head or
back.
3.Weakness,incordination.
4.Numbness,tingling or loss of sensation.
5.Loss of bladder or bladder control.
6.Difficulty with balance and walking.
7.Sexual impairment.
8.Muscle spasm.
26. SURGICAL MANAGEMENT
1. Surgical decompression.
2.Fixation or stabilization with a steel rod.
3.External immobilization with a brace or cast.
27. NURSING DIAGNOSIS
1.Ineffective airway clearence related to paralysis of
respiratory,chest and abdominal muscle.
2.Ineffective breathing pattern related to paralysis of
respiratory,chest and abdominal muscle.
3.Acute pain related to irritated nerve root and soft
tissue injury.
4.Impaired physical mobility related to loss of motor
function.
5.Disturbed sensory perception related to motor and
sensory impairment.
28. NURSING DIAGNOSIS
6.Impaired urinary elimination related to inability to
void spontaneously.
7.Constipation related to presence of atonic bowel as a
result of autonomic disruption.
8.Risk of impaired skin integrity related to immobility
and sensory loss.
9.Anxiety related to prognosis of neurological deficits.
31. BIBLIOGRAPHY:
Barbara k, Nancy E. Introductory Medical-Surgical
Nursing.9th ed . USA. Lippincott Williams and
Wilkins.2007.p.731-5.
Suzanne C,Brenda G,Janice L,Kerry H.Textbook of
Medical-Surgical Nursing.11st ed. New Delhi.Wolters
Kluwer.2008.p.2250-2257.
Barbara C, Wilma J, Virginia L. Medical-Surgical
Nursing , A Nursing Process Approach. 3rded.USA.Alison
Miller.1993.p.1276-81.
Gail A , Judith R. Medical Surgical Nursing .9th ed.
USA . Nancy L.Coon.1996.p.932.
32. Lois w ,Gena D . Medical-Surgical
Nursing.USA.Dalmar.1997.p.708-13.
Marcia A ,Doris W ,Patrica A . Medical-Surgical
Nursing . USA . Springhouse
corporation.1998.p.321-3.
Ray A. Medical-Surgical Nursing .3rd ed. USA.
Lippincott and Wilkins.2001.p.356-9
http://en.wikipedia.org/wiki/Spinal_cord
http://www.nlm.nih.gov/medlineplus/spinalcordinj
uries.html
http://stemcellstm.alphamedpress.org/content/earl
y/2015/02/15/sctm.2014-0107.short
33. Sudhakar Vadivelu, Todd J. Stewart, Kevin Horn, Qun Li et al . Stem
Cells Translational Medicine.NG2+ Progenitors Derived From
Embryonic Stem Cells Penetrate Glial Scar and Promote Axonal
Outgrowth Into White Matter After Spinal Cord Injury.March 2015
4(3).
Jeannette Spalding. Journal Nature. Peptide Shows Great Promise for
Treating Spinal Cord Injury .December 3, 2014