Spinal Cord Injury

PHYSIOLOGY/PATHOPHYSIOLOGY

• Injury can occur at any point along the cord
• Caused by excessive traction, rotation, and torsion of the vertebral column and neck
• Occurs from stretching of spinal cord; damage ranges from complete transection to laceration, edema, hemorrhage, and hematoma formation (Bonifacio et al., 2012; Ditzenberger & Blackburn, 2014; Fenichel, 2007; Madsen, Frim, & Hansen, 2005; Volpe, 2008)

ASSESSMENT

• Birth history: breech delivery, dystocia, macrosomia, cephalopelvic disproportion

CLINICAL MANIFESTATIONS/DIAGNOSIS

• Spinal cord shock: hypotonia, weakness, flaccid extremities, sensory deficits, relaxed abdominal muscles, diaphragmatic breathing, Horner syndrome (ipsilateral ptosis, anhidrosis, and miosis), distended bladder
• Low cervical lesions: shallow, paradoxical respirations
• Degree of neurologic insult often cannot be accurately evaluated until the infant has recovered from the initial period of spinal shock and any edema or hemorrhage has been reabsorbed
• Spinal ultrasonography, CT, or MRI to determine level and extent of injury

TREATMENT

• Stabilize

• Treat associated problems (e.g., asphyxia, hemorrhage, shock)

• Maintain respiratory status

• Midcervical to upper cervical or brainstem lesions require assisted ventilation

• Monitor for signs of respiratory infection and pneumonia

• Maintain skin integrity over the paralyzed area

• Require meticulous bowel, bladder care; regular glycerin suppositories, urinary catheterization

• Follow-up care: multidisciplinary team: nursing, medicine, neurology, neurosurgery, physical therapy, orthopedics, urology, social work, and psychology

PROGNOSIS

• Depends on the level and severity of the injury; generally, poor

• Many are stillborn or die shortly after birth

• Survivors have varying degrees of residual paralysis, respiratory problems, and bowel and bladder dysfunction, depending on the level of the injury