spinal cord problems

Back pain

• low back pain
• muscle, spasm, ligament problems, degeneration
• herniated nucleus pulposis - puts pressure on spinal cord
• spinal stenosis - narrowing of spinal canal - bony overgrowth
• spondylolisthesis - vertebrae slide on each other putting pressure on nerve roots causing pain in lower back and butt

• good posture
• proper lifting
• exercise
• ergonomics

• positioning - William's position = semi fowler with pillows under knees or in a recliner
• drug therapy - pain meds, muscle relaxants, epidural injections to reduce inflammation, antiepileptics for chronic nerve pain
• heat therapy
• physical therapy
• weight control
• CAM - chiropractor

• diskectomies
• laminectomy
• spinal fusion

• neuro assessment
• voiding ability
• pain control
• wound care - infection prevention
• CSF check
• positioning and mobility - log rolling

• conservative treatment is same as described for back pain except that the exercises focus on shoulder and neck
• if these treatments do not work, soft collar may be used at night no longer than 10 days
• surgery - diskectomy and fusion - performed if nothing else works

head flexed forward

Head extended back

• hit on top of head - diving
• fall on butt

• hyperflexion
• hyperextension
• axial loading/vertical compression
• excessive rotation of head beyond range
• penetration injury

• hemorrhage
• ischemia
• hypovolemia
• neurogenic shock

• trauma is leading cause - usually in men
• 50% of injuries occur in car accidents
• falls
• acts of violence
• sports/recreation
• cervical cord injuries are most common

• Airway, breathing, circulation
• indications of intra-abdominal hemorrhage or hemorrhage around fracture sites
• LOC
• level of spinal injury

• occurs immediately as a concussion response to injury
• flaccid paralysis
• loss of reflex activity below level of lesion
• usually resolves within 24 hrs
• muscle spasticity begins in patients with cervical or high thoracic injuries

decreased sensation

increased sensation

• cardio dysfunction if injury is above 6th thoracic vertebrae
• systolic BP below 90 requires treatment b/c lack of perfusion to spinal cord could worsen client condition
• hypothermia
• possible swelling
• risk for respiratory problems r/t immobility or interruption of spinal innervations to respiratory muscles
• THORACIC 4 AND 5 KEEP THE DIAPHRAGM ALIVE
• monitor pulse oximetry

• abdomen assessment for hemorrhage, distention, paralytic ileus
• decrease in peristalsis and gastric distention reflex
• assess for areflexic (neurogenic) bladder which later leads to urinary retention

• muscle tone, size and strength
• longer term damage below level of damage = muscle atrophy

• muscle spasticity
• contracture after spinal shock has resolved

high risk for pressure ulcers

bony growth in soft tissue

• UA for blood
• ABGs for respiratory sufficiency
• CBC for blood loss, infection

• constant assessment
• assess for neurogenic shock

spinal shock syndrome with bradycardia, decreased/absent bowel sounds, warm, dry skin, hypothermia, hypotension

• fixed skeletal traction to realign vertebrae, facilitate bone healing and prevent further injury
• halo fixation and cervical tongs
• stryker frame, rotational bed, kinetic treatment table
• pin site care and monitoring of traction ropes

• for patients with thoracic injuries - bedrest and possible immobilization with body cast
• for patients with lumbar and sacral injuries - immobilization of spine with a brace or corset worn when patient is out of bed

• Methylprednisolone
• - glucocorticoid
• - monitor for infections, Cushings, BGs, stress ulcers
• Dextran - plasma expander for hypotension
• Atropine sulfate for HR below 50-60
• Tizanidine - CNS acting muscle relaxant
• Intrathecal baclofen - pain

• emergency surgery necessary for spinal cord decompression
• decompressive laminectomy
• spinal fusion
• harrington rods to stabilize thoracic spinal surgeries

• bladder retraining program
• external pressure on a spastic bladder
• valsalva maneuver for flaccid bladder
• 2000-2500 ml of fluid daily
• UTI monitoring
• long-term catheterization is possible

• commonly seen in patients with upper spinal cord injury
• sudden, severe throbbing headache and hypertension
• bradycardia
• flushing above level of lesion
• nasal stuffiness
• sweating
• nausea
• blurred vision
• goose bumps
• impending doom

• sitting position - priority
• notify HCP
• loosen tight clothing
• assess for and treat cause - monitor BP q10-15min; nitrates or hydralazine; I&O

• catheter obstruction
• bladder distention
• fecal impaction
• room temp too cool/drafty

• consistent time for bowel elimination
• high fluid intake
• high fiber diet
• rectal stimulation
• stool softener meds as needed

• primary - meninges
• intramedullary - small # within spinal cord
• extramedullary - in spinal dura outside of the cord - most common

• depends on location and rate of growth
• pain
• weakness
• mobility problems
• loss of bowel/bladder control
• MRI, CT scan
• possible need for emergency surgery
• radiation/chemotherapy

• chronic autoimmune disease affecting the myelin sheath and conduction pathway of CNS - leading cause of disability in young adults
• characterized by remission/exacerbation
• inflammatory response resulting in random or patchy areas of plaque in the white matter of CNS impairing nerve conduction
• unknown cause
• seen more in colder climates
• more common in women

• vague symptoms
• double vision
• flexor spasms at night
• intnetion tremor
• dysmetria - inability to direct/limit movement
• decreased visual acuity
• change in peripheral vision (scotomas)
• blurred vision
• nystagmus
• hypalgesia (decreased sensitivity to pain)
• numbness
• tingling
• burning
• bowel/bladder dysfunction

• nothing specific
• CSF - may find increased proteins

• drug therapy
• promoting mobility
• managing symptoms
• CAM - bee stings

• Lou Gehrig's disease
• adult onset upper and lower motor neuron disease characterized by progressive weakness, muscle wasting and spasticity eventually leading to paralysis
• generally die of respiratory failure

• fatigue while talking
• tongue atrophy
• dysphagia
• weakness of hands and arms
• fasciculations
• nasal speech quality
• dysarthria

• no known cure
• no treatment
• no preventive measures
• Riluzole is the only drug approved to extend survival time
• exercise and mobility programs
• swallow management
• respiratory support