Spinal cord injury, SCI

Notes

## Basic introduction

  • This is a traumatic event that leads to disturbances of normal sensory, motor, or autonomic function and ultimately impacts a patient’s physical, psychological, and social well-being.
  • Injuries to the spinal cord in the cervical spine are the most severe and may cause complete tetraplegia.

## Statistics

  • Globally, 250 000 -500 000 people suffer a spinal cord injury.
  • The SCIs mostly affect the 18-35 year old, mainly due to motor accidents. This is followed by the elderly due to falls
  • 90% of cases of spinal cord injuries have traumatic causes.
  • Males are at a higher risk of spinal cord injuries than females (2:1 ratio).
  • About 20-30% of people with spinal cord injury manifest with signs of depression
  • Statistics in Kenya were scanty

## Causes of spinal injury

  • Road accidents (leading cause)
  • Sport injury
  • Assault
  • Falling from height
  • Penetrating injuries
Symptoms
  • Symptoms and signs depend on the severity and location of the injury
  • Back or neck pain
  • Breathing disorders
  • Digestive disorders
  • Loss of bowel and bladder function
  • Muscle spasm
  • Neurogenic shock
  • Numbness
  • Hypotension
  • Bradycardia
  • Peripheral vasodilatation
  • Tingling sensation
  • Weakness
  • Sexual dysfunction
  • Paraplegia (paralysis of the legs and lower body)
  • Quadriplegia or tetraplegia (paralysis of all four limbs)
  • Vertebral body compression fracture (Sudden downward force shatters and collapses the body of the vertebrae)
  • Burst fracture (bone fragments into the spinal canal)
  • Dislocation of spinal cord (bones come out of alignment)
  • Fracture-dislocations (broken bones and the torn ligaments)
  • Spinal shock (there is initial hyporeflexia that is manifested by loss of both cutaneous and deep tendon reflexes BELOW the level of injury together with a loss of sympathetic outflow that leads to hypotension and bradycardia. This initial stage is followed by a return of reflexes in a specific pattern)
Diagnosis
  • Clinical review
  • X-rays
  • CT scan
  • MRI
  • Other tests

_HB

_Renal function tests and electrolytes

Differential
  • Epidural and Subdural Infections
  • Spinal Cord Infections
  • Hanging Injuries
  • Strangulation injuries
  • Neck Trauma
  • Syphilis
  • Peripheral neuropathy
  • Diabetic neuropathy
  • Polymyositis
Prevention
  • In most cases, there is nothing that can be done to prevent spinal injury
  • Best driving practices such as the use of a seatbelt, avoiding the use of mobile phone while driving, observing speed limit etc.
  • Avoid moving someone who has a suspected spinal cord injury.
  • Avoiding clutter and slippery floor at home
  • Observe sport safety guidelines
Reference

1. Kenyan Ministry of Health. Clinical guidelines for management and referral of common conditions at levels 4-6. Hospitals. 2009; 3:259-261.http://apps.who.int/medicinedocs/documents/s21000en/s21000en.pdf

2. Ministry of Health, Kenya. Kenya Essential Medicine List (2016). http://publications.universalhealth2030.org/uploads/KEML-2016Final-1.pdf

3. Pickett W, Simpson K, Walker J, Brison RJ. Traumatic spinal cord injury in Ontario, Canada. J Trauma. 2003;55(6):1070–1076.

4. Spinal cord injury.http://www.who.int/mediacentre/factsheets/fs384/en/. 2013. Accessed on 16th January 2017.

Management
  • Resuscitation following ABCDE protocol, when required
  • Analgesia

_Tabs Ibuprofen 400mg TID Or

_IM Diclofenac 75mg STAT

_Other appropriate analgesics

  • Where an open wound exists give

_Tetanus toxoid 0.5ml STAT

_Appropriate antibiotic cover

  • Application of cervical collar and/or hard board when required (to prevent further injuries of the spinal cord)
  • Surgical toilet
  • Management of fractures
  • Rehabilitation with physiotherapy, occupational therapy, prosthetics and orthotic fittings among others.
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