Asalamualaikum and today i want to share a knowledge regarding what is a spinal injuries and what is the plan and goal for manage it.
Vertebrae
l
The
vertebral column is made up of 26 bones that provide axial support to the
trunk. The vertebral column provides protection to the spinal cord, which runs
through its central cavity. Between each vertebra is an intervertebral disk,
which acts as a shock absorber
Anatomy of spine
l
The
spinal cord ends in the lumbar area and continues through the vertebral canal
as spinal nerves. Because of its resemblance to a horse's tail, the collection
of these nerves at the end of the spinal cord is called the cauda equina. These
nerves send and receive messages to and from the lower limbs and pelvic organs.
Vertebra and spinal nerves
l
The
spinal cord and its peripheral nerves are protected by the vertebral column, a
stack of bones which surround and provide support. Between the vertebrae is a
fluid-filled disk
Spinal Injuries
Alternative names
Spinal cord compression
Definition
Spinal cord trauma is damage to the
spinal cord that results from direct injury to the cord itself, or from
indirect injury from damage to the bones, soft tissues, and blood vessels
surrounding the spinal cord
Causes, incidence, and risk factors
l
motor
vehicle accidents
l
falls
l
sports
injuries (particularly diving into shallow water)
l
industrial accidents
l
gunshot
wounds
l
assault
l
Diseases
(Cancer, infections, arthritis and inflammation of the spinal cord )
l
A
seemingly minor injury can cause spinal cord trauma if the spine is weakened
(such as from rheumatoid arthritis or osteoporosis) or if the spinal canal
protecting the spinal cord has become too narrow (spinal stenosis) due to the
normal aging process .
l
Direct
injury, such as cuts, can occur to the spinal cord, particularly if the bones
or the discs have been damaged. Fragments of bone (from fractured vertebrae,
for example) or fragments of metal (such as from a traffic accident) can cut or
damage the spinal cord
l
Bleeding,
fluid accumulation, and swelling can occur inside the spinal cord or outside
the spinal cord (but within the spinal canal). The accumulation of blood or
fluid can compress the spinal cord and damage it
l
Older
people with weakened spines (from osteoporosis) may be more likely to have a
spinal cord injury.
l
Patients
who have other medical problems that make them prone to falling from weakness
or clumsiness (from stroke, for example) may also be more susceptible
Signs & Symptoms
l
Pain
or an intense stinging sensation caused by damage to the nerve fibers in the
spinal cord
l
Loss
of movement
l
Loss
of sensation, including the ability to feel heat, cold and touch
l
Loss
of bowel or bladder control
l
Exaggerated
reflex activities or spasms
l
Changes
in sexual function, sexual sensitivity and fertility
l
Difficulty
breathing, coughing or clearing secretions from the lungs
Emergency signs and
symptoms
of spinal cord injury after a head injury or accident
of spinal cord injury after a head injury or accident
l
Fading
in and out of consciousness
l
Extreme
back pain or pressure in the neck, head or back
l
Weakness,
incoordination or paralysis in any part of the body
l
Numbness,
tingling or loss of sensation in the hands, fingers, feet or toes
l
Loss
of bladder or bowel control
l
Difficulty
with balance and walking
l
Impaired
breathing after injury
l
An
oddly positioned or twisted neck or back
Complication
l
paralysis
(paraplegia, quadriplegia)
l
loss
of sensation
l
loss
of bladder control
l
increased
risk of urinary tract infections
l
increased
risk of chronic bilateral obstructive nephropathy
l
loss
of bowel control
l
loss
of sexual functioning (male impotence)
l
paralysis
of breathing muscles
l
increased
risk of injury to numb areas of the body
l
pain
l
complications
of immobility:
l
deep
vein thrombosis
l
pulmonary
infections
l
skin
breakdown
l
contractures
l
shock
l
extreme
blood pressure fluctuations
l
spasticity
(late complication)
Paralysis
Thoracic and lumbar
spine injuries
Examination &
Investigation
l
Examine
the back for tenderness, kyphos and a gap in the interspinous and supraspinous
ligaments.
Neurological signs
l
Signs
of cord compression are not usually present in a stable fracture. Nerve roots
however, may be damaged by both bone and disc especially in the lumbar region.
X-ray
l
This
does not show any appreciable forward displacement of one vertebra on the next.
Compression of the vertebral body, a burst fracture or a chip fracture are
usually the only abnormalities. In the lumbar region the transverse processes
may be fractured.
Emergency assessment
Level of injuries
Stable spinal
fractures Thoracic lumbar and sacrum
Treatment
l
Medications.
Methylprednisolone (Medrol) is a treatment option for acute spinal cord injury.
This corticosteroid seems to cause some recovery in people with a spinal cord
injury if given within eight hours of injury. Methylprednisolone works by
reducing damage to nerve cells and decreasing inflammation near the site of
injury.
l
Immobilization. You may need traction to stabilize your spine and bring the spine into
proper alignment during healing. Sometimes, traction is accomplished by placing
metal braces, attached to weights or a body harness, into your skull to hold it
in place. In some cases, a rigid neck collar also may work.
l
Surgery.
Occasionally, emergency surgery is necessary to remove fragments of bones,
foreign objects, herniated disks or fractured vertebrae that appear to be
compressing the spine. Surgery may also be needed to stabilize the spine to
prevent future pain or deformity. However, some surgeons believe it's safer to
wait for several days before attempting any surgery
Type Of spinal
injuries and Dr management
Treatment Stable
injuries of the thoracic and lumbar
spine
spine
l
Bed
rest — The patient should be nursed on a mattress with fracture boards for a
few days.
l
Back
extension exercises — These should be started immediately, plus radiant heat
locally.
l
Back
support — This is usually required when the patient is mobilised out of bed.
a. Taylor brace — Supports both the
thoracic and lumbar spine.
b. Lumbo-sacral brace — Supports the
lumbar spine. This should be used for 3 months, or longer when the patient is
mobile. The patient can be up and walking in the support but must not lift
weights.
Type of spinal brace
Unstable spinal fractures
Immediate management
l
Transport
flat on back if possible, on a stretcher; otherwise face down with spine
extended.
Initial treatment
l
The
patient should be nursed on a soft mattress supported by fracture boards.
Two-hourly turning and back exercises are essential. Most patients should be
treated conservatively without operation .
Thoracic
l
In
the thoracic region patients usually have a complete transection of the cord
with complete paraplegia due to the relatively ‘tight fit’ of the thoracic
cord. These patients are often best treated by 2-hourly turning and lifting on
a soft mattress on fracture boards to prevent bed sores and to facilitate care
of bladder and bowel, and prevention of joint contractures. Occasionally
internal stabilisation of the spine will enable earlier mobilisation, and ease
the problem of nursing.
Thoraco-lumbar region
l
Occasionally,
there is an indication for stabilisation of the fracture with spinal Harrington
rods or CD instrumentation for incomplete lesions in the thoraco–lumbar region.
Operative stabilisation may make for ease of nursing and earlier mobilisation.
Cauda equina lesions
l
These should be explored as an emergency if
pressure by an intervertebral disc or bone is suspected. MRI or myelography may
be valuable. Perineal numbness and paralysis of the anus and bladder make this
an emergency, and decompression should be carried out without delay.
Progressive lesions
l
All
progressive lesions should be urgently explored. There may be a place for
systemic cortisone administration.
l
Lumbar — In the lumbar region early
stabilisation will enable early mobilisation, but operation is usually not
indicated unless these is pressure on the cauda equina by bone or disc.
Further management — unstable
spinal
injuries
injuries
Mobilisation
l
The
patient should be mobilised in 8 – 12 weeks with the help of calipers, crutches
and a wheelchair.
Rehabilitation
l
This
is essential and should be commenced immediately after admission to hospital.
Nursing
l
• Bed sores —
The use of a hydrostatic flotation bed for patients with paraplegia may
prevent the occurrence of bed sores and often allow bed sores to heal. Water
bed treatment is indicated in hospitals where lack of nursing staff prevents
2-hourly turning of the patient.
Walking
l
Most
patients with good power in the arms can walk with the aid of crutches and
above-knee calipers. A high or midthoracic lesion may necessitate a tripod gait
with both legs swung forward simultaneously as the body is supported by
calipers plus 2 crutches placed firmly on the ground.
l
Both
crutches are then moved forward, with the legs this time acting as the fixed
pivotal unit. It is essential that every effort be made to encourage the
patient to walk.
Flexion contractures
l
These are common in the hip, knee and
ankle and should be prevented or treated by physiotherapy where
possible. Failing this, subcutaneous fasciotomy to correct the
contractures is preferable to open operation.
Rehabilitation And
Aims
l
a
rehabilitation team will work with pt to improve pt remaining muscle strength
and to give pt the greatest possible mobility and independence .
l
Rehabilitation
team may include a physical therapist, occupational therapist,
rehabilitation nurse, rehabilitation psychologist, social worker, dietitian
recreation therapist and a doctor who specializes in physical medicine
(physiatrist) or spinal cord injury.
l
During
the initial stages of rehabilitation, The team therapists usually emphasize
regaining leg and arm strength, redeveloping fine-motor skills and learning
adaptive techniques to accomplish day-to-day tasks
l
A
program typically includes exercise by physiotherapist and occupational therapist will help to train
in ADL as a wheelchair user or equipment that can make it easier to fasten
buttons or dial a telephone.
l
Therapy
often begins in the hospital and continues for several weeks in a rehabilitation
facility. As therapy continues, you and your family members will receive
counseling and assistance on a wide range of topics, from dealing with urinary
tract infections and skin care to modifying your home and car to accommodate
your disability
l
Therapists
will encourage you to resume your favorite hobbies, participate in athletic
activities and return to the workplace, if possible.
l
They'll
even help determine what type of assistive equipment you'll need for these
vocational and recreational activities and teach you how to use it
l
Extensive
physical therapy, occupational therapy, and other rehabilitation interventions
are often required after the acute injury has healed. Rehabilitation assists
the person in coping with disability that results from spinal cord trauma.
Further Treatment
I would say the info i share to you is more a basic and i will help to give us some of the clear picture regarding of this condition and how to deal with this situation .
wallahuaklam...
0 Comments:
Post a Comment