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SCI

Nonprogressive Disorders of the Spinal Cord (Spinal Cord Injury [SCI])

Description/Overview

Neurological Involvement Types (in Alphabetical Order)

Anterior cord syndrome - motor function, pain, & temperature loss below lesion level

Brown-Séquard syndrome - spinal cord hemisection showing ipsilateral side motor involvement & proprioception loss, & contralateral side pain & temperature loss

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Cauda equina injury - similar symptoms to peripheral nerve injury (with specific spinal nerve root involvement)

Central cord syndrome - more severe motor involvement than sensory involvement; upper limbs more involved than lower limbs; common in the elderly & individuals with narrow spinal canals

Conus medullaris syndrome - may present with both UMN & LMN symptoms, including lower limb paralysis & areflexic bowel & bladder; some patients may retain sacral reflexes

Posterior cord syndrome (very rare today) - loss of proprioception & 2-point discrimination below lesion level

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Sacral sparing - the most centrally-located sacral tract is spared; perianal sensation & external anal sphincter remain intact (often observed in incomplete cervical lesions)

Medical Red Flags

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Autonomic Dysreflexia
Occurs most often in patients with injuries above T6
Symptoms Possible Causes Management

  • Flushed face

  • Headache

  • Profuse sweating above lesion level

  • Very high blood pressure

  • Bradycardia

  • Skin rash

  • Impacted bowel

  • Full urinary bladder

  • Blocked urinary catheter

  • Urinary tract infection

  • Noxious stimulus below lesion level (e.g., ingrown toenail)

  • Identify & remove cause

  • Monitor blood pressure & heart rate

  • Keep patient sitting up

  • Notify physician (may need blood pressure medication)

  • If unresolved in 10 minutes, call for emergency medical help

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Orthostatic Hypotension (Postural Hypotension)
Occurs most often in patients with tetraplegia
Symptoms Possible Causes Management

  • Sudden blood pressure drop due to position changes (e.g., from supine to sitting)

  • Poor distal & lower limb venous return

  • Unable to regulate blood pressure

  • Recline patient & elevate lower limbs

  • Constantly monitor blood pressure during position changes

  • Have patient wear pressure stockings & abdominal binder

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Deep Vein Thrombosis (DVT)
Occurs most often in lower limbs
Symptoms Possible Causes Management

  • Swelling, heat, erythema in involved area

  • May not feel pain when testing for Homans' sign (calf muscle pain when passively dorsi-flexing ankle with knee extended)

  • Thrombus formed in deep leg veins due to immobilization

  • Sensory impairment regarding negative Homans' sign

  • Rest & no lower limb exercises

  • Refer to physician

Precautions

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Heterotopic Ossification
Osteogenesis of soft tissue below injury level
Symptoms Possible Causes Management

  • Pain, local swelling/warmth, or sometimes blockage of movements during passive range of motion (ROM) exercises (usually bony end feel)

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