A “complete” spinal cord injury occurs when both motor and sensory functions are absent below the level of the injury. However, trauma patients can also suffer several “incomplete” spinal cord injuries. In addition, complete spinal cord injuries can also cause some unique emergency conditions related to sympathetic response and autonomic regulation.
Following are six spinal cord injuries and emergencies that trauma and emergency nurses should understand and be prepared to address.
1. Central Cord Syndrome
Central cord syndrome occurs when edema from a spinal injury squeezes the outer tissues of the spinal cord but spares the center of the cord. Nurses may note:
- Weakness that is worse in the arms than in the legs
- Impaired sensation that is more pronounced in the upper extremities than in the lower extremities
Central cord syndrome most often affects the elderly in response to a hyperextension injury, usually from a fall.
2. Anterior Cord Syndrome
Anterior cord syndrome usually occurs when hyperflexion disrupts the anterior spinal artery. This deprives the anterior portion of the spinal cord of its blood supply, which can lead to ischemia and death of spinal cord tissue. Nurses may note:
- Urinary retention
- Loss of motor function below the level of the injury
- Loss of pain and touch sensation — but retention of vibration and proprioception — below the level of the injury
Patients with anterior cord syndrome generally do not recover significant function.
3. Brown-Sequard Syndrome
Brown-Sequard Syndrome is caused by a partial spinal cord transection. This transection can be caused by a variety of injury types, such as a penetrating injury or a disc herniation.
- Damage to one side of the spinal cord can affect a range of functions (motor function, proprioception, etc.) on the same side of the body.
- But because pain and temperature sensations traverse the spinal cord contralaterally, partial spinal cord transection can also affect these functions on the opposite side of the body.
The classic example: A patient is able to pick up a hot pan with one hand, but he or she does not perceive that the same hand is burning.
4. Spinal Shock
The commonly used term “spinal shock” is a misnomer. The more accurate description is spinal cord contusion or bruising.
The signs and symptoms of spinal shock can be similar to those of a complete cord injury, including loss of motor and sensory function below the level of injury and problems with autonomic regulation related to the location of the cord injury. However, these injuries may be transient, and patients who suffer spinal shock are often able to recover some motor and sensory function.
5. Neurogenic Shock
Neurogenic shock is an emergency condition that most often occurs with spinal cord injuries at the level of T6 and above. It is a form of distributive shock that has a unique presentation compared to other types of shock.
- Patients in neurogenic shock present bradycardic, hypotensive, and usually pink and warm.
- Due to the spinal cord injury, the body is unable to mount a tachycardic response to the bradycardia.
- The body is also unable to vasoconstrict, which further contributes to hypotension and the pink appearance of the patient.
- Poikilothermia (inability to maintain a constant body temperature) is also a presenting feature of neurogenic shock.
Patients in neurogenic shock should be treated with fluids, but care teams should be careful to avoid fluid overload. Vasopressors may also be used to help ensure adequate blood pressure.
6. Autonomic Dysreflexia
Autonomic dysreflexia results when a spinal cord injury interferes with autonomic regulation. It is an emergency condition that most often occurs with injuries at or above the level of T6, but injuries as low as T10 can also lead to this condition.
Autonomic dysreflexia might be a presenting feature upon ED arrival or it may develop during the patient’s stay. In the presence of a spinal cord injury, a trigger (such as a full bowel or bladder, a pressure ulcer, or a medical procedure) generates a severe hypertensive response. Signs and symptoms may include:
- Flushing, goose bumps (piloerection) and unexplained sweating (diaphoresis) above the level of the injury
- Headache and visual disturbances
- Anxiety and “feelings of doom”
- Nausea and vomiting
Unresolved autonomic dysreflexia can lead to cardiac arrhythmias, pulmonary edema, intracranial hemorrhage or death.
The source of the trigger must be resolved in order to resolve the symptoms. Additional interventions include sitting the patient up, removing restrictive clothing and lowering the patient’s blood pressure.
Learn more about spinal cord injuries: This article is based on Step on a Crack: Spinal Cord Trauma, an interactive online course from the Board of Certification for Emergency Nursing (BCEN®). Developed by nursing experts, this CE-eligible course reviews the anatomy and physiology of the spinal cord, outlines the steps of a thorough neurological assessment, and examines the survival barriers that may be caused by spinal cord injuries. To access this course and other learning opportunities for trauma nurses, visit BCEN Learn.
Step on a Crack: Spinal Cord Trauma supports the continuing education requirements of the Trauma Certified Registered Nurse (TCRN®) program. The TCRN credential is the only national board certification for trauma nursing, and it spans the body of knowledge for care of the injured patient. More than 8,000 nurses worldwide have earned the TCRN credential. For more information, click here.