Case Study on Spinal Cord Injury

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Neurologic

Pre - operative/ Post- operative:

Client is conscious, coherent, responsive and communicates well. He is able to recall past memories and has normal cognitive ability. He is oriented to time, place and person but is depressed regarding his current situation. Client is able to express his concerns to his family.

Anatomy and Physiology

SpinalCord
The spinal cord is part of the central nervous system of the human body. It is a vital pathway that conducts electrical signals from the brain to the rest of the body through individual nerve fibers. The spinal cord is a very delicate structure that is derived from the ectodermal neural groove, which eventually closes to form a tube during fetal development. From this neural tube, the entire central nervous system, our brain and spinal cord, eventually develops. Up to the third month of fetal life, the spinal cord is about the same length as the canal. After the third month of development, the growth of the canal outpaces that of the cord. In an adult the lower end of the spinal cord usually ends at approximately the first lumbar vertebra, where it divides into many individual nerve roots (L1).Spinal cord injury (SC) occurs when a traumatic event results in damage to cells within the spinal cord or severs the nerve tracts that relay signals up and down the spinal cord. The most common types of SCI include contusion (bruising of the spinal cord) and compression (caused by pressure on the spinal cord). Other types of injuries include lacerations (severing or tearing of some nerve fibers, such as damage caused by a gun shot wound), and central cord syndrome (specific damage to the corticospinal tracts of the cervical region of the spinal cord). Severe SCI often causes paralysis (loss of control over voluntary movement and muscles of the body) and loss of sensation and reflex function below the point of injury, including autonomic activity such as breathing and other activities such as bowel and bladder control. Other symptoms such as pain or sensitivity to stimuli, muscle spasms, and sexual dysfunction may develop over time. SCI patients are also prone to develop secondary medical problems, such as bladder infections, lung infections, and bed sores.

SpinalCanal
The spinal canal is the anatomic casing for the spinal cord. The bones and ligaments of the spinal column are aligned in such a way to create a canal that provides protection and support for the spinal cord. Several different membranes enclose and nourish the spinal cord and surround the spinal cord itself. The outermost layer is called the "dura mater," which is a Latin term that means "hard mother," indicating that early anatomists had at least a rudimentary sense of humor. The dura is a very tough membrane that encloses the brain and spinal cord and prevents cerebrospinal fluid from leaking out from the central nervous system. The space between the dura and the spinal canal is called the "epidural space". This space is filled with tissue, vessels and large veins. The epidural space is important in the treatment of low-back pain, because it is into this space that medications such as anesthetics and steroids are injected in order to alleviate pain and inflammation of the nerve roots. The low back officially begins with the lumbar region of the spine directly below the cervical and thoracic regions and directly above the sacrum. The lumbar vertebrae, L1-L5, are most frequently involved in back pain because these vertebrae carry the most amount of body weight and are subject to the largest forces and stresses along the spine. The true spinal cord ends at approximately the L1 level, where it divides into many different nerve roots that travel to the lower body and legs. This collection of nerve roots is called the "cauda equina," which means horse's tail and describes the continuation of the nerve roots at the end of the spinal cord.

Vertebrae
The...
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