Spinal

Cord
Compres
Reporter: Sheril Casanes
OBJECTIVES
At the end of this discussion the students are expected to
learn the following:

01 02
How the pathophysiology is What clinical symptoms are
related to the basic anatomy pertinent to assess spinal
of the spinal cord; cord compressions;

03 04
What the basic management of
What investigations and
alternative diagnoses to spinal cord compression
consider when evaluating for entails and why it is
spinal cord compression; considered an oncology
emergency.
Vertebrae??? Quiz
Cervival
Thoracic
Lumbar
Sacral
Coccyx
S1-5

C1-4
Spinal Cord
Compression
Is an oncology emergency that happens when a
tumor causes impingement of the spinal cord.
This may be a primary or metastatic tumor near
by the cord.
This leads to:

PAIN

POTENTIALLY
IRREVERSIBLE
NEUROLOGICAL
DYSFUNCTIONAL
ANATOMY
ANATOMY
“Horses’s tail”
PATHOPHYSIOLOGY
 MOST
common
cause

osteoarthritis
Other Diagnostic Tests:
• Myelography
• Electromyography
• Nerve conduction velocity
testing
EMERGENCY ACTIONS

Minimize the effects of head or neck

trauma.

Immobilize the spine as gently and

quickly as possible using a rigid
neck collar and a rigid carrying
board, which they use during
transport to the hospital.
EMERGENCY ACTIONS
Early (acute) stages of treatment

In the emergency room, doctors focus on:

 Maintaining your ability to breathe

 Preventing shock
 Immobilizing your neck to prevent further spinal cord damage
 Avoiding possible complications, such as stool or urine
retention, respiratory or cardiovascular difficulty, and formation
of deep vein blood clots in the extremities
ICU or regional spine injury center

With neurosurgeons, orthopedic surgeons, spinal cord

medicine specialists, psychologists, nurses, therapists
and social workers with expertise in spinal cord injury.
Initial measure immediately after diagnosis
 lie flat, neutral spine alignment
Early (acute) stages of treatment

Medications: Methylprednisolone (Solu-Medrol)

-given through a vein in the arm (IV) has been used as
a treatment option for an acute spinal cord injury in the
past. But recent research has shown that the potential
side effects, such as blood clots and pneumonia, from
using this medication outweigh the benefits.

Immobilization:
You might need traction to stabilize or align your spine.
Options include soft neck collars and various braces.
Early (acute) stages of treatment

Medications: Methylprednisolone (Solu-Medrol)

-given through a vein in the arm (IV) has been used as
a treatment option for an acute spinal cord injury in the
past. But recent research has shown that the potential
side effects, such as blood clots and pneumonia, from
using this medication outweigh the benefits.

Immobilization:
You might need traction to stabilize or align your spine.
Options include soft neck collars and various braces.
Early (acute) stages of treatment

Surgery: Often surgery is necessary to remove

fragments of bones, foreign objects, herniated disks or
fractured vertebrae that appear to be compressing the
spine. Surgery might also be needed to stabilize the
spine to prevent future pain or deformity.

Experimental treatments. Scientists are trying to

figure out ways to stop cell death, control inflammation
and promote nerve regeneration. For example, lowering
body temperature significantly — a condition known as
hypothermia — for 24 to 48 hours might help prevent
damaging inflammation. More study is needed.
 Biphosphonates
Ongoing Care

After the initial injury or condition stabilizes, doctors turn their attention to
preventing secondary problems that may arise, such as deconditioning,
muscle contractures, pressure ulcers, bowel and bladder issues,
respiratory infections, and blood clots.

The length of your hospital stay will depend on your condition and the
medical issues you face. Once you're well enough to participate in
therapies and treatment, you might transfer to a rehabilitation facility.
Initial measure immediately after diagnosis
 Log roll
Initial measure immediately after diagnosis
 Log roll
Initial measure immediately after diagnosis
 Venous compression stockings/devices
Rehabilitation
 team might include a physical therapist, an occupational therapist, a rehabilitation nurse, a
rehabilitation psychologist, a social worker, a dietitian, a recreation therapist, and a doctor who
specializes in physical medicine (physiatrist) or spinal cord injuries.

 During the initial stages of rehabilitation, therapists usually emphasize maintaining and
strengthening muscle function, redeveloping fine motor skills, and learning ways to adapt to do
day-to-day tasks.

 Educate the patient on the effects of a spinal cord injury and how to prevent complications, and
they’ll be given advice on rebuilding their life and increasing their quality of life and
independence.

 They will be taught with many new skills, and they’ll use equipment and technologies that can
help them live on their own as much as possible. They’ll be encouraged to resume their favorite
hobbies, participate in social and fitness activities, and return to school or the workplace.
Rehabilitation
MEDICATIONS
-Medications might be used to manage some of the effects of spinal cord injury. These include
medications to control pain and muscle spasticity, as well as medications that can improve bladder
control, bowel control and sexual functioning.
Rehabilitation
New technologies

Modern wheelchairs
Rehabilitation
New technologies

Computer adaptations
Rehabilitation
New technologies

Electronic aids to daily living.

Rehabilitation
New technologies

Electrical stimulation devices

Prognosis and recovery

Doctor might not be able to give prognosis to their patient right away. Recovery, if it
occurs, usually relates to the severity and level of the injury. The fastest rate of
recovery is often seen in the first six months, but some people make small
improvements for up to 1 to 2 years.
Nursing Interventions
After diagnosis of this oncologic emergency, the nurse will assist with stabilizing
the patient’s clinical status and work to prevent further complications. Nurses are
responsible for the following steps:

 Tumors located in the cervical spine may alter pulmonary function, necessitating emergency
endotracheal intubation; therefore, closely assess the patient’s airway and respiratory status.
 Perform a thorough neurologic assessment including vital signs and evaluation for presence of clinical
manifestations at least every 2 hours.
 Optimize patient mobility and mitigate sequelae of immobility. Patients with spinal instability
diagnosed by MRI should be maintained on bed rest, lying flat to prevent further neurologic damage.
For patients with spinal instability, use log-rolling technique when changing position. As symptoms
improve, gradually assist the patient to a sitting position.
Nursing Interventions
After diagnosis of this oncologic emergency, the nurse will assist with stabilizing
the patient’s clinical status and work to prevent further complications. Nurses are
responsible for the following steps:

 If symptoms worsen, return the patient to the most comfortable position.

 Perform range-of-motion exercises, as tolerated.
 Collaborate with the physical therapist to optimize function.
 Obtain equipment to maintain alignment, augment patient mobility, and promote spine stabilization.
 Initiate and maintain venous thromboembolism (VTE) prophylaxis, such as intermittent compression
devices, graduated compression stockings, or low-molecular-weight heparin or unfractionated heparin.
Nursing Interventions
After diagnosis of this oncologic emergency, the nurse will assist with stabilizing
the patient’s clinical status and work to prevent further complications. Nurses are
responsible for the following steps:

 Although constipation is usually a result of loss of voluntary control of the anal sphincter, it’s also an
adverse reaction to opioid therapy. Collaborate with the provider to initiate a bowel regimen,
including
administration of stool softeners, laxatives, and suppositories every 1 to 2 days as needed for bowel
elimination.
 Collaborate with the healthcare provider to determine the need for intermittent or indwelling urinary
catheterization. If an indwelling urinary catheter is inserted, implement the catheter-associated urinary

tract infection prevention bundle and monitor for signs and symptoms of urinary tract infection such
as
urinary frequency and dysuria.
Nursing Interventions
After diagnosis of this oncologic emergency, the nurse will assist with stabilizing
the patient’s clinical status and work to prevent further complications. Nurses are
responsible for the following steps:

 Decreased mobilization and RT increase the risk of skin breakdown.

 Perform a thorough assessment of the skin and risk for pressure ulcer development using a valid and
reliable tool each shift and as needed.
 Initiate preventive strategies such as turning and repositioning every 2 hours, using pressure relieving
devices, and maintaining adequate nutrition.
Patient Education &
Support
After diagnosis of this oncologic emergency, the nurse will assist with stabilizing
the patient’s clinical status and work to prevent further complications. Nurses are
responsible for the following steps:

 Decreased mobilization and RT increase the risk of skin breakdown.

 Perform a thorough assessment of the skin and risk for pressure ulcer development using a valid and
reliable tool each shift and as needed.
 Initiate preventive strategies such as turning and repositioning every 2 hours, using pressure relieving
devices, and maintaining adequate nutrition.
Thank
s Do you have any questions?

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+91 620 421 838

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