Treatment

• What is the immediate treatment for SCI?

  Spine & neck immobilisation

  Sugery to remove fluid, tissue or bone fragments that press on spinal cord

  IV fluids because there is a period of gastric & intestinal stasis from autonomic dysfunction
• How do you recover after a spinal cord injury?

  Increase in neuroplasticity & axon sprouting

  People with incomplete injury are more likely than people with complete injury to regain control of more muscle movement - due to spared neural connection
• What is weight-supported locomotor training (WSLT)?

  Uses assisted devices & therapists to support pts weight while they walk on treadmill

  Goal = promote the remaining nerve connectivity between regions above the injury & locomotor central pattern generator in the spinal cord
• What are the 2 types of urinary catheters?

  Intermittent catheters - temporarily inserted into bladder & removed once bladder is empty

  Indwelling catheters - remain in place for many days/weeks, held in place by inflated balloon (high risk of infection)
• What are the advantages of graduated compression stockings?

  Improved lymphatic flow

  Increase volume & rate of venous blood flow = improved efficiency of skeletal muscle pump & reduced vein diameter

  Reduced venous reflex due to improved valve function

  Reduced oedema & inflammation

  Reduced risk of thromboembolism

  Improved microcirculation & cutaneous oxygenation
• What happens if compression stockings weren't used?

  Increased risk of thromboembolism from blood stasis

  Venous reflux, blood stasis & venous hypertension

  Pain, oedema, inflammation, skin changes & ulceration
• What is spinal fusion?

  A surgical procedure that joins two or more vertebrae together by placing an additional section of bone in the space between them

  Helps to prevent excessive movement between 2 adjacent vertebrae

  Lowers risk of further irritation/compression of nearby nerves
• What is spinal fixation?

  2 or more vertebrae anchored to each other using plates, rods & screws -> reduces vertebral mobility

  Uses devices to provide stability & realign
• What is the decompression procedure?

  Type of surgery used to treat compressed nerves in the spine

  Only recommended when non-surgical treatments haven't helped

  Carried out under general anaesthetic
• What are the 2 types of spinal fusion?

  Interbody fusion

  Posterolateral fusion
• What is laminectomy?

  Remove lamina from 1 of vertebra (to relieve pressure by enlarging spinal canal)
• What is a discectomy?

  Section of damaged disc removed to relieve pressure on nerve
• What is a foraminotomy?

  Widening of foramen where spinal nerves leave
• How do graduated compression socks work?

  Pressure gradient ensures blood flows upward towards heart instead of refluxing down towards foot or laterally into superficial veins
• What are graducated compression stockings?

  Specifically designed to apply pressure to lower legs to maintain blood flow, reduce discomfort & swelling

  
• What is inotrophic support?

  Agent that helps in change of speed or force of muscle contraction

  Often needed for intensive care pts to stabilise circulation & optimise O2 supply (noradrenaline, adrenaline, dopamine)

  Provides effects like vasoconstriction (via alpha receptors), vasodilation (via beta receptors) & an increase in cardiac output - enhancing iontropy & HR (via beta 1 receptors)
• What is interbody fusion?

  Removal of intervertbral disc & replacement with a bone graft/spacer to maintain alignment & disc height
• What is posterolateral fusion?

  Places the bone graft between the transverse processes rather than intervertebral disc space
• Fill in the blanks

  A) Simple Analgesics

  B) Weak Opioids

  C) Strong Opioids