The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

Cervical Spinal Cord Injury

John M. Luce, MD Monday, November 4, 1996

Cervical spinal cord injury usually occurs following extreme flexion or extension of the neck, coupled with rotation. This results in a microvascular injury causing ischemia and necrosis of the spinal cord and leading initially to a flaccid paralysis below the level of the lesion. From a respiratory standpoint, patients develop decreased lung volumes due to dysfunction of the respiratory muscles; lesions above the level of the phrenic nerve nuclei (C_{3} - C_{5}) cause bilateral hemidiaphragmatic dysfunction and dysfunction of the intercostal and abdominal muscles, whereas lesions below the level of the phrenic nerve nuclei cause intercostal and abdominal muscle dysfunction only. Because of respiratory muscle dysfunction, patients may develop atelectasis, pneumonia, and aspiration; they may also manifest pulmonary embolism and neurogenic pulmonary edema. From a cardiovascular standpoint, patients develop initial hypotension and bradycardia due to spinal shock. Gastrointestinal effects include gastric and gut atony, and genitourinary effects include bladder denervation and bacterial colonization and infection. Neurological management includes immobilization and the administration of methylprednisolone. Respiratory management includes airway protection, mechanical ventilation, secretion clearance, treatment of pneumonia, and prevention of pulmonary embolism. Cardiovascular management includes the administration of fluids or vasopressors. Gastrointestive management includes the placement of a nasogastric tube and avoidance of aspiration. Genitourinary management includes bladder drainage and prevention of colonization and infection. Overall, more than 90 percent of patients survive acute cervical spinal cord injury, an improvement in outcome over time.

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