CEDERA MEDULLA SPINALIS

YULIATI
FIKES / KEPERAWATAN
CEDERA MEDULLA SPINALIS

75 % TERJADI PADA PRIA

Review anatomy :
Kerusakan medulla spinalis
berkisar dari komusio, sampai
kontusio.
Pasien mengalami paralisis
Dianggap reversibel pada 4 6
jam pertama
Spinal cord trauma is damage to
the spinal cord. It may result
from direct injury to the cord
itself or indirectly from damage
to surrounding bones, soft
tissues, and blood vessels.
Causes
Spinal cord trauma can be caused
by any number of injuries to the
spine. They can result from motor
vehicle accidents, falls, sports
injuries (particularly diving into
shallow water), industrial
accidents, gunshot wounds,
assault, and others.
A minor injury can cause spinal
cord trauma if the spine is
weakened (such as from
rheumatoid arthritis or
osteoporosis) or if the spinal canal
protecting the spinal cord has
become too narrow (spinal
stenosis) due to the normal aging
process.
Direct injury, such as cuts, can
occur to the spinal cord, particularly
if the bones or the disks have been
damaged. Fragments of bone (from
fractured vertebrae, for example) or
fragments of metal (such as from a
traffic accident) can cut or damage
the spinal cord.
Direct damage can also occur if
the spinal cord is pulled, pressed
sideways, or compressed. This
may occur if the head, neck, or
back are twisted abnormally
during an accident or injury.
Bleeding, fluid accumulation,
and swelling can occur inside
the spinal cord or outside the
spinal cord (but within the
spinal canal). The accumulation
of blood or fluid can compress
the spinal cord and damage it.
Most spinal cord trauma occurs
to young, healthy individuals.
Males between ages 15 and 35
are most commonly affected.
The death rate tends to be
higher in young children with
spinal injuries.
Risk factors include participating
in risky physical activities, not
wearing protective gear during
work or play, or diving into
shallow water.
Older people with weakened spines
(from osteoporosis) may be more
likely to have a spinal cord injury.
Patients who have other medical
problems that make them prone to
falling from weakness or clumsiness
(from stroke, for example) may also
be more susceptible.
Symptoms
Symptoms vary somewhat
depending on the location of the
injury. Spinal cord injury results in
varying degrees of weakness and
sensory loss at and below the
injury. The pattern depends on
whether the entire cord is injured
(complete) or only partially
(incomplete).
The spinal cord doesn't go
below the 1st lumbar vertebra,
so injuries at and below this
level do not cause spinal cord
injury. However, they may cause
"cauda equina syndrome" --
injury to the nerve roots in this
area.
CERVICAL (NEAR THE NECK) INJURIES
When spinal cord injuries occur near the neck,
varying degrees of symptoms can affect both the
arms and the legs:
Weakness, paralysis
Breathing difficulties (from paralysis of the
breathing muscles)
Spasticity (increased muscle tone)
Sensory changes
Numbness
Pain
Loss of normal bowel and bladder control
(such as constipation, incontinence, bladder
spasms)
THORACIC (CHEST-LEVEL) INJURIES
When spinal injuries occur at chest level, varying
degrees of symptoms can affect the legs:
Weakness, paralysis
Breathing difficulties (from paralysis of the
breathing muscles)
Spasticity (increased muscle tone)
Sensory changes
Numbness
Pain
Loss of normal bowel and bladder control
(such as constipation, incontinence, bladder
spasms)
Injuries to the cervical or high
thoracic cord may also result in
blood pressure problems,
abnormal sweating, and trouble
maintaining regular body
temperature.
 Spinal cord injury is a medical
emergency requiring immediate
attention.
The health care provider will
perform a physical exam, including
a neurological exam. This will help
identify the exact location of the
injury, if it is not already known.
Some of the person's reflexes may
be abnormal or absent.
 Once swelling goes down,
some reflexes may slowly
recover.
The following tests may be
ordered:
Spine x-rays may show
fracture or damage to the
bones of the spine.
A CT scan or MRI of the spine
may show the location and
extent of the damage and
reveal problems such as blood
clots (hematomas).
Myelogram (an x-ray of the
spine after injection of dye)
may be necessary in rare cases.
Somatosensory evoked
potential (SSEP) testing or
magnetic stimulation may
show if nerve signals can
pass through the spinal
cord.
Treatment
A spinal cord trauma is a medical
emergency requiring immediate
treatment to reduce the long-
term effects. The time between
the injury and treatment is a
critical factor affecting the
eventual outcome.
Corticosteroids, such as dexamethasone or
methylprednisolone, are used to reduce
swelling that may damage the spinal cord. If
spinal cord compression is caused by a mass
(such as a hematoma or bony fragment) that
can be removed or brought down before
there is total destruction of the nerves of the
spine, paralysis may in some cases be
reduced or relieved. Ideally, corticosteroids
should begin as soon as possible after the
injury.
Surgery may be necessary. This
may include surgery to remove fluid
or tissue that presses on the spinal
cord (decompression laminectomy).
Surgery may be needed to remove
bone fragments, disk fragments, or
foreign objects or to stabilize
fractured vertebrae (by fusion of
the bones or insertion of hardware).
Bedrest may be needed to allow
the bones of the spine, which
bears most of the weight of the
body, to heal.
Anatomic realignment is important.
Spinal traction may reduce
dislocation and/or may be used to
immobilize the spine. The skull may
be immobilized with tongs (metal
braces placed in the skull and
attached to traction weights or to a
harness on the body).
Treatment will address muscle
spasms, care of the skin, and
bowel and bladder dysfunction.
Extensive physical therapy,
occupational therapy, and other
rehabilitation interventions are
often required after the acute injury
has healed. Rehabilitation assists
the person in coping with disability
that results from spinal cord
trauma.
Spasticity can be reduced by many
oral medications, medications that
are injected into the spinal canal, or
injections of botulinum toxins into
the muscles. It is important to treat
pain with analgesics, muscle
relaxants, or physical therapy
modalities.
Support Groups For
organizations that provide
support and additional
information, see spinal injury
resources.
Outlook (Prognosis) Paralysis
and loss of sensation of part of the
body are common. This includes
total paralysis or numbness and
varying degrees of movement or
sensation loss. Death is possible,
particularly if there is paralysis of
the breathing muscles.
How well a person does depend
on the level of injury. Injuries
near the top of the spine result
in more extensive disability than
injuries low in the spine.
Recovery of some movement or
sensation within 1 week usually
means the person will eventually
recover most function, although this
may take 6 months or more. Losses
that remain after 6 months are
more likely to be permanent.
Possible Complications Paralysis (paraplegia,
quadriplegia)
Loss of sensation
Loss of bladder control
Increased risk of urinary tract infections
Increased risk of chronic bilateral obstructive
nephropathy
Loss of bowel control
Loss of sexual functioning (male impotence)
Paralysis of breathing muscles
Increased risk of injury to numb areas of the
body
Pain
Complications of immobility:
Deep vein thrombosis
Pulmonary infections
Skin breakdown
Contractures
Shock
Blood pressure changes - can
be extreme
Muscle spasticity
When to Contact a Medical
Call your health care provider if
injury to the back or neck occurs.
Call 911 if there is any loss of
movement or sensation. This is a
medical emergency!

Penatalaksanaan tidak tepat dapat

menyebabkan kerusakan dan
kehilangan fungsi
Management of spinal cord
injury begins at the site of an
accident with paramedics trained
in immobilizing the injured spine
to prevent further damage to the
nervous system.
Someone suspected of having a
spinal cord injury should NOT be
moved without immobilization
unless there is an immediate
threat.
Prevention
Safety practices during work and
recreation can prevent many
spinal cord injuries. Use proper
protective equipment if an injury
is possible.
Diving into shallow water is a
major cause of spinal cord
trauma. Check the depth of
water before diving, and look for
rocks or other possible
obstructions.
Football and sledding injuries
often involve sharp blows or
abnormal twisting and bending
of the back or neck and can
result in spinal cord trauma. Use
caution when sledding and
inspect the area for obstacles.
Use appropriate techniques and
equipment when playing football
or other contact sports.
Falls while climbing at work or
during recreation can result in
spinal cord injuries.
Defensive driving and wearing
seat belts greatly reduces the
risk of serious injury if there is
an automobile accident.
Tindakan yang harus dilakukan

1. Imobilisasikan korban pada spinal

board,inline posision
2. satu orang petugas menjaga kepala
tetap inline.
3. Gunakan traksi leher atau collar neck
4. Hati-hati saat mengangkat dan
memindahkan ke rs minimal 4 orang
Penatalaksanaan

1. Farmakoterapi; pemberian
metilprednisolon dosis tinggi,mannitol
dan dextran.
2. Hipotermia, untuk mengatasi
autodestruktif.
3. Bantuan pernafasan
4. Traksi dan reduksi skelet.
5.Prosedur pembedahan
Intervensi perawatan lanjutan

1. Tingkatkan pernafasan adekuat

2. Perbaiki mobilitas fisik
3. Pertahankan integritas kulit
4. Pertahankan eliminasi urine
5. Perbaiki fungsi defekasi
6. Tingkatkan kenyamanan pasien dan
minimalisasi stressor