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
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
 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
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
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 ComplicationsParalysis
(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
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