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Mean LOS: 6 days Description: MEDICAL: Spinal Disorders and Injuries

Spinal cord injury (SCI), trauma to the spinal cord, affects approximately 12,000 Americans every year. A physiological cascade of events occurs at the time of an SCI and leads to neuronal damage and neurological deficit. Approximately 10,000 persons have SCIs each year, and half of the injuries produce paraplegia and half quadriplegia.

The initial injury causes a release of glutamate, which causes cellular damage and petechial hemorrhages at the injury site. Calcium influx into the neuron is caused by thrombus formation. This alteration in calcium triggers the arachidonic acid cascade to be initiated, thus leading to free radical formation, lactic acidosis, and lipid peroxidation. This final series of events hastens ischemia of the white matter and microvasculature destruction, with resultant neuronal damage and permanent neurological deficit. This series of physiological and chemical events associated with acute SCI lead to the permanent neurological deficit. With aggressive medical interventions and nursing management, approximately 90% of patients with acute SCI survive.

SCI can be classified by a variety of methods: complete and incomplete cord injury, mechanism of injury, and the level of injury. In a complete SCI, the patient loses all function below the neurological injury level (the lowest neurological segment with intact motor and sensory function). In an incomplete SCI, some motor or sensory function below the neurological injury level remains intact (Table 2).

• TABLE 2 Types of Incomplete Spinal Cord Injury
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