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Management of patients with non-traumatic spinal cord injury – Nursing Times

Monday, 18 March, 2019

Management of patients with non-traumatic spinal cord injury – Nursing Times

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Introduction

Traumatic spinal cord injury (TSCI) caused by an external event, such as a road traffic accident, previously accounted for the largest portion of spinal cord compression (SCC) cases in the general spinal cord injury population worldwide (Cosar et al, 2010). However, the incidence of non-traumatic spinal cord injury (NTSCI), caused by pathology such as infection or tumours, appears to be rising (Barclay et al, 2017) –New and Biering-Sørensen (2017) suggest that, in many countries, the incidence of NTSCI is higher than that of TSCI, making it an area of growing significance (Kennedy and Hasson, 2016).

The prevalence of NTSCI has not been widely reported as literature has focused on TSCI; however, New et al (2014), suggested the median rate of NTSCI was six cases per million per year in eight Western European countries, with 25% being caused by tumours and 32% by degenerative conditions. The authors noted that the reporting of NTSCI was poor. Furlan et al (2013) reported 15 new cases per million per year of TSCI in western Europe. The higher reported number of TSCI may explain why research has focused in this area.

NTSCI is most likely to affect older people (Cosar et al, 2010) and, due to the ageing of the population, incidence rates are expected to rise (New et al, 2013). This article provides an overview of NTSCI to help nurses meet patients’ needs.

Causes

According to New et al (2015), the main causes of NTSCI are spinal tumours and degenerative disorders of the spinal column, followed by vascular and autoimmune disorders. Causes are summarised in Table 1 and detailed below.

Spinal tumours

Primary benign tumours can occur anywhere along the spinal cord and take years to grow to a size that causes neurological symptoms. Primary malignant tumours of the spine tend to grow quickly and spread into surrounding tissue; it is difficult to predict their progress and effects. Cancerous metastases in the spinal cord or bones mainly result from primary cancers in the lung, breast, bowel or prostate (Spinal Injuries Association, 2014).

Degenerative disorders

The most frequent cause of neurological loss related to degenerative disease of the spine is extruded disc material compressing the spinal cord in the cervical or thoracic spine (Oyinkan Marquis and Capone, 2016). As the spine ages, the discs degenerate, losing their ability to fulfill their weight-bearing and load-transferring role and the spine becomes unstable; this increases stress on the facet joints, spinal ligaments and tendons, and traversing neurological tissues (Buser et al, 2018).

Vascular

Spinal strokes occur when there is disruption in the blood supply to the spinal cord, commonly caused by a blood clot that blocks or partially blocks a blood vessel. Clots can form in the spinal cord vessels, but also travel to the spinal cord having formed in other parts of the body. Spinal strokes can also occur when there is bleeding from a blood vessel due to a small tear; they are rare compared with cerebral strokes. Common causes of spinal stroke are damaged arteries due to atherosclerosis, weakness and narrowing. Contributory factors are high blood pressure, smoking, diabetes and malformed blood vessels.

Other vascular conditions that can cause NTSCI are aneurysms and haematomas (SIA, 2014).

Inflammatory/autoimmune

Transverse myelitis is a neurological disorder that can be caused by an autoimmune reaction against the spinal cord or a bacterial or viral infection. Sometimes its cause is unknown. Symptoms include flu-like feelings around the time of neurological loss (SlA, 2014).

Read more at: https://www.nursingtimes.net/clinical-archive/neurology/management-of-patients-with-non-traumatic-spinal-cord-injury/7027972.article

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