Spinal Cord Injury: Assessment & Treatment

Nursing Knowledge

Spinal Cord Injury: Assessment & Treatment

Spinal cord injuries (SCIs) can have profound, life-changing implications for individuals and their families. Nurses play a critical role in the assessment and treatment of SCIs, as well as in providing education and support to clients and their loved ones. This guide provides an overview of the degree of injury, nursing care priorities, and assessment tools used in the care of clients with SCIs, and covers important topics such as complications, client education, and psychological adjustment.
Last updated: December 4, 2023

Table of contents

Classifying the degree of injury: complete vs incomplete spinal cord injury 

  • Complete spinal cord injury: total loss of feeling and motion below the injury site
  • Incomplete spinal cord injury: may have some sensation or motion below the injury

The degree of impairment depends on the level of the injury. Generally, the higher the injury in the spinal column, the greater the loss of function.

  • Tetraplegia:
    • Paralysis of all 4 extremities
    • Occurs from cervical SCIs
    • C4 or higher paralysis of all limbs and trunk
  • Paraplegia: 
    • Paralysis of the legs
    • Occurs from thoracic, lumbar, or sacral SCIs
    • T6 paralysis below the chest
    • L1 paralysis below the waist

Spinal cord injury nursing care priorities

  • Spinal cord immobilization to prevent further injury
  • Assessment and stabilization of airway, breathing, and circulation
  • Complete neurological assessment using ASIA grading scale
  • Prevent and promptly treat infection and other complications.
  • Provide client education and support psychological adjustment.

How to assess a spinal cord injury

Clients with a suspected SCI should be thoroughly examined using a validated assessment tool, such as the International Standards for Neurological Classification of Spinal Cord Injury from the American Spinal Injury Association (ASIA) examination.

Table: ASIA impairment scale

ACompleteNo sensory or motor function is preserved inthe sacral segments.
BIncompleteSensory function, but not motor function, is preserved below neurological level and extends through sacral segments S4–S5.
CIncompleteMotor function is preserved below the neurologic level, and most key muscles below the neurologic level have a muscle grade of less than 3.
DIncompleteMotor function is preserved below the neurologic level, and most key muscles below the neurologic level have a muscle grade that is greater than or equal to 3.
EIncompleteSensory and motor functions are normal.

What finding raises suspicion of a complete spinal cord injury? 

A complete spinal cord injury is suspected when there is loss of all sensory and motor function below the level of injury, characterized by: 

  • Inability to feel anything in the lower body
  • Inability to move the lower body
  • Loss of bladder and bowel control 

Findings should be confirmed by imaging studies. 

Mri of spinal cord injury

MRI of spinal cord injury:
Spinal cord transection at the T6 injury level (arrow) noted in a patient who had a fall from 300 feet.

Image: “Survival following a vertical free fall from 300 feet: the crucial role of body position to impact surface” by Weckbach S, Flierl MA, Blei M, Burlew CC, Moore EE, Stahel PF. License: CC BY 2.0, cropped by Lecturio.

How to educate clients with spinal cord injuries

  • Teach how to complete ADLs given new limitations. 
  • Consider client’s psychosocial, emotional, and financial needs.
  • Team will include PT, OT, social work.
  • Client/family may need additional information on bowel and bladder functioning, sexual health, skin care, pain management, and risk for mental health concerns. 
  • Connect client with home health care and rehabilitation services prior to discharge. 

What is spinal shock?

Spinal shock is a temporary condition following a spinal cord injury, characterized by loss of reflexes, sensation, and motor activity below the level of the injury. It can resolve within hours to weeks.

What is neurogenic shock?

Neurogenic shock can be life-threatening. It is a type of distributive shock that can occur with a spinal cord injury above T6, and is characterized by bradycardia and hypotension due to disrupted autonomic pathways.

What is autonomic dysreflexia?

Autonomic dysreflexia is potentially life-threatening. It can occur in clients with SCIs above T6 and is characterized by severe hypertension, headache, and other symptoms, often triggered by a distended bladder or bowel.

How to manage bladder and bowel control in clients with SCIs

Management may involve: 

  • Intermittent catheterization 
  • Bowel program: diet modification; scheduled toileting; potentially manual evacuation 


Spinal Cord Injury: Assessment & Treatment

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