Spinal cord injury: anatomy and physiology of the spinal cord

Abstract

The imminent arrival of spinal injured patients at emergency departments often sparks fear in all but the most experienced clinicians. Unfortunately, this fear is usually based on an unfounded surety that any movement of patients, or of cervical collars, results in neurological impairment. Patients are therefore often left lying on spinal boards with hard cervical collars in place for long periods of time, potentially suffering skin damage. Where cord damage has occurred, there may be devastating outcomes that require timely management and rehabilitation. The successful management of spinal injured patients is dependent on care pathways that are characterised by excellence and continuity during all stages of care: pre-hospital, acute and rehabilitation. It is vital therefore that practitioners who are likely to come into contact with patients with spinal injuries have a sound knowledge and understanding of the anatomy and physiology of the spinal cord as well as the pathophysiology of injury and subsequent management. This series of articles aims to provide an easily accessible and concise account of care for people with traumatic spinal cord injury, starting with a description of the normal anatomy and physiology of the spinal cord. The second article looks at the pathophysiology and mechanism of spinal cord injury, and the third discusses nursing issues in the immediate post-injury period. It should be noted that the articles are based on managing spinal cord injured patients at the National Spinal Injuries Unit, Dublin.