📘 Spinal Cord Injury Comprehensive HESI
Study Sheet
(Based on Lewis, Perry & Potter, and Harding — HESI-aligned)
1️⃣ Pathophysiology & Classification
● Primary injury: Direct mechanical disruption of the spinal cord (fracture, dislocation, compression,
laceration).
● Secondary injury: Ongoing damage from ischemia, inflammation, and edema extending beyond the initial
injury.
● Complete injury: Total loss of motor and sensory function below the level of injury.
● Incomplete injury: Partial preservation of motor and/or sensory function.
● Common mechanisms: Flexion, hyperextension, flexion-rotation (most severe), vertical compression
(axial loading), and penetrating trauma.
2️⃣ Shock States — Spinal vs Neurogenic
Type Cause Key Findings Nursing Care
Spinal Shock Temporary loss of all reflex Flaccid paralysis, areflexia, Monitor for return of reflexes;
activity, sensation, and motor absent sensation, prevent complications (skin
function below injury bowel/bladder retention breakdown, DVT)
Neurogenic Loss of sympathetic tone Bradycardia, hypotension, Maintain airway, fluids,
Shock (injury T6 or higher) warm dry skin vasopressors, and atropine for
bradycardia
, 3️⃣ Incomplete Spinal Cord Injury Syndromes
Syndrome Pathology Key Findings
Central Cord Cervical hyperextension Weakness greater in upper extremities than lower
Anterior Cord Anterior spinal artery Loss of motor, pain, and temperature below lesion;
damage preserved touch and position sense
Brown-Séquard Hemisection of spinal cord Ipsilateral motor and proprioception loss; contralateral
pain/temperature loss
Conus Medullaris / Injury to distal cord or Flaccid paralysis of lower limbs; areflexic
Cauda Equina nerve roots bowel/bladder
4️⃣ Surgical & Stabilization Care
● Goal: Decompression, realignment, and stabilization.
● Procedures: Laminectomy, fusion, rod/screw fixation.
● Post-op Care:
○ Maintain spinal alignment (log roll, neutral position).
○ Assess for CSF leak (clear drainage).
○ Monitor for infection and hardware complications.
○ Prevent VTE, pressure injuries, and respiratory issues.
Study Sheet
(Based on Lewis, Perry & Potter, and Harding — HESI-aligned)
1️⃣ Pathophysiology & Classification
● Primary injury: Direct mechanical disruption of the spinal cord (fracture, dislocation, compression,
laceration).
● Secondary injury: Ongoing damage from ischemia, inflammation, and edema extending beyond the initial
injury.
● Complete injury: Total loss of motor and sensory function below the level of injury.
● Incomplete injury: Partial preservation of motor and/or sensory function.
● Common mechanisms: Flexion, hyperextension, flexion-rotation (most severe), vertical compression
(axial loading), and penetrating trauma.
2️⃣ Shock States — Spinal vs Neurogenic
Type Cause Key Findings Nursing Care
Spinal Shock Temporary loss of all reflex Flaccid paralysis, areflexia, Monitor for return of reflexes;
activity, sensation, and motor absent sensation, prevent complications (skin
function below injury bowel/bladder retention breakdown, DVT)
Neurogenic Loss of sympathetic tone Bradycardia, hypotension, Maintain airway, fluids,
Shock (injury T6 or higher) warm dry skin vasopressors, and atropine for
bradycardia
, 3️⃣ Incomplete Spinal Cord Injury Syndromes
Syndrome Pathology Key Findings
Central Cord Cervical hyperextension Weakness greater in upper extremities than lower
Anterior Cord Anterior spinal artery Loss of motor, pain, and temperature below lesion;
damage preserved touch and position sense
Brown-Séquard Hemisection of spinal cord Ipsilateral motor and proprioception loss; contralateral
pain/temperature loss
Conus Medullaris / Injury to distal cord or Flaccid paralysis of lower limbs; areflexic
Cauda Equina nerve roots bowel/bladder
4️⃣ Surgical & Stabilization Care
● Goal: Decompression, realignment, and stabilization.
● Procedures: Laminectomy, fusion, rod/screw fixation.
● Post-op Care:
○ Maintain spinal alignment (log roll, neutral position).
○ Assess for CSF leak (clear drainage).
○ Monitor for infection and hardware complications.
○ Prevent VTE, pressure injuries, and respiratory issues.
