 Hi and welcome to Nursing School Explained and this video on spinal cord injury. So first of all passive physiologically typically what happens there's some sort of a traumatic injury. Most of spinal cord injuries are related to motor vehicle crash, falls, or an act of violence such as stabbings or contract wounds or sports traumatic sports events or any kind of other traumatic events you can think of. Now we have to also think about the primary degree of injury or then secondary injury that can occur. So typically primary injury occurs from the actual insult to the spinal cord itself, so the actual injury itself and secondary injuries result from either bleeding, hemorrhage, edema, ischemia to the spinal cord infections that may occur after the fact after the injuries. So let's look at this here. So typically we have classifications into mechanism of injury, level of injury, and then the degree of injury. So mechanism of injury can be flexions. This could be anything like a car accident where the where the head gets flexed forward. It can be a hyperextension. So for example if I trip and fall and I hit my chin on the table, my head gets hyperextended back. I might have a spinal cord injury in my C or high T spine. That can be flexion and rotation injuries. So that would be flexion and then rotation and then extension and rotation. So extension again and rotation and then or compression. So this could be something as of a fall of a building or maybe diving into a pool and hitting the head on the ground where the vertebra gets compressed. Typically the most significant injuries and the most common are the flexion and extension injuries. And they cause a lot of damage because they involve a lot of the ligaments that can tear and actually support the spinal cord and the vertebral column. And therefore the injuries are can be pretty significant. Now then regarding the level of the injury. So I drew a head here and then the spinal cord and recall that there are seven cervical vertebra, 12 in the thoracic spine, five in the lumbar spine, five in the sacral area, and then four fused vertebra in the coccyx area. And depending on the level of the injury, the higher up the injury, the more significant signs and symptoms the patient will have and the more significant the possible paralysis can be. And so cervical injuries, so anything from C1 through 7 usually involves the arms and will result in quadriplegia or sometimes now it's also called tetraplegia. So that will involve the arms and usually again the higher the injury the worse it is. And there's a saying that says C3, 4 and 5 keep the diaphragm alive. And so we have to think about the diaphragm as the major muscle of breathing. So if there is an injury to level C3, 4 and 5, that may involve the patient's ability to breathe and they may need to go on a ventilator and actually be ventilator dependent for the rest of their life depending if it's a partial or complete injury to their spinal cord. And then injuries to the thoracic lumbar and sacral areas will usually result in paraplegia so only the lower extremities are involved. And then regarding the degree of injury it can either be a partial or complete loss of sensory and motor functions. And keep in mind that every extremity or on every part of our body really we have sensory and motor innervation that allow us to feel and then also contract the musculature of the extremity or that body part and depending on the level of injury and the severity of the injury motor and or sensory sensations or function might be impaired. And then so over here if there's a partial degree of injury there are basically four different syndromes that can occur and they all depend on what happens. And so I've drawn out the spinal cord here in the middle with the ventral and the dorsal horn and then in red is the area that's actually affected. So central cord syndrome is the most common and is usually related to hyperextension with swelling on the spinal cord on the central cord so it usually involves the middle section of the spinal cord where anterior cord syndrome is related to an anterior compression from bony fragments or disc herniation those are the discs that cushion us between the vertebra. If there's an injury and the disc herniates so it moves out of its space it can put pressure on that anterior cord and cause anterior cord syndrome. Now regarding posterior cord syndrome that will be on the posterior side usually a smaller area that is affected and that is usually because of an acute compression injury and then there can be a hemisection from a penetrating injury or from secondary ischemia or hemorrhage. So that will only be affecting one part of the spinal cord and these penetrating injuries usually involve violent injuries such as gun shot wounds or stabbing injuries on one side of the spinal cord. And the signs and symptoms will be different for each one of those but you can look those up separately.