Spinal Cord Injury Cheat Sheet
Injury levels and deficits, emergency immobilization, autonomic dysreflexia, neurogenic vs spinal shock, and spinal surgeries — high-yield for the NCLEX-RN.
What's in this cheat sheet
Trauma to the spinal cord disrupts motor, sensory and autonomic signaling below the level of injury. This cheat sheet covers how injury level predicts deficit, the airway-first emergency sequence and spinal immobilization, the acute-care priorities including the medical emergency of autonomic dysreflexia, and the nursing care for common spinal surgeries.
Pathophysiology & Assessment
Complete vs incomplete injury, the secondary injury cascade, and how injury level maps to clinical deficit and risk.
Emergency Management
Airway and breathing first, immediate spinal immobilization, IV access and neurogenic vs hemorrhagic shock.
Acute Care
Maintaining alignment and halo care, neuro monitoring, autonomic dysreflexia and preventing immobility complications.
Spinal Surgeries
Discectomy, laminectomy and fusion with post-op alignment, neuro checks and recognizing a CSF leak.
Key Takeaways
High-yield facts most likely to appear on the NCLEX-RN.
Cervical injuries at C3–C5 paralyze the diaphragm — continuously monitor respiratory status and be ready to assist with intubation.
Treat ALL trauma as a potential SCI until proven otherwise: apply a cervical collar immediately and use the logroll technique.
Halo traction: monitor pin sites and skin under the vest, and keep a wrench at the bedside for emergency vest removal during CPR.
Autonomic dysreflexia (injuries T6 and above): severe HTN, bradycardia, pounding headache, flushing — sit the patient up and remove the trigger.
Neurogenic shock = hypotension + bradycardia + warm dry skin; hemorrhagic shock = hypotension + tachycardia + cold clammy skin.
After spinal surgery, maintain alignment and monitor extremity motor/sensory function — any acute change needs urgent review.
1. Pathophysiology & Assessment
Complete SCI
Total loss of motor and sensory function below the injury level.
Incomplete SCI
Some function preserved — prognosis is better.
Injury level vs clinical deficit
| Level | Deficit | Key risk |
|---|---|---|
| Cervical (C1–C8) | Tetraplegia (all 4 limbs) | Respiratory failure |
| Thoracic (T1–T12) | Paraplegia (trunk + legs) | Trunk instability |
| Lumbar / Sacral | Paraplegia (legs only) | Bowel/bladder dysfunction |
Key assessment findings
- Loss of sensation and voluntary movement below the injury level
- Absent or decreased deep tendon reflexes
- Bladder/bowel dysfunction (retention or incontinence)
- Loss of temperature regulation below the injury
2. Emergency Management
Treat every trauma patient as a potential SCI until imaging rules it out.
Critical sequence
- 1. Airway & breathing — cervical SCI may paralyze the diaphragm (C3–C5); monitor SpO2, prepare to intubate
- 2. Cervical collar — apply a rigid C-collar (the #1 immobilization action)
- 3. Backboard immobilization — logroll with a minimum of 4 people for repositioning
- 4. Rapid transport, maintaining neutral spinal alignment
IV access & hemodynamic support
- Establish 2 large-bore IV lines; give fluids cautiously to avoid overload
- Target MAP ≥ 85–90 mmHg to perfuse the cord
- Use vasopressors (norepinephrine) for neurogenic shock
Neurogenic vs hemorrhagic shock
| Feature | Neurogenic | Hemorrhagic |
|---|---|---|
| HR | Bradycardia | Tachycardia |
| Skin | Warm, dry | Cold, clammy |
| BP | Low | Low |
3. Acute Care Management
Alignment & halo traction
- Logroll when repositioning (minimum 4 staff); never remove the C-collar without an order
- Clean halo pin sites with sterile water or chlorhexidine daily; pad pressure points
- Keep a wrench at bedside — required to remove the vest for CPR
- Teach: move the whole body together, no twisting or bending
Neurogenic shock
Hypotension + bradycardia + vasodilation. Treat with IV fluids and vasopressors.
Spinal shock
Temporary flaccid paralysis below injury; resolves in days–weeks but masks true neuro status.
Autonomic dysreflexia (AD) — medical emergency
| Signs | Triggers | Interventions |
|---|---|---|
| Severe HTN, pounding headache | Bladder distension (most common) | 1. Raise HOB immediately (lowers BP) |
| Bradycardia | Fecal impaction / constipation | 2. Find & remove the stimulus: catheterize, disimpact |
| Sweating/flushing above injury | Pressure injury, tight clothing, UTI | 3. Loosen tight clothing; give antihypertensive (nifedipine) if unresolved; notify HCP |
Preventing complications of immobility
- DVT: sequential compression devices + LMWH
- Pressure injuries: turn every 1–2 hours, specialty mattress, daily skin checks
- Bowel/bladder program: intermittent catheterization, stool softeners
- Respiratory: incentive spirometry, chest physiotherapy, assisted coughing
4. Spinal Surgeries
Procedures
| Procedure | Purpose |
|---|---|
| Discectomy | Removes herniated disc material pressing on a nerve |
| Laminectomy | Removes part of the vertebral arch to decompress cord/nerves |
| Spinal fusion | Fuses two or more vertebrae to stabilize the spine |
Post-op nursing priorities
- Maintain strict spinal alignment — logroll, no twisting or bending; brace as prescribed
- Assess motor and sensory function in all four extremities every 1–4 hours
- Acute neuro deterioration → suspect cord compression or epidural hematoma → notify HCP STAT
- Multimodal pain control; SCDs/LMWH; incentive spirometry; monitor for infection
Spinal Cord Injury Self-Test
6 quick questions — answers reveal after you submit.
Q1. A client with a C4 spinal cord injury is admitted. Which assessment is the highest nursing priority?
Q2. A client with a T4 spinal cord injury suddenly develops a pounding headache, BP of 200/110, and flushing above the injury. What is the nurse's first action?
Q3. Which finding distinguishes neurogenic shock from hemorrhagic shock?
Q4. A client is in halo traction. Which item must remain at the bedside at all times?
Q5. After a laminectomy, the nurse notes clear drainage on the dressing and the client reports a severe headache that worsens when sitting up. What should the nurse do first?
Q6. When repositioning a client with an acute spinal cord injury, which technique must the nurse use?
Answered 0 / 6 — unanswered count as incorrect.