nursing school question: spinal cord injury; sacral vs higher lesion

[unsaint77]

From what I found, in the injury at or above T12, pt will have some bladder control, although spasmic, and some can even learn to bear down to urinate, whereas the injury in the sacrum will cause almost total atonic bladder. Did I get it right? If I got it right, I don't understand how a higher lesion is less serious than the lower lesion? I always thought the higher the injury lesion, the more dysfunction happens as a result.

[RachRN66]

I have dealt with many sci patients over the years, some on a personal level and some on a professional level. I can tell you that no matter what you read, every patient regardless of where their sci is located, is different. No matter what you read, no matter what you see in a book, they are different, depending on many different factors. Whether it's a complete sci, or a partial sci, whether they are in "spinal shock" or post spinal shock, and if they have dysreflexia or not, and depending on age, and other "medical" problems. I recently completed this ceu course that you might find helpful.

Interactive Online Continuing Education for Nurse Professionals

I don't know how to make that an active link on this forum, but it's basically a "general understainding" of SCI and urilogical problems. If that "link" doesn't work go to www.rnceus.com and look for the course Bladder Management after a Spinal Cord Injury: A Practical Approach.

Good luck!

[nurseprnRN, BSN, RN]

t12 is above the sacral nerves which control bowel and bladder (inred below), so a complete t12 (also called t12 asia a) will not have those.

but there is such a thing as an incomplete injury, in which some functions below the injury level are spared, partially or completely (asia b, c, or d), including the sacral nerves s4-5. for more info, go to the asia website.

(oops-- picture did not join us...look for a picture of dermatomes)

[table]

[tr]

[td][/td]

[td][h=2]asia impairment scale[/h][/td]

[/tr]

[tr]

[td]a = complete[/td]

[td]no motor or sensory

function is preserved in the sacral

segments s4-s5

[/td]

[/tr]

[tr]

[td]b = incomplete[/td]

[td]sensory but not motor

function is preserved below the

neurological level and includes the

sacral segments s4-s5

[/td]

[/tr]

[tr]

[td]c = incomplete[/td]

[td]motor function is pre-

served below the neurological

level, and more than half of key

muscles below the neurological

level have a muscle grade less

than 3

[/td]

[/tr]

[tr]

[td]d = incomplete[/td]

[td]motor function is pre-

served below the neurological

level, and at least half of key mus-

cles below the neurological level

have a muscle grade of 3

or more

[/td]

[/tr]

[tr]

[td]e = normal[/td]

[td]motor and sensory function normal normal[/td]

[/tr]

[/table]

[Esme12, ASN, BSN, RN]

What they said! Great resources.

http://sci.rutgers.edu/dynarticles/2001_Classif_worksheet.pdf