Spinal Cord Injury

A spinal cord injury sometimes referred to as an SCI, is defined as damage that occurs to a portion of the spinal cord itself or to the nerves at the end of the spinal canal. Spinal cord injuries may be the result of direct trauma or injury to the spinal cord, or they can occur as a secondary complication due to a disease or condition affecting the tissues, blood vessels or bones which surround the spinal cord and its nerves. Injuries to the spinal cord and nerves many times cause damage that is permanent. Changes in sensation, muscle strength and other body functions may occur as a result of an SCI.

Anatomy

The spinal cord in an adult is approximately 18 inches long. It begins at the base of the brain and extends to about waist-level as the major messaging network of communication between the brain and all other parts of the body. Upper motor neurons are nerves within the spinal cord that carry messages to and from the brain to the spinal nerves that lie along the spinal tract. Lower motor neurons extend out from the spinal cord to other body parts. These carry sensations and also messages that instruct body parts to perform specific actions. The spinal cord is housed within the spinal column of the vertebrae or the backbone. As a general rule, the higher up in the spinal column (closer to the brain) an injury occurs, the more severe the level of dysfunction.

Prevalence

According to the Centers for Disease Control in the United States:

• At the present time in the United States, there are approximately 200,000 people with spinal cord injuries
• Each year, between 12,000 and 20,000 new spinal cord injuries occur
• In one-quarter of the cases of SCI, alcohol plays a major role in spinal cord injuries

Causes of Spinal Cord Injuries in the United States

• 46% of spinal cord injuries are caused by motor vehicle accidents. Using a seat belt combined with an airbag reduces the risk of injury by 80%; wearing a seat belt alone decreases the risk by 60%.
• 22% of spinal cord injuries are due to falls
• 16% of spinal cord injuries are due to violent acts
• 12% of spinal cord injuries are caused by sports-related accidents

Demographics

Most spinal cord injuries in the U.S. occur in young males. 80% of all SCI occur in males; it is estimated that between 50 and 70% of these injuries occur in people who are 15 to 35 years old. Most new cases of spinal cord injury occur in people who are less than 30 years of age.

It is also estimated that most (65% of) spinal cord injury victims in the United States are White. 25% are African American; 8% are Hispanic and 2% are of other races.

Risk factors

Not all spinal cord injuries can be prevented, but some activities increase the risk of SCI. These include:

• Taking part in activities that are known to be high-risk
• Being a passenger in a vehicle that is moving at a high rate of speed
• Diving into a water of unknown depth or into a shallow body of water

Elderly individuals whose bones are fragile due to Osteoporosis, or persons who have medical conditions such as a stroke that make them more at risk to fall may also be at increased risk for spinal cord injury.

Reasons for Spinal Cord Injuries

Your spinal cord is the primary messaging network between your body and your brain. It is housed within the spinal column. Injury to the spinal cord can be caused by trauma to the spine, such as that which occurs in the case of:

• Sports injuries and accidents
• Motor vehicle accidents
• Falls
• Personal assault
• Gunshot wounds
• Industrial accidents (injuries at work or on the job)

If the spinal column is in a weakened condition due to an underlying disorder such as Osteoporosis or Rheumatoid Arthritis, even a minor injury can damage the spinal cord. Trauma can also occur if the spinal column narrows (spinal stenosis) due to degeneration and aging and compresses or pinches the spinal cord or its nerves.

Bruising or other direct trauma sometimes occurs if the vertebrae of the spine or the intervertebral discs have become weakened and fragile. Bone fragments from fractured or broken vertebrae or pieces of foreign material, such as gunshot or metal from a motor vehicle accident, can enter the spinal column and damage the spinal cord.

If the spinal cord is pinched, compressed, pulled or pressed sideways, direct damage may occur. This may happen if the back, head, or neck is twisted or contorted as a result of force in an accident or during chiropractic manipulation.

Blood or fluids can also build up within the spinal canal or inside the spinal cord and create pressure or compression which creates trauma to the spinal cord.

Symptoms

Because the spinal cord is the central messaging system between the brain and the body, if it is injured, loss of function will occur in the nerves, organs, and limbs below the site of the injury. An SCI is described as either complete or incomplete.

• Complete SCI: In these injuries, there is a complete loss of muscle function and sensation below the level of injury.
• Incomplete SCI: In these injuries, some function may remain in the body below the level of injury

Most of the time, in both complete and incomplete spinal cord injury, both sides of the body are affected in the same way.

If spinal cord injury symptoms occur in the upper portion of the spinal cord, in the neck, for example, quadriplegia may result. Quadriplegia is paralysis of both the upper and the lower extremities. If spinal cord injury symptoms occur in the lower part of the spinal cord, it may result in paraplegia, which is paralysis of both legs. A spinal cord injury symptoms that occur at C5 usually results in the person having control of their shoulders, but no movement in their wrists or hands. A C6 injury generally results in the person having control of the wrist, but no control over their hands. Injuries that occur at C7 and T1 leave the ability to straighten and bend the elbow intact, but hand and finger movement are limited.

Injuries below T1 result in the paralysis of both lower extremities (paraplegia). If the injury occurs from T1 to T8, the person can usually control their hands, but their torso control is poor due to lack of control of the abdominal muscles. T9 to T12 injuries result in little impairment of the abdominal and torso muscles. Sacral and lumbar spinal cord injury result in reduced control of the muscles responsible for hip flexion and leg muscles.

In addition to changes in motor function and loss of sensation, spinal cord injury also affects other body functions. Bowel and bladder dysfunction can result as well as sexual dysfunction. A woman’s fertility is not generally affected, however, a man’s fertility may be affected by SCI. A spinal cord injury that occurs very high in the spinal cord (C1, C2) may result in an inability to breathe independently. These patients may require mechanical ventilation or diaphragmatic pacemakers. Other involuntary functions affected by SCI may include regulation of blood pressure and the control of body temperature.

Spinal cord injury symptoms that the doctor may assess for often includes:

• Pain is one of the primary spinal cord injury symptoms
• Weakness
• Loss of sensation
• Loss of bowel or bladder control is considered one of the extreme spinal cord injury symptoms
• Mobility problems
• Inability to control arms or legs is also one of the main spinal cord injury symptoms
• Headaches
• An unnatural head position is also one of the spinal cord injury symptoms
• Falling unconscious

Diagnostic Procedures

Diagnosing a spinal cord injury starts with a complete medical history and a thorough physical examination. If the spinal cord injury occurred as a result of an injury, the physician will ask questions related to how and when the injury occurred. Spinal cord injury is most often considered to be a medical emergency. The sooner treatment is initiated, the better the patient’s chance is for recovery. The physician will also need other details about the patient’s past medical history including any previous back or neck injuries, prior surgeries or procedures, any other medical conditions and the presence of current spinal cord injury symptoms and when they started to occur.

The physician’s physical examination will include testing of reflexes in the upper and lower extremities and checking muscle strength. The doctor will also check to see if the patient responds to touch. Often following accidents in which spinal cord injury symptoms are suspected, the patient is kept immobilized on a backboard or in a cervical collar until they are examined.

Usually, x-rays are taken of the neck and/or the back to help identify the presence of vertebral fractures or dislocations and detect the cause of the symptoms. It is possible for an SCI to occur without injury to the vertebrae. X-rays can also help to determine if there are other spinal cord injury symptoms such as infection, arthritis or tumors.

The physician often needs more information than simple x-rays are able to provide. Special imaging studies can provide this information.

• CT scan: A Computed Tomography (CT) scan is able to identify symptoms that may not be seen on standard x-ray films using cross-sectional views.
• MRI: A magnetic resonance imaging (MRI) scan uses magnets to produce images of soft tissues such as the nerves, spinal cord, ligaments, and discs. This study can also provide information related to symptoms within the spinal cord.

Treatment

Spinal cord injuries are medical emergencies and need to be treated immediately. The amount of time that elapses between the initial injury and treatment can have a great effect on the outcome and the chance of recovery.

Corticosteroids are often given to patients who have suffered trauma as a spinal injury treatment. These medications help to reduce swelling and decrease the amount of pressure on the spinal cord. If the spinal cord is being compressed by a tumor, the growth can sometimes be removed or reduced in size to avoid complete destruction of the cord. Once the tumor is removed or made smaller, the patient’s condition and spinal injury treatment may improve.

In addition to removing spinal tumors, surgery may be necessary as a treatment for spinal cord injury to:

• Remove foreign materials, such as pieces of metal, glass or gunshot, or fragments of discs or bones
• Remove tissue or fluids that are compressing the spinal cord. This procedure is called a Decompression Laminectomy
• Realign the bones of the spine
• Fuse the broken or fractured vertebrae or apply spinal hardware or braces

Sometimes spinal traction is applied to hold the spine in correct alignment and keep it from moving. Rods may be used to hold the skull in place. These are braces made of metal which is placed in the skull and attached either to weights or to a vest that is worn by the patient (halo vest). The patient may need to remain in bed to allow the bones of the spine to fuse for the spinal injury treatment. Braces are also sometimes worn for several months.

Patients who lose control of their bowel and bladder function will be taught how to manage these functions and know the spinal injury treatment. The healthcare team will also provide instructions on how to control pain and muscle spasms, and how to prevent pressure ulcers and promote healing.

Many people who have injured their spinal cord need rehabilitation. Physical therapists and occupational therapists help patients regain strength, mobility, and functioning after their injury has healed.

In truth, there’s no real way to cure injury to the spinal cord. In any case, scientists are consistently researching for new spinal injury treatment, solutions, and medicines, including prostheses and solutions that may advance nerve cell recovery or enhance the capacity of the nerves that stay after spinal cord damage.

Meanwhile, the spinal injury treatment concentrates on forestalling further damage and engaging individuals with spinal cord damage to come back to a dynamic and beneficial life.

Emergency restorative consideration is basic to limit the impacts of any head or neck injury. That is the reason spinal injury treatment frequently starts at the scene of the mishap.

Emergency workforce regularly immobilizes the spine as tenderly and rapidly as conceivable utilizing an unbending neckline and an inflexible conveying board, which they’ll use to transport you to the clinic.

Early phases of spinal injury treatment

In the emergency room, specialists concentrate on:

• Controlling your breathing
• Anticipating and handling a shock
• Immobilizing your neck to prevent further damage to the spinal cord
• Staying away from other possible complications, for example, stool or urine maintenance, respiratory or cardiovascular trouble and blood clots

In the event that you do have spinal cord damage, you’ll be admitted to the injury unit treatment. You may even be exchanged to territorial spine damage focus that has a group of neurosurgeons, orthopedic specialists, spinal cord specialists, authorities, analysts, medical caretakers, advisors and social laborers with ability in spinal cord damage.

• Medicine. Intravenous (IV) methylprednisolone (A-Methapred, Solu-Medrol) is a treatment choice for intense spinal cord damage. In the event that methylprednisolone is given inside eight hours of damage, a few people encounter mellow change.

It seems to work by lessening injury to nerve cells and diminishing irritation close to the site of damage. Nonetheless, it’s not a cure for spinal cord damage.

• Immobilization. You may require a brace to balance out your spine, to bring the spine into a legitimate arrangement or both. Sometimes, an unbending neck brace may work. Additionally, a specialized bed unit may help immobilize your body.
• Surgery. Frequently surgery is important to extract sections of bones, outside articles, herniated plates or cracked vertebrae that give off an impression of being packing the spine. Surgery may likewise be expected to balance out the spine to forestall future torment or disfigurement.
• Trial medicines. Researchers are attempting to make sense of approaches to stop cell passing, control irritation and advance nerve recovery. Get some information about the accessibility of such medicines.