Spinal Injury

Defined

Your spinal cord is a bundle of nerves that runs down the middle of your back. It carries signals back and forth between your body and your brain. A spinal cord injury disrupts the signals. Spinal cord injuries usually begin with a blow that fractures (breaks) or dislocates your vertebrae, the bone disks that make up your spine. Most injuries don't cut through your spinal cord. Instead, they cause damage when pieces of vertebrae tear into cord tissue or press down on the nerve parts that carry signals.

 

Spinal cord injuries can be complete or incomplete. With a complete spinal cord injury, the cord can't send signals below the level of the injury. As a result, you are paralyzed below the injury. With an incomplete injury, you have some movement and sensation below the injury.

 

A spinal cord injury is a medical emergency. Immediate treatment can reduce long-term effects. Treatments may include medicines, braces or traction to stabilize the spine, and surgery. Later treatment usually includes medicines and rehabilitation therapy. Mobility aids and assistive devices may help you to get around and do some daily tasks.

 

NIH: National Institute of Neurological Disorders and Stroke

https://medlineplus.gov/spinalcordinjuries.html

Diagnosis

SCIs are not always immediately recognizable. The following injuries should be assessed for possible damage to the spinal cord1:

  • Head injuries, particularly those with trauma to the face

  • Pelvic fractures

  • Penetrating injuries in the area of the spine

  • Injuries from falling from heights

 

If any of these injuries occur together with any of the symptoms mentioned above (acute head, neck, or back pain; decline of feeling in the extremities; loss of control over part of the body; urinary or bowel problems; walking difficulty; pain or pressure bands in the chest area; difficulty breathing; head or spine lumps), then SCI may be implicated.2

 

A person suspected of having an SCI must be carefully transported—to prevent further injury the spine should be kept immobile—to an emergency room or trauma center. A doctor will question the person to determine the nature of the accident, and the medical staff may test the patient for sensory function and movement. If the injured person complains of neck pain, is not fully awake, or has obvious signs of weakness or neurological injury, diagnostic tests will be performed.

These tests may include3:

  • A CT ("cat") scan. This approach uses computers to form a series of cross-sectional images that may show the location and extent of the damage and reveal problems such as blood clots (hematomas).

  • An MRI (magnetic resonance imaging) scan. An MRI machine "takes a picture" of the injured area using a strong magnetic field and radio waves. A computer creates an image of the spine to reveal herniated disks and other abnormalities.

  • A myelogram. This is an X-ray of the spine taken after a dye is injected.

  • Somatosensory evoked potential (SSEP) testing or magnetic stimulation. Performing these tests may show if nerve signals can pass through the spinal cord.

  • Spine X-rays. These may show fracture or damage to the bones of the spine.

 

On about the third day after the injury, doctors give patients a complete neurological examination to diagnose the severity of the injury and predict the likely extent of recovery. This involves testing the patient's muscle strength and ability to sense light touch and a pinprick. Doctors use the standard ASIA (American Spinal Injury Association) Impairment Scale for this diagnosis. X-rays, MRIs, or more advanced imaging techniques are also used to visualize the entire length of the spine.

 

The ASIA Impairment Scale has five classification levels, ranging from complete loss of neural function in the affected area to completely normal4:

  • A: The impairment is complete. There is no motor or sensory function left below the level of injury.

  • B: The impairment is incomplete. Sensory function, but not motor function, is preserved below the neurologic level (the first normal level above the level of injury) and some sensation is preserved in the sacral segments S4 and S5.

  • C: The impairment is incomplete. Motor function is preserved below the neurologic level, but more than half of the key muscles below the neurologic level have a muscle grade less than 3 (i.e., they are not strong enough to move against gravity).

  • D: The impairment is incomplete. Motor function is preserved below the neurologic level, and at least half of the key muscles below the neurologic level have a muscle grade of 3 or more (i.e., the joints can be moved against gravity).

  • E: The patient's functions are normal. All motor and sensory functions are unhindered.

 

To illustrate, a person classified as C-level on the ASIA scale functions better than a person at the B level. Time was, a patient might have been labeled a C4 quadriplegic. Today, however, using the ASIA scale, the classification might be C4 ASIA A tetraplegic. Regarding muscle-strength grades, zero is the lowest, corresponding to complete absence of muscle movement. Five is the highest, representing full, normal strength.5,6

 

https://www.nichd.nih.gov/health/topics/spinalinjury/conditioninfo/diagnosed

Treatment

Unfortunately, there's no way to reverse damage to the spinal cord. But researchers are continually working on new treatments, including prostheses and medications that may promote nerve cell regeneration or improve the function of the nerves that remain after a spinal cord injury.

 

In the meantime, spinal cord injury treatment focuses on preventing further injury and empowering people with a spinal cord injury to return to an active and productive life.

 

Emergency actions

Urgent medical attention is critical to minimize the effects of any head or neck trauma. Therefore, treatment for a spinal cord injury often begins at the scene of the accident.

 

Emergency personnel typically immobilize the spine as gently and quickly as possible using a rigid neck collar and a rigid carrying board, which they'll use to transport you to the hospital.

Early (acute) stages of treatment

In the emergency room, doctors focus on:

  • Maintaining your ability to breathe

  • Preventing shock

  • Immobilizing your neck to prevent further spinal cord damage

  • Avoiding possible complications, such as stool or urine retention, respiratory or cardiovascular difficulty, and formation of deep vein blood clots in the extremities

 

If you do have a spinal cord injury, you'll usually be admitted to the intensive care unit for treatment. You may even be transferred to a regional spine injury center that has a team of neurosurgeons, orthopedic surgeons, spinal cord medicine specialists, psychologists, nurses, therapists and social workers with expertise in spinal cord injury.

  • Medications. Intravenous (IV) methylprednisolone (Solu-Medrol) has been used as a treatment option for an acute spinal cord injury in the past. But recent research has shown that the potential side effects, such as blood clots and pneumonia, from using this medication outweigh the benefits. Because of this, methylprednisolone is no longer recommended for routine use after a spinal cord injury.

  • Immobilization. You may need traction to stabilize your spine, to bring the spine into proper alignment or both. In some cases, a rigid neck collar may work. A special bed also may help immobilize your body.

  • Surgery. Often surgery is necessary to remove fragments of bones, foreign objects, herniated disks or fractured vertebrae that appear to be compressing the spine. Surgery may also be needed to stabilize the spine to prevent future pain or deformity.

  • Experimental treatments. Scientists are trying to figure out ways to stop cell death, control inflammation and promote nerve regeneration. For example, doctors may lower the body temperature significantly — a condition known as hypothermia — for 24 to 48 hours to help prevent damaging inflammation. Ask your doctor about the availability of such treatments.

 

Ongoing care

After the initial injury or condition stabilizes, doctors turn their attention to preventing secondary problems that may arise, such as deconditioning, muscle contractures, pressure ulcers, bowel and bladder issues, respiratory infections, and blood clots.

 

The length of your hospitalization depends on your condition and the medical issues you're facing. Once you're well enough to participate in therapies and treatment, you may transfer to a rehabilitation facility.

 

Rehabilitation

Rehabilitation team members will begin to work with you while you're in the early stages of recovery. Your team may include a physical therapist, an occupational therapist, a rehabilitation nurse, a rehabilitation psychologist, a social worker, a dietitian, a recreation therapist, and a doctor who specializes in physical medicine (physiatrist) or spinal cord injuries.

 

During the initial stages of rehabilitation, therapists usually emphasize maintenance and strengthening of existing muscle function, redeveloping fine motor skills, and learning adaptive techniques to accomplish day-to-day tasks.

You'll be educated on the effects of a spinal cord injury and how to prevent complications, and you'll be given advice on rebuilding your life and increasing your quality of life and independence.

 

You'll be taught many new skills, and you'll use equipment and technologies that can help you live on your own as much as possible. You'll be encouraged to resume your favorite hobbies, participate in social and fitness activities, and return to school or the workplace.

 

Medications

Medications may be used to manage some of the effects of spinal cord injury. These include medications to control pain and muscle spasticity, as well as medications that can improve bladder control, bowel control and sexual functioning.

New technologies

Inventive medical devices can help people with a spinal cord injury become more independent and more mobile. Some devices may also restore function. These include:

  • Modern wheelchairs. Improved, lighter weight wheelchairs are making people with spinal cord injuries more mobile and more comfortable. For some, an electric wheelchair may be needed. Some wheelchairs can even climb stairs, travel over rough terrain and elevate a seated passenger to eye level to reach high places without help.

  • Computer adaptations. For someone who has limited hand function, computers can be very powerful tools, but they're difficult to operate. Computer adaptations range from simple to complex, such as key guards or voice recognition.

  • Electronic aids to daily living. Essentially any device that uses electricity can be controlled with an electronic aid to daily living. Devices can be turned on or off by switch or voice-controlled and computer-based remotes.

  • Electrical stimulation devices. These sophisticated devices use electrical stimulation to produce actions. They're often called functional electrical stimulation systems, and they use electrical stimulators to control arm and leg muscles to allow people with spinal cord injuries to stand, walk, reach and grip.

  • Robotic gait training. This emerging technology is used for retraining walking ability after a spinal cord injury.

 

Prognosis and recovery

Your doctor may not be able to give you a prognosis right away. Recovery, if it occurs, typically starts a week to six months after an injury. The fastest rate of recovery is often seen in the first six months, but some people experience small improvements for up to one to two years.

 

https://www.mayoclinic.org/diseases-conditions/spinal-cord-injury/symptoms-causes/syc-20377890

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