About spinal cord injury

What is spinal cord injury?

Spinal Cord Injury Facts

  • The most common cause of spinal cord injury is trauma.
  • Spinal cord injury is most common in young, white men.
  • Spinal cord injury can be either complete or incomplete. In complete injuries there is no function below the level of injury. In incomplete injuries there is some function remaining below the level of injury.
  • Early immobilization and treatment are the most important factors in achieving recovery from spinal cord injury.
  • Aggressive rehabilitation and assistive devices allow even people with severe spinal cord injuries to interact in society and remain productive.

What is the spinal cord injury?

The spinal cord is a collection of nerves that travels from the bottom of the brain down your back. There are 31 pairs of nerves that leave the spinal cord and go to your arms, legs, chest and abdomen. These nerves allow your brain to give commands to your muscles and cause movements of your arms and legs. The nerves that control your arms exit from the upper portion of the spinal cord, while the nerves to your legs exit from the lower portion of the spinal cord. The nerves also control the function of your organs including your heart, lungs, bowels, and bladder. For example, signals from the spinal cord control how fast your heart beats and your rate of breathing.

Other nerves travel from your arms and legs back to the spinal cord. These nerves bring back information from your body to your brain including the senses of touch, pain, temperature, and position. The spinal cord runs through the spinal canal. This canal is surrounded by the bones in your neck and back called vertebrae which make up your back bone. The vertebrae are divided into 7 neck (cervical) vertebrae, 12 chest (thoracic) vertebrae and 5 lower back (lumbar) vertebrae. The vertebrae help protect the spinal cord from injury.

The spinal cord is very sensitive to injury. Unlike other parts of your body, the spinal cord does not have the ability to repair itself if it is damaged. A spinal cord injury occurs when there is damage to the spinal cord either from trauma, loss of its normal blood supply, or compression from tumor or infection. There are approximately 12,000 new cases of spinal cord injury each year in the United States. They are most common in white males.

Spinal cord injuries are described as either complete or incomplete. In a complete spinal cord injury there is complete loss of sensation and muscle function in the body below the level of the injury. In an incomplete spinal cord injury there is some remaining function below the level of the injury. In most cases both sides of the body are affected equally.

An injury to the upper portion of the spinal cord in the neck can cause quadriplegia-paralysis of both arms and both legs. If the injury to the spinal cord occurs lower in the back it can cause paraplegia-paralysis of both legs only.

What are the symptoms for spinal cord injury?

Your ability to control your limbs after a spinal cord injury depends on two factors: the place of the injury along your spinal cord and the severity of injury to the spinal cord.

The lowest normal part of your spinal cord is referred to as the neurological level of your injury. The severity of the injury is often called "the completeness" and is classified as either of the following:

  • Complete. If all feeling (sensory) and all ability to control movement (motor function) are lost below the spinal cord injury, your injury is called complete.
  • Incomplete. If you have some motor or sensory function below the affected area, your injury is called incomplete. There are varying degrees of incomplete injury.

Additionally, Paralysis from a spinal cord injury may be referred to as:

  • Tetraplegia. Also known as quadriplegia, this means your arms, hands, trunk, legs and pelvic organs are all affected by your spinal cord injury.
  • Paraplegia. This Paralysis affects all or part of the trunk, legs and pelvic organs.

Your health care team will perform a series of tests to determine the neurological level and completeness of your injury.

Spinal cord injuries of any kind may result in one or more of the following signs and symptoms:

  • Loss of movement
  • Loss or altered sensation, including the ability to feel heat, cold and touch
  • Loss of bowel or bladder control
  • Exaggerated reflex activities or spasms
  • Changes in sexual function, sexual sensitivity and fertility
  • Pain or an intense stinging sensation caused by damage to the nerve fibers in your spinal cord
  • Difficulty breathing, coughing or clearing secretions from your lungs

Emergency signs and symptoms

Emergency signs and symptoms of a spinal cord injury after an accident may include:

  • Extreme Back Pain or pressure in your neck, head or back
  • Weakness, incoordination or Paralysis in any part of your body
  • Numbness, tingling or Loss of sensation in your hands, fingers, feet or toes
  • Loss of bladder or bowel control
  • Difficulty with balance and walking
  • Impaired breathing after injury
  • An oddly positioned or twisted neck or back

When to see a doctor

Anyone who experiences significant trauma to his or her head or neck needs immediate medical evaluation for the possibility of a spinal injury. In fact, it's safest to assume that trauma victims have a spinal injury until proved otherwise because:

  • A serious spinal injury isn't always immediately obvious. If it isn't recognized, a more severe injury may occur.
  • Numbness or Paralysis may occur immediately or come on gradually as bleeding or swelling occurs in or around the spinal cord.
  • The time between injury and treatment can be critical in determining the extent and severity of complications and the possible extent of expected recovery.

If you suspect that someone has a back or neck injury:

  • Don't move the injured person — permanent Paralysis and other serious complications may result
  • Call 911 or your local emergency medical assistance number
  • Keep the person still
  • Place heavy towels on both sides of the neck or hold the head and neck to prevent them from moving until emergency care arrives
  • Provide basic first aid, such as stopping any bleeding and making the person comfortable, without moving the head or neck

What are the causes for spinal cord injury?

Spinal cord injuries may result from damage to the vertebrae, ligaments or disks of the spinal column or to the spinal cord itself.

A traumatic spinal cord injury may stem from a sudden, traumatic blow to your spine that fractures, dislocates, crushes or compresses one or more of your vertebrae. It also may result from a gunshot or knife wound that penetrates and cuts your spinal cord.

Additional damage usually occurs over days or weeks because of bleeding, swelling, inflammation and fluid accumulation in and around your spinal cord.

A nontraumatic spinal cord injury may be caused by arthritis, cancer, inflammation, infections or disk degeneration of the spine.

Your brain and central nervous system

The central nervous system comprises the brain and spinal cord. The spinal cord, made of soft tissue and surrounded by bones (vertebrae), extends downward from the base of your brain and is made up of nerve cells and groups of nerves called tracts, which go to different parts of your body.

The lower end of your spinal cord stops a little above your waist in the region called the conus medullaris. Below this region is a group of nerve roots called the cauda equina.

Tracts in your spinal cord carry messages between the brain and the rest of the body. Motor tracts carry signals from the brain to control muscle movement. Sensory tracts carry signals from body parts to the brain relating to heat, cold, pressure, pain and the position of your limbs.

Damage to nerve fibers

Whether the cause is traumatic or nontraumatic, the damage affects the nerve fibers passing through the injured area and may impair part or all of your corresponding muscles and nerves below the injury site.

A chest (thoracic) or lower back (lumbar) injury can affect your torso, legs, bowel and bladder control, and sexual function. A neck (cervical) injury affects the same areas in addition to affecting movements of your arms and, possibly, your ability to breathe.

Common causes of spinal cord injuries

The most common causes of spinal cord injuries in the United States are:

  • Motor vehicle accidents. Auto and motorcycle accidents are the leading cause of spinal cord injuries, accounting for almost half of new spinal cord injuries each year.
  • Falls. A spinal cord injury after age 65 is most often caused by a fall. Overall, falls cause more than 15 percent of spinal cord injuries.
  • Acts of violence. Around 12 percent of spinal cord injuries result from violent encounters, often involving gunshot and knife wounds.
  • Sports and recreation injuries. Athletic activities, such as impact sports and diving in shallow water, cause about 10 percent of spinal cord injuries.
  • Alcohol. Alcohol use is a factor in about 1 out of every 4 spinal cord injuries.
  • Diseases. Cancer, arthritis, osteoporosis and inflammation of the spinal cord also can cause spinal cord injuries.

What are the treatments for spinal cord injury?

The first step in treatment of a suspected spinal cord injury is to verify the patient is breathing and the heart is beating. A spinal cord injury in the upper neck can cause a loss of control of normal breathing. This may require the placement of a breathing tube and use of a ventilator.

The next step in treatment of a spinal cord injury is immobilization. This often occurs at the time of injury prior to being transported to the hospital. Emergency medical technicians may place the patient in a cervical collar or on a backboard to help prevent the spine from moving. If the patient has a spinal cord injury, further movement of the spine could lead to further damage.

After a spinal cord injury is diagnosed, the patient might be started on a high dose of steroids. This could help decrease the amount of damage to the spinal cord by reducing inflammation and swelling. There are risks associated with using steroids for spinal cord injury. The patient's doctor can help decide if steroids are appropriate. The use of steroids is only beneficial if they are started within eight hours of the time of injury.

Next the patient may be placed in traction or a halo device around the head to try to stabilize the spine and prevent further damage. Many cases of spinal cord injury are treated with surgery. There are two major goals of surgery.

  • The first goal is to relieve any pressure on the spinal cord. This could involve removing portions of the vertebrae that have broken and are compressing the spinal cord. If the spinal cord is being compressed by tumor, infection or severe arthritis, surgery can be performed to reduce the amount of compression.
  • The second major goal of surgery for spinal cord injury is to stabilize the spine. If the vertebrae are weakened from fracture, tumor or infection, they may not be capable of supporting the normal weight from the body and protecting the spinal cord. A combination of metal screws, rods and plates may be necessary to help hold the vertebrae together and stabilize them until the bones heal.

There are many potential complications related to spinal cord injury that may require specific treatment. These complications include:

  • urinary tract infections or urinary incontinence (inability to control the flow of urine),
  • bowel incontinence (inability to control bowel movements),
  • pressure sores,
  • infections in the lungs (pneumonia),
  • blood clots,
  • muscle spasms,
  • chronic pain, and
  • depression.

After the initial treatment and stabilization of patients with a spinal cord injury, much of the treatment is geared toward rehabilitation. This includes methods to help the patient maximize their function through physical and occupational therapy and the use of assistive devices.

What are the risk factors for spinal cord injury?

Although a spinal cord injury is usually the result of an accident and can happen to anyone, certain factors may predispose you to a higher risk of sustaining a spinal cord injury, including:

  • Being male. Spinal cord injuries affect a disproportionate amount of men. In fact, females account for only about 20 percent of traumatic spinal cord injuries in the United States.
  • Being between the ages of 16 and 30. You're most likely to suffer a traumatic spinal cord injury if you're between the ages of 16 and 30.
  • Being older than 65. Falls cause most injuries in older adults.
  • Engaging in risky behavior. Diving into too-shallow water or playing sports without wearing the proper safety gear or taking proper precautions can lead to spinal cord injuries. Motor vehicle crashes are the leading cause of spinal cord injuries for people under 65.
  • Having a bone or joint disorder. A relatively minor injury can cause a spinal cord injury if you have another disorder that affects your bones or joints, such as arthritis or osteoporosis.

Is there a cure/medications for spinal cord injury?

There is no way to repair spinal cord injury. However, researchers are constantly developing novel treatments, including prostheses and drugs, that may accelerate nerve cell renewal or improve the condition of the nerves that survive a spinal cord injury.

  • Medications: In the past, methylprednisolone (Solu-Medrol) injected through an arm vein (IV) was utilized as a therapeutic option for an acute spinal cord injury. However, a new study has revealed that the risks of using this medicine, such as blood clots and pneumonia, exceed the benefits. As a result, methylprednisolone is no more indicated for routine treatment following a spinal cord injury.
  • Immobilization: Traction may be required to stabilize or correct your spine. Soft neck collars and various braces are available as options.
  • Surgery: Surgery is frequently required to remove bone fragments, foreign objects, herniated discs, or broken vertebrae that appear to be crushing the spine. Surgery may also be required to stabilize the spine and avoid future discomfort or deformity.
  • Rehabilitation: During the early stages of rehabilitation, therapists typically focus on keeping and strengthening muscle activity, redeveloping fine motor skills, and having to learn how to adapt to do daily tasks.
  • Treatments under investigation: Scientists are working on techniques to prevent cell death, reduce inflammation, and enhance neuron regeneration. For example, dramatically reducing body temperature - a state known as hypothermia - for 24 to 48 hours may help prevent harmful inflammation.


Symptoms
Permanent loss of strength,Sensation and function below the site of the injury
Conditions
Numbness or paralysis
Drugs
Corticosteroids. Corticosteroids are a type of medication that can help minimize damage in the early phases of spinal cord injury,NSAIDs,Antidepressants,Anticonvulsants,Narcotic Analgesics (Opioids),Antispasmodics and Muscle Relaxants,Antibiotics

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