Spinal Cord Injury

Spinal cord trauma may result from direct injury to the cord itself or indirectly from damage to surrounding tissues, blood vessels or bones. The damage or trauma results in an impaired function of the spinal cord causing a lack of sensation or reduced mobility. Many spinal cord trauma injuries occur in men aged 15-35 who are relatively healthy individuals. The death rates of these young individuals with spinal injuries are significantly very high.

Causes

Many injuries are a result of gunshot wounds, motor accidents, falls and sports injuries. A minor spinal cord injury occurs if spine is weakened (osteoporosis/rheumatoid arthritis/spinal stenosis). The reason behind this can be explained by the normal ageing process. Patients who have had other medical problems which make them more prone to falling from weakness (e.g. stroke) can also be classified under this heading. Other causes include direct injury to the spinal column where the disks or bones have been fragmented. This can be for example if the cord is compressed, pulled in either direction or even if the head, back or neck are twisted beyond their normal rotational angle during an injury or accident. Compression can result from blood being accumulated inside the spinal canal causing damage to occur to the spinal cord.

Symptoms

The symptoms patients experience depend on the location of the injury as it causes weakness and sensory loss at and below the point of injury. Injury severity is determined by a complete or partial cord impairment.

NB. “The spinal cord doesn't go below the 1st lumbar vertebra, so injuries at and below this level do not cause spinal cord injury. However, they may cause "cauda equina syndrome" -- injury to the nerve roots in this area.”

Cervical Injuries – Injuries that occur in the neck region can affect the rest of the body and can either by ipsilateral or unilateral. Symptoms include: Numbness, abnormal blood pressure, pain, spasticity, weakness, sensory loss, urinary + bowel incontinence and breathing paralysis.

Thoracic Injuries – Injuries that occur in the chest region and symptoms can affect the legs. Symptoms include: Numbness, pain, abnormal blood pressure, spasticity, weakness, sensory loss and urinary + bowel incontinence.

Lumbar and Sacral Injuries – Injuries that occur in the lower back. Symptoms include: Numbness, pain, spasticity, weakness, sensory loss and urinary + bowel incontinence.

Treatment

Spinal cord trauma’s are medical emergencies and require immediate treatment to ensure a long term benefit. Corticosteroids (e.g. dexamethasone or methylprednisolone) are the main course of treatment used to reduce inflammation that can damage the spinal cord. Other medication includes analgesia and muscle relaxers to control the pain. Bony fragments and hematomas can be surgically removed to improve paralysis or before spinal nerves become permanently damaged. Other surgical techniques used include decompression laminectomy (the removal of fluid or tissues compressing the spinal cord). After surgery bed rest is recommended to allow the spinal bones to recover before the weight of the body is placed onto them once again. The multidisciplinary team is important in the recovery of patients, physiotherapists use spinal traction which keeps the spine from moving. Other healthcare professionals can take care of bodily functions and prevent muscle spasms. Extensive rehabillation techniques may be required to help cope a person with disability following an injury.