Spinal Cord Injury
Definition
The spinal cord connects the base of the brain to the body’s nerves, making it an important communication highway between the brain and the rest of the body. It is surrounded and protected by a bony canal, which is part of the spinal column (also known as the spine or backbone).
A spinal cord injury happens when the spinal column fractures or when the ligaments holding the spinal column together fall out of alignment. As a result, the spinal cord within the bony canal may be bruised or crushed. When a spinal cord injury occurs, the damaged nerve pathways cannot properly send messages to other parts of the body, potentially resulting in loss of sensation and control of muscles. The extent of the damage depends on the location of the injury.
Quadriplegia is paralysis of the arms, torso, and legs, which can be caused by an injury to the spinal cord at the cervical (neck) level. Breathing problems and problems with bowel and bladder control may occur.
Paraplegia can result from injury to the spinal cord anywhere between the base of the neck and the lower back. This area includes the thoracic and lumbar segments of the spine. Injury to the thoracic area results in paralysis of the torso and legs. An injury at the lumbar area causes paralysis of the legs.
Spinal cord injuries can be complete or incomplete.
- A complete injury occurs when the spinal cord is cut all the way through. When this occurs, the person has no feeling and cannot move below the level of the injury.
- In an incomplete injury, there is some feeling or voluntary movement below the level of the injury. This happens when there is little damage to the spinal cord.
Causes
- trauma, including, but not limited to, sports injuries, falls, and car accidents
- birth defects, such as spina bifida
- disease, including arthritis, cancer, inflammation of the spinal cord, degenerative disc disease, infection
Risk Factors
Spinal cord injuries are usually caused by unexpected trauma. However, certain risk factors, such as being active in sports, or predisposing conditions may increase your odds of sustaining a spinal cord injury.
Symptoms
Symptoms vary depending on the extent and location of the spinal cord injury.
Potential symptoms include:
- balance problems
- impaired breathing
- incontinence or retention (urinary or bowel)
- loss of control over part of the body (complete or partial)
- loss of sensation in limbs and digits (arms, legs, fingers, feet, or toes)
- pain or pressure (head, neck, or back)
Diagnosis
Spinal cord injury is classified according to the level of the cord that is injured. To determine the extent of the injury, the physician will test a patient’s strength and movement of specific muscles, ability to feel light touch and a pinprick on the skin in key areas of the body, and ability to feel pressure at the anus and rectum.
Other tests may include:
x-ray: Electromagnetic radiation is used to take photographic-like images of the inside of the body. X-rays are used to show bone fractures and whether the bones of the spine are properly aligned.
computed tomography (CT) scan: A computerized x-ray machine is used to take a series of detailed pictures from many different angles. Dye may be injected to help clarify organs and tissues.
magnetic resonance imaging (MRI): Powerful magnets and radio waves are used to make a series of detailed pictures.
Both a CT scan and an MRI are useful in identifying cord tissue damage.
Following diagnosis, the physician grades the extent of the injury according to the American Spinal Injury Association (ASIA) scale.
Treatment
Treatments may vary depending on the extent, type, and location of the spinal cord injury. Injuries are treated with rest, analgesics, and muscle-relaxing agents with or without surgery until swelling and local pain have subsided.
Steroid therapy: Corticosteroids started within eight hours of a spinal cord injury may improve neurological outcomes in blunt injuries.
Surgery: To insure proper alignment, unstable injuries are immobilized until the bone and soft tissues have healed. Once the bone and soft tissues have healed, surgical fusion with internal fixation is often necessary. Patients with incomplete cord injuries can have significant neurological improvement following decompression of neural structures. For patients in this subset, surgery within the first 24 hours may facilitate a better neurological outcome and allow for earlier mobilization and rehabilitation. In contrast, those with complete cord injuries rarely regain useful function below the level of the injury. Surgery for this type of injury aims simply to stabilize the spine to enable early mobilization. Timing is less critical for those with complete injuries.
The type of surgical procedure depends on the extent and location of the injury. Specialists at MINC have extensive training and experience with minimally invasive spinal surgery and state-of-the-art technologies to treat a range of spine injuries, painful disc conditions, and neck, arm, back, and leg pain.
Physical therapy: Rehabilitation may begin as soon as the patient’s condition is considered stable. The patient learns how to use special equipment and how to care for his or her body to prevent injury or complications.
Prevention
Taking necessary safety precautions, such as wearing protective equipment while playing sports, always wearing your seatbelt, and learning how to prevent falls, may decrease your chances of sustaining a spinal cord injury caused by trauma.