Spinal Cord Injuries

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

A spinal cord injury — damage to any part of the spinal cord or nerves at the end of the spinal canal (cauda equina) — often causes permanent changes in strength, sensation and other body functions below the site of the injury.

If you’ve recently injured your spinal cord, it might seem like every aspect of your life has been affected. You might feel the effects of your injury mentally, emotionally and socially.

Many scientists are optimistic that advances in research will someday make repair of spinal cord injuries possible. Research studies are ongoing around the world. In the meantime, treatments and rehabilitation allow many people with spinal cord injuries to lead productive, independent lives.

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

The lowest part of your spinal cord that remains undamaged after an injury 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 can be referred to as:

• Tetraplegia. Also known as quadriplegia, this means that 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.

Symptoms of Spinal cord injuries

Spinal cord injuries can cause one or more of the following signs and symptoms:

• Loss of movement
• Loss of 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 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

Causes

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

A traumatic spinal cord injury can stem from a sudden, traumatic blow to your spine that fractures, dislocates, crushes or compresses one or more of your vertebrae. It can also 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 non-traumatic spinal cord injury can 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 is made of soft tissue and surrounded by bones (vertebrae). It extends down from the base of your brain and contains 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 your brain and the rest of your body. Motor tracts carry signals from your brain to control muscle movement. Sensory tracts carry signals from body parts to your brain relating to heat, cold, pressure, pain and the position of your limbs.

Damage to nerve fibers

Whether the cause is traumatic or non-traumatic, the damage affects the nerve fibers passing through the injured area and can impair part of or all the 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.
• Acts of violence. About 12% of spinal cord injuries result from violent encounters, usually from gunshot wounds. Knife wounds also are common.
• Sports and recreation injuries. Athletic activities, such as impact sports and diving in shallow water, cause about 10% of spinal cord injuries.
• Diseases. Cancer, arthritis, osteoporosis and inflammation of the spinal cord also can cause spinal cord injuries.

Diagnosis of Spinal cord injuries

In the emergency room, an Orthopedic Specialist at Shreya Hospital can be able to rule out a spinal cord injury by examination, testing for sensory function and movement, and by asking some questions about the accident.

But if the injured person complains of neck pain, isn’t fully awake, or has obvious signs of weakness or neurological injury, emergency diagnostic tests may be needed.

These tests can include:

• X-rays. X-rays can reveal vertebral (spinal column) problems, tumors, fractures or degenerative changes in the spine.
• CT scan. A CT scan can provide a clearer image of abnormalities seen on X-ray. This scan uses computers to form a series of cross-sectional images that can define bone, disk and other problems.
• MRI. MRI uses a strong magnetic field and radio waves to produce computer-generated images. This test is helpful for looking at the spinal cord and identifying herniated disks, blood clots or other masses that might compress the spinal cord.

A few days after injury, when some of the swelling might have subsided, your doctor will conduct a more comprehensive neurological exam to determine the level and completeness of your injury. This involves testing your muscle strength and your ability to sense light touch and pinprick sensations.

Treatment of Spinal cord injuries

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 might 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 head or neck trauma. Therefore, treatment for a spinal cord injury often begins at the accident scene.

Emergency personnel typically immobilize the spine as gently and quickly as possible using a rigid neck collar and a rigid carrying board, which they use during transport 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 have a spinal cord injury, you’ll usually be admitted to the intensive care unit for treatment. You should go to Shreya Hospital in Ghaziabad,best 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. Methylprednisolone (Solu-Medrol) given through a vein in the arm (IV) 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 might need traction to stabilize or align your spine. Options include soft neck collars and various braces.
• 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 might 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, lowering body temperature significantly — a condition known as hypothermia — for 24 to 48 hours might help prevent damaging inflammation. More study is needed.