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Spinal Cord Injuries Overview
A spinal cord injury (SCI) is a damage to any part of the spinal cord or the nerves at the end of the spinal canal which causes permanent changes in sensation, strength and other body functions below the site of the injury. Every year, about 250,000 to 500,000 people suffer a spinal cord injury globally.
About 90% of the spinal cord injury cases are due to traumatic causes while the proportion of the non-traumatic spinal cord injury is growing. In this article, we discuss about the causes, symptoms and treatments for spinal cord injuries.
Types of Spinal Cord Injuries
- 1. Complete spinal cord injuries:
It refers to the types of injuries which result in complete loss of function below the site of injury. This condition can result in complete paraplegia or tetraplegia.
- Complete paraplegia:
It indicates the permanent loss of motor and nerve function at T1 level or below. This will result in loss of movement or sensation in the bowel, legs, bladder and sexual region. The arms and hands retain the normal function.
Some people with this condition have a partial trunk movement which allows them to walk short distances with assistive equipments. In the majority of cases, the complete paraplegics opt for using a self-propelled wheelchair.
- Complete tetraplegia:
It is characterized by the loss of hand and arm movement. Some tetraplegics require ventilator systems to assist breathing.
Some of the tetraplegics may have the arm and hand movements depending upon the location of injury.
- 2. Incomplete spinal cord injuries:
This spinal cord injury is more common than the complete injuries and it refers to the types of injuries that result in some feeling and sensation loss below the point of injury. The degree and level of function in the incomplete injuries vary from individual to individual and is dependent completely on the way the spinal cord is damaged.
Generally, the extent of an incomplete injury is determined after the spinal shock has been subsided that means it may take nearly six to eight weeks post injury. The spinal injuries will cause in some feeling but little or no movement or in some movement, but little or no feeling at all. The incomplete spinal injuries are further classified as:
- Anterior cord syndrome: It refers to the damage to the front of the spinal cord and result in impaired temperature, pain and touch sensations below the area of the injury. Some movement can be recovered later.
- Central cord syndrome: It indicates the damage in the center of the spinal cord which causes a loss in the function of arms and some leg movement. Some recovery is possible in this case.
- Posterior cord syndrome: It refers to damage to the back of the spinal cord, causing good muscle power, temperature sensation and pain but may cause poor coordination.
- Brown-Sequard syndrome: This indicates the damage to one side of the spinal cord, causing impaired loss of movement, but preserve the sensation on one side of the body or preserved movement and loss of sensation on the other side of the body.
- Cauda equine lesion: This refers to the injury of the nerves located between the first and second lumbar region of the spine that causes a partial or complete loss of sensation. In some cases, the nerves regrow and the function may be recovered.
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Causes of Spinal Cord Injuries:
Often the spinal cord injuries are traumatic and caused by dislocation, rotation, bending, hyperflexion or hyperextension of the cord and axial loading. The spinal cord injuries can be non-traumatic origin as in case of infection, cancer, intervertebral disc disease, spinal cord vascular disease and vertebral injury.
Common causes of spinal cord injury are:
- Motor vehicle accidents: Auto and motorcycle accidents are major causes of spinal cord injuries with more than 35% of new cases reported each year.
- Acts of violence: As per the National Spinal Cord Injury Statistical Center about 15% of the spinal cord injuries occur due to violent encounters involving the knife wounds and gunshot.
- Falls: People at the age of 65 are more prone to spinal cord injury due to a fall. The falls are responsible for a quarter of the SCIs.
- Alcohol: Out of one in four spinal cord injuries is caused due to alcohol.
- Sports and recreation injuries: About nine percent of the spinal cord injuries are caused from athletic activities like diving in shallow water and impact sports.
- Diseases: Arthritis, cancer, inflammation of the spinal cord and osteoporosis can cause the SCI.
Diagnosis of spinal cord injuries:
The doctor will examine the injured person using X-ray, MRI or CT scan to determine the damage caused to the spinal cord. If the injured person complains of the neck pain and shows obvious signs of weakness or neurological injury need the following tests.
- X-rays: People who are suspected to have a spinal cord injury after trauma need to undergo these tests. The results reveal the tumors, vertebral problems, fractures or the degenerative changes in the spine.
- MRI: It uses a strong magnetic field and radio waves to produce the computer-generated images. It will help determine the herniated discs, blood clots or other masses that may be compressing the spinal cord.
- CT scans: This scan uses computers to form a series of cross-sectional images to provide a better view at the abnormalities in bone or disc.
The doctor will conduct a neurological exam to determine the level and completeness of the injury, a few days after the injury when the swelling has subsided. This exam will help to determine your muscle strength and the ability to sense a pinprick and a light touch.
Symptoms of Spinal Cord Injuries:
SCI of any kind shows one or more of the following symptoms:
- Loss of sensation, including the ability to feel cold, heat and touch.
- Exaggerated reflux activities or spasms.
- Loss of movement.
- Changes in sexual sensitivity, sexual function and fertility.
- Difficulty in coughing, breathing or clearing secretions from the lungs.
- Intense stinging sensation or pain caused by damage to the nerve fibers in the spinal cord.
The new treatments for spinal cord injuries help people survive and recover a great deal of the function. The treatments of SCI include medication and surgery and often always require physical therapy.
- Medications: Intravenous methylprednisolone is a treatment option given for acute SCI. If this medication is given within eight hours of injury, the patient may experience mild improvement. It helps reducing the damage to nerve cells by decreasing inflammation at the site of the injury. However, this may not cure SCI.
- Immobilization: A traction is required to stabilize your spine which will bring the proper alignment to the spine. In certain cases, a rigid neck collar may work while a special bed may help immobilize the body.
- Surgery: Often surgery will help remove the fragments of bones, herniated dics, foreign objects or fractured vertebrae that seem to be compressing your spine. Surgery will be required to stabilize the spine in order to prevent deformity or future pain.
The different treatments focus to prevent further injury to the spinal cord and help people to return to an active and productive life. Consult your doctor to get the best treatment for SCI suitable for your health.