Социална мрежа за здравето - с грижа за вашето здраве

First of all, let’s start with some common facts about Spinal Cord injuries:

• Spinal cord injury is most common in white men in young age
• Spinal cord injury is 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. Both could bear risk for the affected individual’s life.
• First aid is crucial! Instant immobilization and early treatment are some of the most important factors for a good prognosis right after the injury. These are also the most important factors in achieving recovery from injuries of the spinal cord.
• Even those with severe spinal cord injuries can lead a quality life, interact in society and remain productive with the assistance of different devices and when undergoing rehabilitation.

What is spinal cord injury?

The spinal cord is a collection of nerves that starts from the back of the head (or the bottom of the brain) and travels down the back. There are 31 pairs of nerves that start from the spinal cord and go to the arms, legs, chest and abdomen. These nerves allow the brain to give commands to the muscles of the body. This results in voluntary movements of the arms and also the legs. The nerves that control the arms exit from the upper portion of the spinal cord. The nerves that are responsible for the legs exit from the lower part of the cord.

These nerves also control the function of your organs. This includes the heart, lungs, bowels, and bladder.

Other nerves travel from the arms and legs back to the spinal cord. These nerves bring information back from the body to a person’s brain. These are responsible for the senses: touch, pain, temperature and position.

The spinal cord runs through a spinal canal. It is surrounded by the bones in your neck and back called vertebrae. The vertebrae protects the spinal cord from injuries. The vertebrae consists of parts, that are divided into seven neck (or cervical) vertebrae, twelve chest (or thoracic) vertebrae and five lower back (or lumbar) vertebrae.

What’s important to know about spinal cord injury?

The spinal cord is very sensitive and prone to injury. Unlike other body parts, the spinal cord does not have the ability to regenerate or repair itself in case it is damaged.

A spinal cord injury occurs in case of damage to the spinal cord. This could be either a result of trauma, loss of normal blood supply of the cord or compression from various conditions such as tumor or infection.

As stated earlier in the article, the injuries of the spinal cord are either complete or incomplete. In a complete spinal cord injury there is complete loss of sensation and muscle function in the body (below the injury level). An incomplete spinal cord injury usually means there is some function remaining. In many cases both sides of the body are equally affected.

An accident causing injury of the upper portion of the spine (in the neck area) can cause a condition, known as quadriplegia. This means paralysis of both arms and both legs. When the spinal trauma and injury occurs in the lower back most cases end in what is known as paraplegia - paralysis of the (both) legs.

Spinal cord injury usually causes weakness and loss of feeling at where the injury is, or below. The severity of symptoms depends on whether the entire cord is badly injured (complete injury) or it’s only partially injured (incomplete spinal injury).

An injury at and below the first lumbar vertebra usually doesn’t cause spinal cord injury, but may cause a condition known as cauda equina syndrome. This is a serious injury to the nerve roots in the affected area. It’s important to know that such type of spinal cord injury is considered a medical emergency case and needs surgery immediately.

Injuries of the spinal cord at any level can cause:

• Spasticity: increased muscle tone
• Loss of normal bowel and bladder control (resulting in constipation, incontinence, bladder spasms or other)
• Numbness in and below the affected area
• Sensory changes or malfunction
• Pain
• Weakness of the limbs and body, paralysis

Neck (cervical) injuries

Spinal cord injuries can affect the neck area. In these cases symptoms can affect the arms, legs, as well as the body. Symptoms may occur either on one or both sides of the body. If the injury is caused higher up the neck, symptoms include also difficulties in breathing. This is caused from paralysis of the breathing muscles.

Chest level (thoracic) injuries

With spinal injuries at chest level, symptoms usually affect the legs. Injuries to the cervical and/or high thoracic spinal cord could result in blood pressure problems, and also abnormal sweating and further trouble maintaining normal temperature of the body.

Lower back (lumbar sacral) injuries

With spinal injuries at the lower back level, symptoms can affect either one or both legs. Muscles that control the bowels and bladder can also be severely affected, resulting in incontinence. 

It is crucial to know that spinal cord injury is a medical emergency that needs immediate medical attention and following supervision in hospital.

Your doctor will perform a primary physical exam and will also run a couple of tests, including a brain and neurological exam, a CT scan or other. This helps the identification of the exact location of the injury. After a spinal injury some of the reflexes may be abnormal or clearly missing. Depending on the severity of the damage, once the swelling goes better, some of the reflexes could gradually recover.

Diagnosis

Some of the first steps in diagnosing a spinal cord trauma and injury is carefully collecting a medical history and undergoing detailed physical examination. The amount of time since the injury is crucial and highly important, since a spinal cord injury is a most definitely a medical emergency. The quicker the patient is treated, the better the chances for recovery. A careful investigation regarding any prior neck or back injuries or surgeries is also important. The doctor will check for the presence of pain and visible wounds or swelling in the neck or back area, weakness in the arms or legs, and also loss of bowel or bladder control, loss of sensation in the limbs, as well as routine check for previous medical conditions.

Some of the tests that could be ordered include, but are not limited to:

• Computed tomography (CT) scan or magnetic resonance imaging (MRI) of the spine
• X-rays
• Electromyography (EMG)
• Myelogram (an x-ray of the spine with injecting dye)
• Nerve conduction tests

The physical examination also includes testing for sensation to touch as well as muscle strength and reflexes in the limbs. The injured person may be kept in a cervical collar. Other measure is immobilization on a backboard until a doctor determines whether or not a spinal cord injury is present.

Usually one of the first steps is an x-ray test of the neck and/or back.

X-rays can help identify a fracture or dislocation of the vertebrae, although these may or may not be present with a spinal cord injury. It is possible to have a spinal cord injury without an injury to the vertebrae. X-rays tests can also help identify a tumor, infection or severe arthritis that could be the cause for a spinal cord injury.

A computed tomography (CT) scan is a more advanced imaging method that can provide the doctor with a better view of the vertebrae. CT is used to identify injuries to the vertebrae that could not be visible with x-rays.

A magnetic resonance imaging (MRI) scan is another (more advanced) imaging examination that can identify an injury to the spinal cord. The MRI shows better results at evaluating the soft tissues, incl. the ligaments, intervertebral discs, nerves and the spinal cord. MRI scans also show clear evidence of injury within the spinal cord.

A spinal cord injury is a medical emergency case and needs to be treated right away, as quick as possible. The time between the injury and treatment is crucial and can affect the possible outcome.

Corticosteroids are sometimes used to reduce the swelling thatcould cause damage to the spinal cord.

Conditions with undergoing paralysis may improve in cases where spinal cord pressure is caused by a growth. If this growth is removable or can be reduced before the spinal nerves are completely destroyed, there is a much better chance for regaining movement in the affected limbs.

Surgery may be necessary to:

• Realign the bones in the spine (vertebrae)
• Remove excessive fluid or tissue causing pressure on the spinal cord (decompression laminectomy)
• Remove bone, disk fragments or foreign objects
• Fuse broken spinal bones
• Place spinal braces

Spinal traction is usually recommended - this measure helps keeping the spine immobilized. The skull may be held in place (with tongs). Thongs are braces made of metal, that are placed in the skull and attached to weights or a harness on the body (also known as “halo vest”). An injured patient may need to wear the spine braces for several months.

A patient with injured spine will also need physical therapy, occupational therapy as well as other possible rehabilitation after the injury has primarily healed. Rehabilitation will help the injured person cope with the disability caused by the spinal cord injury.

Of course, the outlook (prognosis) or how well a person does in therapy depends on the level and severity of the injury. Injuries near the top of the spine are harder to heal and tend to lead to more disability than injuries that take place lower in the spine.

Paralysis and loss of sensation are quite common. This includes total paralysis or numbness and also loss of movement and feeling.

A person who recovers some movement and/or feeling within 1 week after the injury usually has a positive outlook and a chance of recovering more function. This may take as long as 6 months or sometimes more. Any losses remaining prevalent for more than 6 months are likely to stay permanent.

Possible Complications

The following are possible complications of a spinal cord injury:

• Blood pressure changes (autonomic hyperreflexia)
• Increased risk of injury to the numb body areas
• Increased risk of infections in the urinary tract
• Shock
• Long-term kidney complications
• Loss of bladder control
• Loss of bowel control
• Loss of feeling
• Loss of sexual function
• Excessive pain
• Paralysis of breathing muscles
• Paralysis (paraplegia, quadriplegia)
• Pressure sores
• DVT (deep vein thrombosis), infections of the lungs, skin breakdown, muscle stiffness

Spinal injuries are a medical emergency! Call a doctor immediately if you or someone has a back or neck injury, has fallen from stairs or was injured in a road or car accident. Call 112 immediately if you or someone else experiences loss of movement and/or feeling after an injury.

Managing a spinal cord injury begins right at the site of the accident. Trained paramedics immobilize the injured spine immediately to prevent any further nervous system damage.

An injured person who may have a spinal cord injury should not be moved, unless in case of immediate danger.

Rehabilitation programs often combine physical therapy with skill-building activities to provide better physical, social and psychological support.

While undergoing rehabilitation from injuries to the spine you could need the help of different medical and non-medical specialists and staff: a doctor, specializing in physical medicine and rehabilitation (physiatrist), social workers, physical and occupational therapists, recreational therapists, nurses, psychologists, vocational counselors, nutritionists and in some specific cases - other specialists.

In the initial phase of therapy and rehabilitation specialists try to emphasize the regaining leg and arm strength. Mobility and communication are some of the most important areas of function. In many cases mobility becomes possible only with assistive devices such as a walkers, leg braces and wheelchair. Sometimes communication skills such as writing, typing, and using the phone may require adaptive devices and techniques.

Physical therapy incl. exercise programs that aim regaining muscle strength. Occupational therapy helps with the fine motor skills. Bladder and bowel management programs aim to help basic toileting routines. Patients can also learn new adapted techniques for self-grooming. It is important for injured people to acquire coping strategies for recurring episodes of spasticity, autonomic dysreflexia as well as neurogenic pain.

Proper safety practices during work and play can prevent many spinal cord injuries. Use proper protective equipment for any activity in which an injury is possible.

Diving into shallow water is one of the most dangerous causes of spinal cord injury. Always check water depth before diving. Always look for rocks or other possible objects in your way.
Sports like football and sledding can involve sharp blows or abnormal twisting and bending of the back or neck. This can cause spinal cord injury.

Always use the right techniques and personal protective equipment when practicing football or contact sports.

Careful driving and wearing a seat belt at all times greatly reduces the risk of serious injury in case of a a road accident.

Keep in mind that not all injuries are preventable at all times. Nevertheless, the following simple steps can help greatly reduce the risk of getting one:

• Always use safety equipment: seat belts, bicycle and motorcycle helmets
• Always follow driving and bicycle safety recommendations
• Do not drink and drive
• Do not allow yourself to be driven by someone under the influence

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