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When a person experiences a spinal cord injury, it can result in damage to various parts of the spinal cord, as well as the nerves located at the lower end of the spinal canal (known as the cauda equina), as well as the surrounding tissues and bones. The extent of the damage can vary in severity, and can often lead to permanent changes in bodily functions such as strength, sensation, and other functions below the area of the injury.
When an injury prevents nerves from communicating with the brain, the body experiences a loss of crucial functions. These may include bladder and bowel control, breathing, regulation of heart rate, the body’s metabolism, muscle movements, sensations, and reflexes.
The neurological level of an injury is the lowest portion of the spinal cord that is still intact after suffering damage. The completeness of the injury can fall into one of the following types:
- Complete: Total paralysis (loss of sensory and motor function) below the level of the injury results from a complete injury. Both sides of the body are affected. A complete damage may result in the paralysis of the lower body (paraplegia) or all four limbs (quadriplegia).
- Quadriplegia: Also known as tetraplegia. This indicates that the spinal cord injury has an impact on the arms, hands, trunk, legs, and pelvic organs.
- Paraplegia: The trunk, legs, and pelvic organs may be completely or partially paralyzed.
- Incomplete: Some function (sensory and motor function) may still be present on one or both sides of the body following an incomplete damage. There are still certain channels where the body and brain can communicate.
Individuals who have recently sustained a spinal cord injury may feel as if their entire life has been altered. The injury can have psychological, emotional, and social impacts on them.
Numerous scientists are confident that advancements in science will eventually enable the repair of spinal cord injuries. Ongoing research projects are being conducted worldwide to pursue this goal. Meanwhile, medical interventions and therapy have made it possible for many individuals with spinal cord injuries to lead active and independent lives.
Symptoms
To determine the severity and extent of the neurological injury, the healthcare provider will do a number of tests. The following signs and symptoms could result from a spinal cord injury:
- Loss of muscle movements
- Loss of sensation
- Loss of bowel or bladder function
- Reflex activities or spasms are heightened
- Changes to sexual sensitivity, sexual function, and fertility
- Pain or a sharp stinging sensation caused by spinal cord never damage.
- Problems breathing, coughing, or releasing lungs’ secretions
Emergency medical attention should be sought if an individual experiences any of the following symptoms after an injury:
- Severe back pain or pressure at the neck, head or back
- Loss of strength, weakness, or paralysis in any part of the body
- Loss of sensation in the hands, fingers, feet, or toes, including numbness or tingling
- Loss of bladder or bowel function
- Having problems with walking and balancing
- Difficulty in breathing following an injury
- Abnormally twisted or positioned neck or back
Individuals who have suffered significant head or neck trauma require urgent medical attention to rule out any potential spinal injuries. Until proven differently, it is safe to presume that trauma victims suffer spinal injuries because sometimes a severe spinal injury is not instantly obvious. In some cases, a severe spinal injury may not be immediately apparent and as a result, there may be a risk of further harm. The onset of numbness or paralysis can occur suddenly or develop gradually over time.
The duration between an accident and receiving medical attention can greatly influence the severity of the consequences and the expected recovery time.
Causes
Damage to the spinal column’s disks, ligaments, or vertebrae as well as the spinal cord itself can cause spinal cord injuries. A sudden, traumatic impact to the spine that fractures, dislocates, crushes, or compresses one or more vertebrae can cause a traumatic spinal cord injury. The spinal cord may also be punctured and cut by a gunshot or knife wound. Bleeding, swelling, inflammation, and fluid buildup in and around the spinal cord typically cause more damage over the course of days or weeks.
A non-traumatic spinal cord injury can be brought on by arthritic conditions, cancer, inflammation, infections, or degenerative disk disease of the spine.
Damage to nerve fibers can result from both traumatic and nontraumatic causes. It can affect the nerve fibers that pass through the injured area as well as some or all of the muscles and nerves below the damaged site.
The most common causes of spinal cord injuries are:
- Vehicle accidents: Nearly half of all new spinal cord injuries each year are caused by auto and motorcycle accidents, which rank as the primary cause of spinal cord injuries.
- Falls: After the age of 65, falls are the most common reason for spinal cord injuries.
- Violence: Spinal cord injuries from gunshot wounds, and knife injuries are also frequent.
- Sports injuries: 10% of spinal cord injuries are the result of athletic endeavors like impact sports and scuba diving.
- Diseases: Spinal cord injuries can also result from cancer, arthritis, osteoporosis, and spinal cord inflammation.
Risk factors
Anyone can sustain a spinal cord injury, which usually results from accidents. However, certain risk factors can make someone more likely to sustain one, such as:
- Gender: Men are more frequently affected than women by spinal cord injuries.
- Age: People at age 16 to 30 years old sustain more than half of all spinal cord injuries. When people reached the age of 65 and above, the risk increase due to that most injuries in older adults are due to falls.
- Alcohol intake: About 25% of traumatic spinal cord injuries are caused by drinking alcohol.
- Risky activities: Spinal cord injuries can result from participating in sports or diving into too shallow of water without wearing the appropriate safety equipment or taking the necessary precautions. For those under 65, automobile accidents are the main cause of spinal cord injuries.
- Pre-existing diseases: If a person has an underlying condition like osteoporosis that affects their bones or joints, even a relatively minor injury can result in a spinal cord injury.
Diagnosis
- Physical examination: A healthcare provider will assess and check if the breathing or heart rate are not affected by the spinal cord injury during emergencies. Healthcare providers will evaluate how well the motor and sensory function works.
Emergency diagnostic procedures may be required if the injured person complains of neck pain, partially alert, or exhibits clear signs of neurological injury or weakness. - Imaging test:
- X-rays: Vertebral (spinal column) issues, tumors, fractures, or degenerative changes in the spine can all be seen on X-rays.
- CT scan: When abnormalities are detected on an X-ray, a CT scan can produce a clearer image. A sequence of cross-sectional images created by computers during this scan can be used to identify bone, disk, and other issues.
- MRI: A powerful magnetic field and radio waves are used in MRI to create computer-generated pictures. This examination of the spinal cord is beneficial for locating herniated disks, blood clots, and other masses that could compress the spinal cord.
- Electromyelogram: If there is concurrent peripheral nerve injury, a medical professional may also use an electromyogram (EMG) to assess electrical activity in muscles and nerve cells. However, EMG is typically not required in spinal cord injuries.
In order to determine the extent of the injury, a healthcare provider will typically conduct a comprehensive neurological examination a few days following the accident, after allowing time for any swelling to subside. This examination will involve assessing the level and completeness of the injury by testing the patient’s muscle strength, as well as their ability to sense light touch and pinprick sensations.
Treatment
In cases where there is trauma to other parts of the body, emergency surgery may be necessary to address a spinal cord injury. Surgical intervention can also be an option for spinal cord injuries resulting from blood clots, tissue damage, or fractured bones.
The spinal cord damage can’t be repaired, which is unfortunate. Treatment for spinal cord injuries long-term objectives is to improve the quality of life, independence, reducing chronic health conditions, and partially restoring the nerve function.
Ongoing research on new treatments, such as drugs and prosthetics, is leading to improvements in the functionality of the nerves that remain after a spinal cord injury.
- Emergency actions: In order to lessen the impact of head or neck trauma, immediate medical intervention is essential. As a result, spinal cord injury therapy frequently starts at the scene of the accident.
When transporting a patient to the hospital, emergency professionals usually immobilize the spine as gently and rapidly as they can using a rigid neck collar and a rigid carrying board. - Early stages of treatment: In the emergency room, healthcare providers prioritize maintaining the patient’s breathing, preventing shock, immobilizing the spinal cord to prevent further injury, and mitigating potential complications such as stool or urinary retention, respiratory or cardiovascular problems, and the formation of blood clots in the limbs.
An intensive care unit admission is typically required for treatment of spinal cord injuries. Patients may be moved to a local spine injury center with a team of specialists in spinal cord medicine, neurosurgery, orthopedic surgery, psychology, nursing, therapists, and social work who are also experienced in treating spinal cord injury.
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- Medications: In the past, methylprednisolone, administered intravenously (IV), has been used to treat acute spinal cord injuries. However, recent studies have indicated that the risks of using this medicine, which include blood clots and pneumonia, exceed the advantages. Methylprednisolone is no longer advised for regular use following a spinal cord injury.
- Immobilization: The patient could require traction to align or stabilize their spine. Choices include a variety of braces and soft neck collars.
- Surgery: In order to remove bone fragments, foreign objects, herniated disks, or broken vertebrae that appear to be crushing the spine, surgery is frequently required. In order to stabilize the spine and stop future pain or deformity, surgery may also be required.
- Experimental treatments: Researchers are looking for ways to reduce inflammation, inhibit cell death, and encourage the regeneration of nerves. For instance, the inflammation may be avoided by reducing body temperature (also known as hypothermia) for 24 to 48 hours.
- Ongoing care: Following the stabilization of the initial injury or condition, medical professionals focus on minimizing potential complications such deconditioning, muscle contractures, pressure ulcers, bowel and bladder problems, respiratory infections, and blood clots.
- Rehabilitation: During the patient’s recovery phase, a team of rehabilitation specialists will begin working with them. This team may include physical therapists, occupational therapists, rehabilitation nurses, rehabilitation psychologists, social workers, dietitians, recreation therapists, and medical professionals who specialize in spinal cord injuries or physical medicine.
Therapy professionals frequently place a strong emphasis on preserving and increasing muscle function, regaining fine motor abilities, and learning how to adapt to do daily chores during the early phases of recovery.
During the rehabilitation process, the patient will acquire and rehearse various new skills, and use tools and technologies that will empower them to live with maximum independence. The patient will be encouraged to resume their favorite hobbies, participate in group and fitness activities, and return to work or school. They will receive support in rebuilding their quality of life and self-sufficiency.
- Medications: Some of the side effects of spinal cord injury may be managed with medication. They include drugs that reduce pain and muscular stiffness as well as drugs that can enhance bowel, bladder, and sexual function.
- New technologies: Innovative medical equipment can increase the independence and mobility of those who have suffered spinal cord injuries. They consist of the following:
- Computer adaptations: Computer use can be challenging for someone with poor hand function. Key guarding and voice recognition are two examples of the simple to complicated computer adaptations.
- Modern wheelchairs: Spinal cord injury patients are becoming more mobile and comfortable thanks to improved, lighter wheelchairs. A powered wheelchair is required by some users. Some wheelchairs can even transport their users up and down stairs, over uneven terrain, and up to heights without assistance.
- Electronic aids: Practically any electrical equipment can be managed by an electronic assistance to daily living. Switches, voice-activated remote controls, and computer-based remotes can be used to turn devices on and off.
- Electrical stimulation devices: These complex devices, also known as functional electrical stimulation systems, regulate the arm and leg muscles of persons with spinal cord injuries so they may stand, walk, reach, and grasp objects.
- Prognosis and recovery: The patient’s prognosis might not be available right away from the healthcare provider. If recovery takes place, it typically depends on how serious and extensive the injury was. Although the first six months are frequently when recovery happens most quickly, some patients continue to improve slowly for up to one to two years.
