Definition and Overview

The spinal cord is a long, tube-like structure that begins at the base of the skull and ends just above the waist. It is made up of nerve fibres and cells that deliver information to and from the brain. It allows the brain to give commands and control the function of the limbs and internal organs.

A spinal cord injury (SCI) refers to any damage to the spinal cord. Often, the damage is caused by trauma. In other cases, the causes are abnormal growths and infections. SCI can also occur if blood supply to the spinal cord is cut off.

SCI can have a lasting impact on most aspects of daily life. It can cause a person to lose some (incomplete SCI) or all muscle function and sensation (complete SCI). If the injury occurs in the neck area, both the arms and legs can become permanently paralysed. The paralysis of both legs, on the other hand, can result from an injury to the lower part of the spinal cord.

The spinal cord does not have the ability to repair itself once damaged. Thus, the prognosis for patients is often poor. SCI is a common cause of permanent disability and death in children and adults worldwide.

Causes of Condition

The most common cause of SCI is trauma. This can result from the following:

  • Acts of violence, like gunshot or stabbing wounds to the spine.

  • Impact sports, such as soccer, diving, and hockey.

  • Falls. This is often the cause of SCI in the elderly population.

  • Motor vehicle accidents. This accounts for up to 35% of all SCI cases.

Other causes of SCI are:

  • Inflammation and disk degeneration of the spine.

  • Abnormal growths that compress the spinal cord.

  • Inadequate blood supply to the spinal cord due to low blood pressure or aneurysms.

  • Arthritis, a joint disorder that can cause stiffness or pain in the back or neck area. It can also affect the spinal nerves and the spinal cord.

Key Symptoms

The symptoms of SCI depend on the part of the spinal cord that has been damaged. They also depend on whether the injury is complete or incomplete.

SCI can cause:

  • Partial or complete loss of sensation

  • Partial or complete loss of muscle function

  • Loss of bladder and bowel control

  • Loss of normal sexual function

  • Difficulty breathing - This occurs if the injury occurs in the upper neck area.

  • Twisted neck or back that causes walking and balance problems

Many health problems can occur when the brain loses its ability to control some bodily functions. Common complications of SCI are:

  • Autonomic dysreflexia (AD) - This is a serious clinical syndrome that can result in acute hypertension. Unless treated promptly, it could lead to death.

  • Urinary tract and kidney infections - These occur when patients lose bladder control.

  • Deep vein thrombosis (DVT) - This refers to blood clots that often form in the lower leg. DVT increases the risk of stroke and heart attack as well as pulmonary embolism.

  • Breathing problems - SCI that affects the chest area can prevent a person from inhaling and exhaling deeply. Patients are also unable to force a strong cough. This increases the risk of respiratory infections and lung congestion.

  • Sepsis - Patients with SCI are prone to infections. This increases the risk of sepsis. This is a potentially life-threatening condition that occurs when the body responds to an infection in a way that it injures its own organs and tissues.

  • Spastic hypertonia (SH) - This causes rapid muscle contractions and exaggerated deep tendon reflexes.

Who to See and Types of Treatments Available

Spinal cord injuries are diagnosed with imaging tests. These include computed tomography (CT) scan, magnetic resonance imaging (MRI), and x-rays. These create clear pictures of the spine and structures surrounding it. They can detect abnormal growths, blood clots, and fractures. They can also detect herniated disks, vertebral problems, and degenerative changes in the spine. A neurological exam is also used. This helps doctors assess the severity of the condition so appropriate treatment can be provided.

Damages caused by spinal cord injuries cannot be reversed. Available treatments are used to prevent the condition from progressing as well as helping patients remain productive despite their condition.

Patients suffering from the condition often receive emergency care either at the scene of the accident or during transport to the hospital. The goals of the emergency response team are to stabilise the spine and neck to prevent further damage and ensure that the patient is breathing properly. These are done with the use of a ventilator and a halo device that is placed around the patient’s head.

In a hospital’s emergency room, patients receive treatment for any swelling and inflammation. Surgery is often a part of treatment. It is used to realign the spine using a rigid brace or an axial traction before it is completely immobilised. This helps relieve pressure on the spinal cord and prevent further damage.

SCI treatment is followed by intensive rehabilitation. Its goal is to help patients restore normal function so they can live independently. Their therapy focuses on helping them maintain their existing muscle function and relearn any motor skills they have lost. They will also be taught techniques on how to accomplish their day-to-day tasks using available tools and methods.

Achieving full recovery is often difficult and challenging for many patients. Successful recovery depends on how well their medical team is able to manage medical complications while preventing new ones from occurring.

References:

  • Spinal cord injury: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/sci/detail_sci.htm.

  • Weiss, J.M. (15 March 2010). “Spinal cord injury”. In Weiss, L.D.; Weiss, J.M.; Pobre, T. Oxford American Handbook of Physical Medicine and Rehabilitation. Oxford University Press, USA.

  • Teufack, S.; Harrop, J.S.; Ashwini, D.S. (29 October 2012). “Spinal Cord Injury Classification”. In Fehlings, M.G.; Vaccaro, A.R.; Maxwell B. Essentials of Spinal Cord Injury: Basic Research to Clinical Practice. Thieme.

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