Definition & Overview
Patients suffering from a spinal cord injury are provided with a full treatment, management, and rehabilitation plan designed not only to treat the injury but also to manage its long-term effects. Spinal cord injury management is extremely crucial, as this type of injury can lead to devastating effects, such as partial or complete paralysis.
Due to various medical advancements, spinal cord injuries are now managed more efficiently and are no longer as fatal as they once were. However, permanent effects can still occur.
Who Should Undergo and Expected Results
Spinal cord injury management is provided to patients suffering from injuries that involve any part of the spine, including the vertebrae, ligaments, discs, and the spinal cord. The management plan is suggested regardless if the injury is brought about by traumatic or non-traumatic causes.
Traumatic causes are those that occur as a result of an accidental blow to the back, causing a severe wound (such as a gunshot or deep knife wound), fracture, dislocation, or compression in any part of the spinal cord. These are often followed by bleeding, inflammation, and fluid retention around the spinal cord. Common traumatic causes of spinal cord injuries include falls, motor vehicular accidents, sports injuries, and acts of violence. Statistics show that as many as 1 out of 4 falls that lead to such injuries are related to alcohol use.
Non-traumatic causes, on the other hand, are those that occur due to diseases, such as arthritis, osteoporosis, and cancer. They can also occur due to infection, inflammation, or degeneration.
Based on studies, spinal cord injuries are more common among men, active individuals between the ages 16 and 30, elderly individuals over the age of 65 (due to disease and falls), and those who engage in extreme activities.
The goal of the management plan is to treat the injury, stabilise the patient’s condition, facilitate recovery, and help the patient deal with any long-term effects of the injury.
How is the Procedure Performed?
A complete spinal cord injury management plan involves:
- Emergency trauma care (for trauma-related cases)
- Physical and occupational therapy
For trauma-related cases, spinal cord injury management begins with emergency trauma care. This involves several steps, including:
Stabilising patients’ breathing, heart rate, and blood pressure Placing the patient on a stiff board and placing a special neck brace to prevent movement Placing the patient under examination, which may include the use of CAT and MRI scans to determine the extent of the injury Assisting the patient’s breathing in case the injury affects the chest area and causes respiratory problems. This step may involve intubation.
Medications used in managing spinal cord injuries include methylprednisolone (Medrol), a powerful corticosteroid that helps promote the patient’s recovery. The drug can help reduce nerve damage and is seen to be very effective in reducing inflammation around the injury site. It is most effective when administered within eight hours after the injury occurred. However, the drug is linked to some serious side effects, so it is only used if the benefits outweigh the risks.
As part of a spinal cord injury management plan, the goals of surgery are to:
- Remove foreign objects
- Remove broken or crushed bone fragments
- Relieve compression in the spine through a decompressive surgery
- Help restore movement and function to certain body parts; one example is a tendon transfer surgery that can restore control and movement to the arms and hands
- Manage bladder control and function
- Manage any complications, such as blood clots and breathing problems
Physical and occupational therapy
Physical therapy is a major part of spinal cord injury management. Its goal is to help relieve residual pain caused by the injury and surgery and to rehabilitate the patient. This involves helping patients to regain control of their arms and legs and to prevent muscle atrophy.
Depending on the need and extent of injury and surgery, the rehabilitation process may involve an occupational therapist, a rehabilitation psychologist, and a recreation therapist.
In the case of disability or paralysis, patients can opt to use computer-operated devices and voice-operated computers to help them manage certain tasks despite the effects of their spinal cord injury.
Possible Risks and Complications
During the recovery and rehabilitation stage, patients are at risk of:
- Neurologic deterioration
- Pressure sores due to lack of movement
- Aspiration and pulmonary complications
- Muscle atrophy
- Severe sepsis
Ahn H., Singh J., Nathens A., et al. “Pre-hospital care management of a potential spinal cord injured patient: A systematic review of the literature and evidence-based guidelines.” J Neurotrauma. 2011 Aug; 28(8): 1341-1361. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3143405/
Bonner S., Smith C. “Initial management of acute spinal cord injury.” Continuing Education in Anaesthesia, Critical Care, and Pain Advance Access. July 12, 2013. http://ceaccp.oxfordjournals.org/content/early/2013/07/11/bjaceaccp.mkt021