SPINAL CORD INJURY Dr. Jayesh Patidar PhD.,M.Sc. Nursing
What is the spinal cord? The spinal cord is a collection of nerves that travels from the bottom of the brain down your back. There are 31 pairs of nerves that leave the spinal cord and go to arms, legs, chest and abdomen. These nerves allow your brain to give commands to your muscles and cause movements of your arms and legs.
The spinal cord is very sensitive to injury. Unlikeother parts of your body, the spinal cord does nothave the ability to repair itself if it is damaged.
DEFINITION A spinal cord injury occurs when there is damage to the spinal cord either from trauma, loss of its normal blood supply, or compression from tumor or infection
Spinal cord trauma is damage to the spinal cord. It may result from direct injury to the cord itself or indirectly from disease of the surrounding bones, tissues, or blood vessels.
Incidence There are approximately 10,000 new cases of spinal cord injury each year in the United States. They are most common in white males. Specifically, 80% of spinal cord injuries occur in males, and 2/3 occur in whites. Most injuries occur in patients 16-30 years of age.
Causes and risk factors Spinal cord trauma can be caused by a number of injuries to the spine, including: Assault Falls Gunshot wounds Industrial accidents Motor vehicle accidents Sports injuries (particularly diving into shallow water) A minor injury can cause spinal cord injury if the spine is weakened (such as from rheumatoid arthritis or osteoporosis) or if the spinal canal protecting the spinal cord has become too narrow (spinal stenosis) due to the normal aging process.
Spinal cord injuries are described as either complete or incomplete. In acomplete spinal cord injury there is complete loss of sensation and muscle function in the body below the level of the injury. In an incomplete spinal cord injury there is some remaining function below the level of the injury. In most cases both sides of the body are affected equally.
An injury to the upper portion of the spinal cord in the neck can cause quadriplegia-paralysis of both arms and both legs. If the injury to the spinal cord occurs lower in the back it can cause paraplegia-paralysis of both legs .
CERVICAL (NECK) INJURIES When spinal cord injuries occur in the neck area, symptoms can affect the arms, legs, and middle of the body. The symptoms may occur on one or both sides of the body. Symptoms can also include breathing difficulties from paralysis of the breathing muscles, if the injury is high up in the neck.THORACIC (CHEST LEVEL) INJURIES When spinal injuries occur at chest level, symptoms can affect the legs. Injuries to the cervical or high thoracic spinal cord may also result in blood pressure problems, abnormal sweating, and trouble maintaining normal body temperature.
LUMBAR SACRAL (LOWER BACK) INJURIES When spinal injuries occur at the lower back level, symptoms can affect one or both legs, as well as the muscles that control the bowels and bladder.
Symptoms Injuries at any level can cause: Increased muscle tone (spasticity) Loss of normal bowel and bladder control (may include constipation, incontinence, bladder spasms) Numbness Sensory changes Pain Weakness, paralysis
Signs and tests Spinal cord injury is a medical emergency that needs immediate medical attention. The health care provider will perform a physical exam, including a brain and nervous system (neurological) exam..The following tests may be ordered: CT scan or MRI of the spine Myelogram (an x-ray of the spine after injecting dye) Spine x-rays
Treatment A spinal cord injury is a medical emergency that needs to be treated right away. The time between the injury and treatment can affect the outcome. Corticosteroids, such as dexamethasone , are used to reduce swelling that may damage the spinal cord. If spinal cord pressure is caused by a growth that can be removed or reduced before spinal nerves are completely destroyed,paralysis may improve. Ideally, corticosteroids should begin as soon as possible after the injury.
Bed rest may be needed to allow the bones of the spine to heal. Spinal traction may be recommended. This can help keep the spine from moving.
The health care team will also provide information on muscle spasms, care of the skin, and bowel and bladder dysfunction. skin will be protected against pressure sores. You will probably need physical therapy, occupational therapy, and other rehabilitation therapies after the injury has healed. Rehabilitation will help cope with the disability from spinal cord injury. Muscle spasticity can be relieved with medications taken by mouth or injected into the spinal canal. Botox injections into the muscles may also be helpful. Painkillers (analgesics), muscle relaxers, and physical therapy are used to help control pain.
Surgery may be needed to: Remove fluid or tissue that presses on the spinal cord (decompression laminectomy) Remove bone fragments, disk fragments, or foreign objects Fuse broken spinal bones or place spinal braces.
Complications These complications include: urinary tract infections or urinary incontinence (inability to control the flow of urine), bowel incontinence (inability to control bowel movements), pressure sores, infections in the lungs (pneumonia), blood clots, muscle spasms, chronic pain, and depression.