Injury: Spinal Cord Injury

Definition
Description
Demographics
Causes and Symptoms
Diagnosis
Treatment
Prognosis
Prevention
The Future
For more information

Definition

Spinal cord injury, or SCI, refers to damage caused either directly to the cord itself or indirectly by injury to the bones, muscles, or soft tissues surrounding the cord. Most spinal cord injuries are caused by accidents or other traumas, but some are the result of tumors, birth defects, or diseases that affect the spine or surrounding muscles. The spinal cord can be compressed by damage to the vertebrae surrounding it or by blood and tissue fluid accumulating inside the spinal column. The spinal cord can also be completely cut or torn in an accident or by a knife or gunshot wound.

Spinal cord injuries can be classified in two ways, by degree of severity and by location. Some doctors refer to an SCI as either complete, meaning that the patient has no sensation or ability to move muscles below the injury; or incomplete, meaning that the patient has some degree of sensation or function in the parts of the body below the injury.

The location of a spinal cord injury is identified by the number of the affected vertebra. The human spine is divided into four segments: cervical (the neck region, containing seven vertebrae); thoracic (the chest region, containing twelve vertebrae); lumbar (the lower back, containing five vertebrae); and sacral (the tailbone region, containing five vertebrae). Thus a C4 injury refers to the fourth cervical vertebra; T12 refers to an injury at the level of the twelfth thoracic vertebra; and so on.

Description

Injury to the spinal cord at any point along its length involves a series of events that damage the nerve endings in the cord. The spinal cord contains two major types of neurons, or nerve cells: sensory neurons that carry messages from the skin, joints, and muscles upward to the brain; and motor neurons, which carry messages from the brain downward to the various parts of the body. Thus any injury to the cord interferes with both sensation and movement.

When the spinal cord is compressed, torn, or cut, the cord swells to fill the entire inside of the spinal column, which cuts off the blood supply to the injured tissue. The patient's blood pressure drops and the nerve endings lose their ability to transmit electrical impulses to or from the brain. This condition is called spinal shock. It is followed by a secondary phase of damage that includes inflammation, the overstimulation of injured nerve cells, and the self-destruction of these nerve cells.

Demographics

According to the National Institutes of Health, there are between 10,000 and 12,000 spinal cord injuries each year in the United States. As of

2008, there were 255,000 Americans living with these injuries; their care costs the country about four billion dollars per year.

Car accidents are the largest single cause of spinal cord injuries, being responsible for 42 percent. Another 27 percent result from falls; the remainder are caused by athletic accidents (8 percent), criminal violence (15 percent), and work-related injuries (7 percent).

There are four times as many men with spinal cord injuries as women. Fifty-five percent of these men are between sixteen and thirty years old.

Causes and Symptoms

Spinal cord injuries may be caused by transportation accidents, falls, workplace accidents, violence, or diseases that affect the bones or muscles of the spinal column.

The symptoms of spinal cord injury include:

• Pain or intense stinging sensations at the point of injury
• Increased muscle tone or muscle spasms
• Inability to feel heat, cold, or touch
• Loss of bowel or bladder control
• Loss of the ability to move parts of the body below the point of injury
• Difficulty breathing or coughing
• Problems with blood pressure or temperature regulation
• Abnormal sweating

First Aid for Spinal Cord Injuries

A spinal cord injury is a medical emergency. It is important, however, not to move someone who may have an SCI as paralysis or permanent injury could result. A spinal cord injury should be assumed in any of the following circumstances

• The person has a head injury and is drifting in and out of consciousness.
• The injured person complains of pain in the neck or back.
• The person cannot move their neck.
• The injury to the head or neck was caused by significant force.
• The person's neck or back is twisted or is positioned oddly.
• The person complains of weakness, numbness, or paralysis.
• The person cannot control their limbs, bladder, or bowels.

To help someone with a suspected SCI:

• Call 911 at once.
• Keep the person still. Put heavy towels on both sides of the neck or hold the head and neck to prevent movement. It is important to keep the person in the same position as they were in when found until emergency help arrives.
• Give as much first aid as possible without moving the injured person's head or neck.
• If it is absolutely necessary to turn the injured person to one side because they are choking on blood or vomiting, get someone else to help turn them. Work together to keep the injured person's head, neck and back in alignment while rolling them onto one side.

The specific disabilities that may result from spinal cord injury depend on the location of the damage. In general, the higher the level of injury (closer to the head), the more extensive the paralysis. Some patterns of disability are as follows:

• C1 through C3: Injuries to these neck vertebrae result in quadriplegia, or paralysis of

• both arms and both legs. The patient will need to be placed on a respirator in order to breathe.
• C5 and C6: The person has some arm function but not the use of the hands.
• T1 through T8: The person has paraplegia; that is, he or she cannot use the legs or lower part of the trunk. The hands, arms, head, and breathing are usually not affected.
• T9 through T12: The person can control their abdominal muscles and sit upright.
• L1 through L5: The person will have difficulty bending or flexing the legs and hips.
• S1 through S5: The person may have some difficulty with bowel and bladder control.

Diagnosis

A person with a suspected SCI must be moved carefully by a specially trained trauma team. The usual practice is to fit a stiff collar around the injured person's neck and move him or her on a rigid board, to prevent further injury to the spinal cord. The injured person is taken to the hospital as quickly as possible, as it is critical not to delay treatment.

If the injured person is able to talk, the doctor may be able to determine the location of the injury fairly rapidly by asking about pain and other sensations, lack of ability to move parts of the body, and so on. The doctor may also test the patient's reflexes or use pinpricks or other forms of touch to determine whether sensation has been lost. If the patient is having difficulty breathing or has lost consciousness, the doctor will order one or more imaging studies, including x rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI). Another imaging technique that is often used with spinal cord injuries is myelography. This test consists of injecting a contrast dye into the spinal column that will show up on an x ray or CT scans.

Patients are usually given a second round of diagnostic tests and imaging studies a few days after the injury to evaluate the extent of the injury and the patient's chances for recovering sensation and function.

Treatment

Treatment of spinal cord injuries usually involves a combination of medications, surgery, traction or bracing, and long-term physical therapy and rehabilitation.

• A medication called Medrol can be given to patients with a severe SCI. Medrol is a corticosteroid that reduces swelling and inflammation of the spinal cord. It must, however, be given within eight hours of the injury.
• Surgery is performed to remove bone fragments, foreign objects, or vertebrae that are compressing the spinal cord. Surgeons differ as to whether it is better to perform surgery immediately or to wait until the extent of the patient's injuries has been determined.
• Traction and braces or a body harness are applied to bring the patient's spine into proper alignment during healing.
• Physical therapy and rehabilitation. These forms of therapy usually begin after the patient has left the hospital, which may take from a few days to several weeks. Rehabilitation includes learning to cope with bowel, bladder, or sexual functions (if any), self-care, and the use of a wheelchair or other assistive devices as well as regaining muscle strength and range of motion.

Most patients also need psychotherapy and support groups to cope with depression and other emotional problems that often occur after a spinal cord injury, particularly if the patient is quadriplegic or paraplegic.

Prognosis

The prognosis of a spinal cord injury varies. It may take several weeks or months for the patient's doctors to determine the extent of possible recovery. In general, impairment that remains a year after the injury is likely to be permanent. Some studies indicate that age makes a difference in a patient's ability to regain function; younger patients are more likely to improve than patients over fifty years of age.

A common complication of spinal cord injuries is chronic pain. Two-thirds of patients with SCIs have ongoing pain, with half of these reporting that their pain is severe. There is no universally successful treatment for such pain. Most patients are given medications for the pain, usually antidepressants or antiseizure drugs.

Spinal cord injury shortens most patients' life spans, although people still live longer with such injuries than was the case in the 1960s. Pneumonia is a common cause of death in patients with quadriplegia. Another common cause of death is suicide; patients with spinal cord injuries have a suicide rate five times higher than the general population.

Prevention

Many spinal cord injuries can be prevented by taking basic safety precautions:

• Practice safe driving. This includes the use of seat belts, keeping the car in good repair, and avoiding driving after drinking or taking drugs.
• When swimming, check the depth of water before diving. Be particularly careful when diving in natural bodies of water because of the possibility of hidden rocks.
• Use appropriate protective equipment when playing football or other contact sports. Avoid movements that put the head and neck at risk, such as sliding into a base headfirst.
• Store firearms in a locked cabinet or safe, and store ammunition in a separate location.
• Protect against falls by checking the house or apartment for safety hazards, wearing properly fitted shoes, and reducing the use of medications that cause drowsiness or loss of balance.

The Future

As of 2008, Medrol was the only drug that is generally used to bring down inflammation following an SCI, although another medication called GM-1 ganglioside is being tested as a treatment for the damage to nerve tissue that follows spinal shock. Other areas of research include various ways to stimulate the regrowth of damaged nerve fibers; the use of computers combined with electrodes implanted in the injured person to restore function to paralyzed limbs; and better ways to control pain in survivors of SCIs.

WORDS TO KNOW

Paraplegia: Paralysis that affects only the lower body.

Quadriplegia: Paralysis that affects both arms and both legs. It is also known as tetraplegia.

Traction: The use of braces, casts, or other devices to straighten broken bones and keep them aligned during the healing process.

SEE ALSO Fractures; Multiple sclerosis; Osteoporosis; Pneumonia; Spina bifida

For more information

BOOKS

Palmer, Sara, Kay Harris Kriegsman, and Jeffrey B. Palmer. Spinal Cord Injury: A Guide for Living. 2nd ed. Baltimore, MD: Johns Hopkins University Press, 2008.

Wilder, Esther Isabelle. Wheeling and Dealing: Living with Spinal Cord Injury. Nashville, TN: Vanderbilt University Press, 2006.

WEB SITES

Centers for Disease Control and Prevention (CDC). Spinal Cord Injury (SCI): Prevention Tips. Available online at http://www.cdc.gov/ncipc/factsheets/sciprevention.htm (accessed August 25, 2008).

Children's Hospital Boston. My Child Has Spinal Cord Injury. Available online at http://www.childrenshospital.org/az/Site1150/mainpageS1150P0.html (accessed August 25, 2008).

Mayo Clinic. Spinal Cord Injury. Available online at http://www.mayoclinic.com/health/spinal-cord-injury/DS00460 (accessed August 25, 2008).

National Institute of Neurological Disorders and Stroke (NINDS). Spinal Cord Injury: Hope through Research. Available online at http://www.ninds.nih.gov/disorders/sci/detail_sci.htm (accessed August 25, 2008).

National Library of Medicine (NLM). Spinal Cord Injury. Available online at http://www.nlm.nih.gov/medlineplus/tutorials/spinalcordinjury/htm/index.htm (accessed August 25, 2008). This is an online tutorial with voiceover; viewers have the option of a self-playing version, a text version, or an interactive version with questions.