Definition

     Spinal cord injury is damage to the spinal cord  that results in a loss of function, such as mobility or feeling. It may result from direct injury to the cord itself or indirectly from damage to surrounding bones, soft tissues, and blood vessels.

Causes

• Spinal cord injuries occur in approximately 10,000 people every year.  Approximately 45,000 people in the United States live with traumatic spinal cord injuries.  Males account for 80 percent of all spinal cord injuries (those between 15 and 30 years of age are most commonly affected).

• The causes include:

   

  1. Motor vehicle accidents

  2. Acts of violence such as gunshot wounds and blunt trauma, falls and sports injuries.

   

• Motor vehicle accidents are the leading cause, accounting for 44 percent of all spinal cord injuries.

Symptoms

• The symptoms and signs of spinal cord trauma usually appear immediately after the injury.  They may include complete or incomplete paralysis below the level of the injury, numbness or pain.  Loss of bowel and bladder control or sexual dysfunction is accompanied in many cases.

• The symptoms and the extent of paralysis can vary depending on the location and the severity of the injury.

• Complete vs. incomplete spinal cord injury
  The spinal cord can be damaged totally or partailly, depending on the type and degree of the injury.  Complete injury may result in the permanent and total loss of motor and sensory functions below  the level of the injury.  In incomplete injuries, motor and sensory functions are partially preserved  below the level of injury, and show a partial recovery of movement and sensation after the injury.

• Level (location) of the injury -- Cervical cord injuries cause the paralysis of the upper and lower limbs, along with the trunk.  Breathing difficulties can accompany high cervical cord damage.  Throacic level injuries usually affect the trunk and lower limbs.  Lumbar and sacral level injuries cause the paralysis of the lower limbs.

Screening and Diagnostics

• Usually, paralysis and numbness may appear immediately after the injury, but the symptoms can get worse slowly as well, because of the gradual swelling of the spinal cord.  A neurologic examination indicates the level and severity of the spinal cord injury.

• Spine X-Rays or a CT scan shows the fracture of the spine

• A spine MRI shows the exact location of the spinal cord injury

Treatment

• A spinal cord trauma is an emergency. Immediate treatment is important for a good prognosis.

• Immedate treatment after injury

- Proper bladder care with catheterization and antibiotics, skin care and frequent position changes to prevent Pressure Sores, prophylactic drugs for Deep Vein Thrombosis, psychiatric counseling and pain control.

1. Rehabilitation -- physical therapy and occupational therapy improves the functional ability, and prevents the contracture of the joints.

2. Skin care --Pressure Sores are one of the most common complications after a spinal cord injury.  Frequent position changes are needed.  Special beds can be helpful.

3. Bladder and bowel management -- the type of bladder and bowel dysfunction depends on the level of injury, so the ideal method of voiding is different from person to person.  The physicians will recommend the proper voiding method after evaluation of the bladder and kidney function.  Inappropriate voiding methods and bladder care may result in kidney dysfunction, so the regular follow-up of bladder and kidney function is important.

4. Pain control -- Anti-depressants or anti-seizure medications are effective in relieving the central pain and tingling sensation resulting from spinal cord damage.

Prognosis

     Recovery of function depends upon the severity of the initial injury.  Unfortunately, the paralysis resulting from a complete spinal cord injury is permanent.  Incomplete injuries show some recovery over time, but this varies with the degree of the injury.

Complications