Spinal Cord Injury (SCI) – Causes, Treatment, and Prevention.

Overview of Spinal Cord Injury

The spinal cord is very sensitive to injury. Unlike other parts of your body, the spinal cord does not have the ability to repair itself if it is damaged. 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. There are approximately 12,000 new cases of spinal cord injury each year in the United States. They are most common in white males.

Spinal cord injuries are described as either complete or incomplete. In a complete spinal cord injury, there is a 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 only.

What are the types of spinal cord injury?

SCI can be divided into two main types of injury:

Complete injury means that there is no function below the level of the injury – either sensation or movement – and both sides of the body are equally affected. Complete injuries can occur at any level of the spinal cord.

Incomplete injury means that there is some function below the level of the injury – movement in one limb more than the other, feeling in parts of the body, or more function on one side of the body than the other. Incomplete injuries can occur at any level of the spinal cord.

Common causes of spinal cord injuries

The most common causes of spinal cord injuries in the United States are:

• Motor vehicle accidents. Auto and motorcycle accidents are the leading cause of spinal cord injuries, accounting for almost half of the new spinal cord injuries each year.
• A spinal cord injury after age 65 is most often caused by a fall. Overall, falls cause more than 15 percent of spinal cord injuries.
• Acts of violence. Around 12 percent of spinal cord injuries result from violent encounters, often involving gunshot and knife wounds.
• Sports and recreation injuries. Athletic activities, such as impact sports and diving in shallow water, cause about 10 percent of spinal cord injuries.
• Alcohol use is a factor in about 1 out of every 4 spinal cord injuries.
• Cancer, arthritis, osteoporosis, and inflammation of the spinal cord also can cause spinal cord injuries.

SCI Risk Factors

Every year, approximately 11,000 new spinal cord injuries are documented. Although a spinal cord injury is often caused by an unexpected accident that can happen to anyone at any age, some groups of people are more likely to suffer a spinal cord injury. These include:

• Men: Men are more likely than women to sustain a spinal cord injury. Over 80 percent of all spinal cord injuries are sustained by men.
• Young adults: People are at a higher risk of sustaining a spinal cord injury between the ages of 16 and 30. Motor vehicle accidents are the leading SCI causes for young adults.
• Seniors: Spinal cord injuries suffered by people over 65 years old are most oftentimes caused by a fall. Falls account for a large number of spinal cord injuries in older people.
• Athletes: Sport-related injuries account for 8 percent of spinal cord injuries each year. High impact sports such as wrestling, football, rugby, and gymnastics result in a higher risk of spinal cord injury.

Spinal Cord Injury Symptoms

Spinal cord injuries have a variety of symptoms. The severity and location of the spinal cord injury directly related to the symptoms a patient will experience. Symptoms of a spinal cord injury do not always show up right away. Some spinal cord injury symptoms are delayed while others are present immediately upon injury.

Symptoms are experienced at the point of and below the affected level of the spine and may be mild, moderate, or life-threatening. They may also vary depending upon the location of the injury, and if the injury is complete or incomplete.

Standard Symptoms

Signs and symptoms of a spinal cord injury may present immediately or some symptoms may be delayed as swelling and bleeding occur in or around the spinal cord. One or more of the following symptoms may occur with a spinal cord injury:

• Pain and numbness, or burning sensation
• Inability to move the extremities or walk
• Inability to feel pressure, heat, or cold
• Muscle spasms
• Loss of bladder or bowel control
• Difficulty breathing

Symptoms by Region

There are three main areas in which a person may suffer spinal cord injury: cervical, thoracic, and lumbar. The fourth section of the spine (sacral), does not contain spinal cord tissue. Consequently, though you may cause damage to the sacral vertebrae or nerves, you will not damage the cord at that level.

• Cervical (C1-C8) – Damage to the spinal cord in the cervical spine is considered the most severe because it can be life-threatening. Symptoms of cervical spinal cord damage may affect the arms, legs, mid-body, and even the ability to breathe on one’s own. The higher up in the cervical spine the damage occurs, the worse the injury. Symptoms may be felt on one or both sides of the body.
• Thoracic (T1-T12) – Damage to the spinal cord in the thoracic spine typically affects the legs. Thoracic spinal cord damage high up in the area may affect blood pressure.
• Lumbar (L1-L5) – Damage to the spinal cord in the lumbar spine typically affects one or both legs. Patients with lumbar spinal cord damage may also have trouble controlling their bladder and/or bowel function.

Spinal Cord Injury Diagnosis

Understanding the Types and Severity of Spinal Cord Injuries

The spinal cord functions as the primary line of communication between the brain and the different areas of the body. A spinal cord injury can occur when trauma or a medical disease causes damage to the spinal cord. Damage can affect the sensory, motor and reflex messages sent between the brain and body:

• Sensory messages include the feelings of hot, cold, touch, pain, and pressure and body position.
• Motor messages are sent to the muscles in your arms, hands, fingers, legs, toes, chest and other parts of your body. These messages tell the muscles how and when to move.
• Reflex messages are involuntary, and they help protect your body with instinctive reactions.

The severity of a spinal cord injury depends on the part of the spinal cord that is injured.

A spinal cord injury will have more effect on a person’s movement, feeling and control the closer the injury is to the brain.

• Tetraplegia, also known as quadriplegia, may result from an injury to the cervical vertebrae, which is close to the neck.
• Paraplegia may result from injuries to the thoracic or lumbar areas, which are in the middle to lower back. This type of injury typically results in paralysis of the legs and lower part of the body.

Timing and medical history, physical examination and diagnostic tests will help your doctor diagnose the possible outcomes and chances of recovery.

Timing and Medical History

Timing and medical history are two important factors in diagnosing a spinal cord injury. The faster a patient can obtain treatment, the better the chances for recovering from the injury.

Also, it is essential to understand how the injury occurred and know a patient’s medical history. Your doctor will need to know if you’ve had any of the following prior to your medical emergency:

• Pain in your neck or back
• Previous injuries or surgeries to your neck or back
• Loss of sensation or weakness in your arms or legs
• Loss of bowel or bladder control

Spinal Cord Injury Physical Examination

A doctor is able to test sensory functions, muscle movement and strength, and reflexes through a physical examination. This examination will help your doctor determine if there are damage to your cervical, thoracic, lumbar or sacral vertebrae. These sections of the spine protect groups of nerves that correspond to specific areas of the body.

Diagnostic Tests for Spinal Cord Injuries

Diagnostic tests for spinal cord injuries may include a CT scan, MRI or X-ray these tests will help the doctors get a better look at abnormalities within the spinal cord. Your doctor will be able to see exactly where the spinal cord injury has occurred.

A complete neurological exam will be performed a few days after the injury. This length of time will allow any swelling to subside, which will allow your doctor to diagnose the severity of the spinal cord injury and predict the likelihood of recovery and the possible outcomes from treatment.

Treatment actions of SCI

Emergency Actions

Urgent medical attention is critical to minimize the effects of any head or neck trauma. Therefore, treatment for a spinal cord injury often begins at the scene of the accident.

Emergency personnel typically immobilize the spine as gently and quickly as possible using a rigid neck collar and a rigid carrying board, which they’ll use to transport you to the hospital.

Early (acute) stages of treatment

In the emergency room, doctors focus on:

• Maintaining your ability to breathe
• Preventing shock
• Immobilizing your neck to prevent further spinal cord damage
• Avoiding possible complications, such as stool or urine retention, respiratory or cardiovascular difficulty, and formation of deep vein blood clots in the extremities

If you do have a spinal cord injury, you’ll usually be admitted to the intensive care unit for treatment. You may even be transferred to a regional spine injury center that has a team of neurosurgeons, orthopedic surgeons, spinal cord medicine specialists, psychologists, nurses, therapists, and social workers with expertise in spinal cord injury.

• Intravenous (IV) methylprednisolone (A-Methapred, Solu-Medrol) has been used as a treatment option for an acute spinal cord injury. But recent research has shown that the potential side effects, such as blood clots and pneumonia, from using this medication outweigh the benefits. Because of this, methylprednisolone is no longer recommended for routine use after a spinal cord injury.
• You may need traction to stabilize your spine, to bring the spine into proper alignment or both. In some cases, a rigid neck collar may work. A special bed also may help immobilize your body.
• Often surgery is necessary to remove fragments of bones, foreign objects, herniated disks or fractured vertebrae that appear to be compressing the spine. Surgery may also be needed to stabilize the spine to prevent future pain or deformity.
• Experimental treatments. Scientists are trying to figure out ways to stop cell death, control inflammation and promote nerve regeneration. For example, doctors may lower the body temperature significantly – a condition known as hypothermia – for 24 to 48 hours to help prevent damaging inflammation. Ask your doctor about the availability of such treatments.

Rehabilitation

A team of therapists and specialists work with patients during their early stages of recovery.  Physical therapists focus on having the patient maintain and strengthen existing muscle function, while occupational therapists, rehab psychologists, and others help the patient learn basic tasks and new skills.

Modern technology for paralysis can provide some independence to individuals living with spinal cord injury. Assistive equipment includes wheelchairs, computer adaptations, electronic aids, robotic gait training, and electrical stimulation.

An experimental technique known as epidural spine stimulation has helped a small number of patients regain the ability to flex their toes and ankles in a pilot study.

Robotic exoskeletons have been used in studies for rehabilitation, allowing some patients to sit or stand upright and take a few steps, with assistance. Researchers are also developing neural prostheses, known as brain-computer interfaces. Electrodes worn on the scalp or implanted in the brain record electrical signals from neurons and translate them into control of a computer or prosthetic limb.

New technologies

Inventive medical devices can help people with spinal cord injury become more independent and more mobile. Some devices may also restore function. These include:

• Modern wheelchairs. Improved, lighter weight wheelchairs are making people with spinal cord injuries more mobile and more comfortable. For some, an electric wheelchair may be needed. Some wheelchairs can even climb stairs, travel over rough terrain and elevate a seated passenger to eye level to reach high places without help.
• Computer adaptations. For someone who has limited hand function, computers can be very powerful tools, but they’re difficult to operate. Computer adaptations range from simple to complex, such as key guards or voice recognition.
• Electronic aids to daily living. Essentially any device that uses electricity can be controlled with an electronic aid to daily living. Devices can be turned on or off by a switch or voice-controlled and computer-based remotes.
• Electrical stimulation devices. These sophisticated devices use electrical stimulation to produce actions. They’re often called functional electrical stimulation systems, and they use electrical stimulators to control arm and leg muscles to allow people with spinal cord injuries to stand, walk, reach and grip.
• Robotic gait training. This emerging technology is used for retraining walking ability after a spinal cord injury.

Spinal Cord Injury Prevention

There are many ways to prevent spinal cord injuries. In motor vehicles, drivers and passengers should always wear seat belts and make sure that children are properly secured in a child safety seat. Children under age 12 should always ride in the back seat. People who are under the influence of alcohol or drugs should not drive; nor should any passenger get into a car with an impaired person at the wheel.

Elderly people are more prone to spinal cord injuries from falls. Many modifications can be made in the home to minimize this risk, including securing banisters and railings and installing grab bars in the bathroom, and non-slip bathmats on both the bathroom floor and the shower. Keeping floor space clear and wearing non-slip shoes can help prevent tripping.

Homes with children should be equipped with safety gates and window guards to prevent falls down stairs and out windows.

Athletes can help protect themselves by wearing proper safety gear. Helmets should be worn when playing football, hockey, baseball, and softball. Bikers, motorcyclists, skiers, horseback riders, and skaters should always wear helmets as well. Swimmers should make sure that water is deep enough for diving and gymnasts should always use spotters.

Firearms should be kept unloaded in a locked case and ammunition should be locked separately. Members of the community can help prevent spinal cord injuries by educating the public, particularly children, on how to stay safe. Coaches can insist that their athletes follow proper procedures regarding safety gear and playing safely.