Spinal cord injury

What is it?

The spinal cord, made of soft tissue and surrounded by vertebrae, extends from the base of the brain, down the back to the buttocks. It carries messages between the brain and the rest of the body.

A Spinal cord injury usually begins with a sudden, traumatic blow to the spine that fractures or dislocates vertebrae. Some injuries will allow almost complete recovery, but some will result in complete paralysis. In countries not affected by war, the leading cause of spinal cord injuries are falls and a motor vehicle collision. Although a spinal cord injury can happen to anyone, certain factors may predispose to a higher risk of sustaining a spinal cord injury, including being male, being between the ages of 16 and 30, being older than 65, and being engaged in risky lifestyle.  

Symptoms

The ability to control the limbs after a spinal cord injury depends on the place of the injury along spinal cord and the severity of injury. If all feeling and all ability to control movement are lost below the spinal cord injury, the injury is called complete. If some motor or sensory function below the affected area is still preserved, the injury is called incomplete. Additionally, paralysis from a spinal cord injury may be referred to as tetraplegia (quadriplegia), which means that arms, hands, trunk, legs, and pelvic organs are all affected by the spinal cord injury, or as paraplegia, which means that paralysis affects all or part of the trunk, legs, and pelvic organs. Spinal cord injuries of any kind may result in one or more of the following signs and symptoms:

  • Pain or an intense stinging sensation
  • Loss of movement and sensation
  • Loss of bowel or bladder control
  • Spasms
  • Deterioration in sexual function and fertility
  • Difficulty breathing and coughing

Diagnosis

In an emergency, a doctor makes sure a spinal cord injury isn’t affecting breathing or heart rate, the ability to move parts of the body, and ability to feel touch. Certain imaging tests can help diagnose a spinal cord injury, such as CT scan, MRI, X-ray, and electromyogram (EMG).

Treatment

The management of acute spinal cord injury includes a combination of pharmacological therapy, surgery, and blood pressure elevation.

There are only two absolute indications for early surgery in spinal cord injury patients: progressive neurological deficit in the presence of cord compression, and dislocation type injury to the spinal column. Both of these situations warrant decompression with or without stabilization. All other indications of surgery are relative, and pros and cons need to be carefully considered.