Spinal Cord Injuries

Overview

Spinal Cord Injuries (SCI) occur when an injury or illness damages the cells within the spinal cord or severs the nerve tracts that send signals up and down the spinal cord. Spinal cord injuries occur in approximately 12,000 to 15,000 people per year in the U.S. About 10,000 of these people are permanently paralyzed, and many of the rest die as a result of their injuries. Most spinal cord trauma caused by injury occurs to young, healthy individuals. Males between 15 and 35 years old are most commonly affected.

Types of Spinal Cord Injuries

A Spinal Cord Injury (SCI) is damage to the spinal cord that results in a loss of function such as mobility or feeling. The spinal cord does not have to be severed in order for a loss of functioning to occur. In fact, in most people with SCI, the spinal cord is intact, but the damage to it results in loss of functioning. SCI is very different from back injuries such as ruptured disks, spinal stenosis or pinched nerves.

A person can "break their back or neck" yet not sustain a spinal cord injury.  This can happen if only the bones around the spinal cord (the vertebrae) are damaged, but the spinal cord is not affected. In these situations, the individual may not experience paralysis after the bones are stabilized.

Classification & Terminology

The effects of SCI depend on the type of injury and the level of the injury. SCI can be divided into two types of injury - complete and incomplete.

Complete: A complete injury means that there is no function below the level of the injury; no sensation and no voluntary movement. Both sides of the body are equally affected.

Incomplete:
An incomplete injury means that there is some functioning below the primary level of the injury. A person with an incomplete injury may be able to move one limb more than another, may be able to feel parts of the body that cannot be moved, or may have more functioning on one side of the body than the other. With the advances in acute treatment of SCI, incomplete injuries are becoming more common.

The following terminology has developed around classification of SCI:

  • Tetraplegia (replaces the term quadriplegia) - Injury to the spinal cord in the cervical/neck  region with associated loss of muscle strength/sensation in both arms and both legs
  • Paraplegia - Injury to the spinal cord in the thoracic/mid, lumbar/lower, or sacral region, with associated loss of muscle strength/sensation in both legs

Injuries / Prognosis

The types of disability associated with SCI vary greatly depending on the severity of the injury, the segment of the spinal cord at which the injury occurs, and which nerve fibers that are damaged. Most people with SCI regain some functions between a week and 6 months after injury, but the likelihood of spontaneous recovery/natural healing diminishes after 6 months. Rehabilitation strategies can minimize long-term disability. The level of injury is very helpful in predicting what parts of the body might be affected by paralysis and loss of function. Remember that in incomplete injuries there will be some variation in these prognoses.


C-1 to C-4: These very high injuries (C-1, C-2) can result in a loss of many involuntary functions including the ability to breathe.  The person may require breathing aids such as mechanical ventilators or diaphragmatic pacemakers. 

C-5: C-5 injuries often result in shoulder and biceps control, but no control at the wrist or hand.

C-6: C-6 injuries generally yield wrist control, but no hand function.

C-7 and T-1: Individuals with C-7 and T-1 injuries can straighten their arms but still may have dexterity problems with the hand and fingers. Injuries at the thoracic (T) level and below result in paraplegia, with the hands not affected.

T-1 to T-8: At T-1 to T-8 there is most often control of the hands, but poor trunk control as the result of lack of abdominal muscle control.

T-9-T12: Lower T-injuries (T-9 to T-12) allow good truck control and good abdominal muscle control. Sitting balance is very good. Lumbar and Sacral injuries yield decreasing control of the hip flexors and legs.

Besides a loss of sensation or motor functioning, individuals with SCI also experience other changes. For example, they may experience problems of the bowel and bladder. Men with SCI may have their fertility affected, while women's fertility is generally not affected. Other effects of SCI may include low blood pressure, inability to regulate blood pressure effectively, reduced control of body temperature, inability to sweat below the level of injury and chronic pain.

Common Causes of Traumatic SCI:

  • Motor vehicle accidents (44.5%) are the major cause of SCI in the United States. SUV's are prone to flip over and these type of accidents can result in a SCI.
  • Falls (18.1%) are the most common cause of SCI in persons aged 45 years or older.
  • Violence (16.6%) is the most common cause of SCI in some urban settings in the United States; there is, however, a trend that shows a slight decrease in violence as a cause of SCI.
  • Sports injuries (12.7%) also cause many cases of SCI. Diving is the sport in which SCI occurs most commonly.


Other causes of SCI include the following:

  • Vascular disorders
  • Tumors
  • Infectious conditions
  • Spondylosis
  • Developmental disorders


Treatment Options

A spinal cord trauma is a medical emergency requiring immediate treatment to reduce the long-term effects. The time between the injury and treatment is a critical factor affecting the eventual outcome.

Medication

Corticosteroid medications are used to reduce swelling that may damage the spinal cord. If spinal cord compression is caused by a mass (such as a hematoma or bony fragment) that can be removed or brought down before there is total destruction of the nerves of the spine, paralysis may in some cases be reduced or relieved. Ideally, corticosteroids should begin as soon as possible after the injury.

Surgery

Surgery may be necessary. This may include surgery to remove fluid or tissue that presses on the spinal cord (decompression laminectomy). Surgery may be needed to remove bone fragments, disc fragments or foreign objects, or to stabilize fractured vertebrae (by fusion of the bones or insertion of hardware).

Bedrest

Bedrest may be needed to allow the bones of the spine, which bear most of the weight of the body, to heal.

Traction / Immobilization

Spinal traction may be used to lesson dislocation and/or may be used to immobilize the spine (so it can't move). The skull may be immobilized with tongs in the event of a cervical injury (these are metal braces that are placed in the skull and attached to traction weights or to a harness on the body).

Physical Therapy / Rehabilitation

Extensive physical therapy, occupational therapy, and other rehabilitation interventions are often required after the acute injury has healed. Rehabilitation assists the person in coping with disability that result from spinal cord trauma.

Coping with a Spinal Cord Injury

A Spinal Cord Injury often provokes a profound emotional response in the patient, his/her family members and his/her friends. Denial, depression, a feeling of hopelessness, and fear are normal and usual reactions. No single response is either expected or unexpected.

A lack of understanding of what's in store, the unknown, and not knowing what's next should be met by thoughtful, straightforward, and frequent discussions between physician, health care team, patient and family. An inability to work, tend to business affairs, care for one's family and/or interact with friends in the usual manner all contribute to emotional distress. Thorough explanations and assistance with making plans for the future may bring emotional relief as the patient focuses on the treatment ahead and the prospect of rehabilitation and recovery.

Family members or loved ones may have questions about alternative methods of treatment. Family members or loved ones should discuss any questions, problems or reactions they may have.   It is best to speak directly with physicians regarding specific medical questions. Nurses and other health professionals understand the complexity of emotions and special ongoing needs of those living with a spinal cord injury. They also will spend much time with patients, become confidants and can be very helpful with emotional support.

Rehabilitation Units

Rehabilitation Units are places where those injured can find hope, strength, inspiration and the specialized medical care needed for spinal cord rehabilitation.

A Rehabilitation Unit provides long-term rehabilitative care and intensive physical, occupational and recreational therapy to help those with spinal cord injuries relearn the basic skills of everyday life. Counseling can also be provided to patients; this can help them learn to cope with their injury and rediscover the fulfilling life that lies ahead for them. The rehabilitative programs are intense. Patients spend several hours each day relearning the skills of everyday life - how to dress, brush their teeth and feed themselves.

Becoming Independent

Developing independence is especially important. Many SCI Rehabilitation Units include kitchens and laundry facilities and other equipment so patients can learn independent living skills such as cooking meals or ironing clothes.

Teaching Self Care Skills

After a spinal cord injury, many things change. It's not just about being unable to walk or move your arms. A spinal cord injury can also affect the nerves and muscles and can cause bowel, bladder and skin problems. Patients should be taught the self-care skills needed to deal with these problems. Spouces, parents or family members of spinal cord injured patients should not be left out; they, too, must learn how to assist in the care of their loved one. Children, in particular,  have special needs so it is important that these needs are specifically addressed.

Having a spinal cord injury doesn't mean that those injured have to stop participating in fun activities. Many hospitals have recreational therapists on staff to show patients that the fun times can begin again. From wheelchair basketball, volleyball and tennis, to specially adapted Nintendo games, all that's required is a little ingenuity.

* All information comes from http://www.spinal-cord.org/index.htm ... click on the Related Information tab below

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