Spinal Cord Injury
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What is Spinal Cord Injury ?
A Spinal Cord Injury (SCI) is damage or trauma to the spinal cord that results in a loss or impaired function causing reduced mobility or feeling. Common causes of damage are trauma (car accident, gunshot, falls, sports injuries, etc.) or disease (Transverse Myelitis, Polio, Spina Bifida, Friedreich’s Ataxia, etc.). The spinal cord does not have to be severed in order for a loss of function to occur. In most people with SCI, the spinal cord is intact, but the cellular damage to it results in loss of functioning. SCI is very different from back injuries such as ruptured disks, spinal stenosis or pinched nerves.
It is possible for a person to "break their back or neck" yet not sustain a spinal cord injury as long as only the bones (the vertebrae) around the spinal cord are damaged, but the spinal cord is not affected. In these cases, the person may not experience paralysis after the vertebrae are stabilized.
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Types of Spinal Cord Injury (SCI)
Complete Spinal Cord Injury - usually the loss of sensation and motor ability associated with a complete spinal cord injury caused by bruising, loss of blood to the spinal cord, or pressure on the spinal cord; cut and severed spinal cords are rare. Generally, complete spinal cord injuries result in total loss of sensation and movement below the site of the injury.
Incomplete Spinal Cord Injury - an incomplete spinal cord injury does not result in complete loss of movement and sensation below the injury site. A variety of patterns exist to classify such injuries -
Anterior cord syndrome - results from damage to the motor and sensory pathways in the anterior areas of the spinal cord. Effects include loss of movement and overall sensation, although some sensations that travel by way of the still intact pathways can be felt.
Central Cord Syndrome - results from injury to the center of the cervical area of the spinal cord. The damage affects the corticospinal tract, which is responsible for carrying signals between the brain and spinal cord to control movement. Patients of central cord syndrome experience weakness or paralysis in the arms and some loss of sensory reception. The loss of strength and sensation is much less in the legs than in the arms. Many patients with central cord syndrome spontaneously recover motor function, and others experience considerable recovery in the first six weeks following the injury.
Brown-Sequard syndrome - results from injury to the right or left side of the spinal cord. On the side of the body where the injury occurred, movement and sensation are lost below the level of the injury. On the side opposite the injury, temperature and pain sensation are lost due to the crossing of these pathways in the spinal cord.
Injuries to individual nerve cells - result in loss of sensory and motor function in the area of the body to which the injured nerve root corresponds. Thus, symptoms from these injuries vary depending on the location and function of the particular nerve root.
Spinal contusions - the most common type of spinal cord injury. The spinal cord is bruised, not severed, but the consequence is inflammation and bleeding from blood vessels near the injury. A spinal contusion results in temporary (usually one to two days) incomplete or complete debilitation of the spinal cord.
Symptoms of Spinal Cord Injury
Symptoms may occur immediately after an injury or gradually as changes such as bleeding & swelling take place around the spinal cord -
Diagnosis of Spinal Cord Injury
Spinal cord injury is a serious condition that requires urgent medical attention. Physical exam and neurological exam (brain and nervous system) of a patient is performed. These tests help in determining the exact location of the injury if the injury is unknown. The different tests include -
Treatment of Spinal Cord Injury
A spinal cord injury is a medical emergency that needs to be treated right away. The time between the injury and treatment can affect the outcome.
Corticosteroids, such as dexamethasone or methylprednisolone, are used to reduce swelling that may damage the spinal cord. If spinal cord pressure is caused by a growth that can be removed or reduced before your spinal nerves are completely destroyed, paralysis may improve. Ideally, corticosteroids should begin as soon as possible after the injury. Surgery may be needed to -
Spinal traction may be recommended. This can help keep the spine from moving. The skull may be held in place with tongs (metal braces placed in the skull and attached to traction weights or to a harness on the body). You may need to wear the spine braces for a long time.
You will probably need physical therapy, occupational therapy, and other rehabilitation therapies after the injury has healed. Rehabilitation will help you cope with the disability from your spinal cord injury.
Muscle spasticity can be relieved with medications taken by mouth or injected into the spinal canal. Botox injections into the muscles may also be helpful. Painkillers (analgesics), muscle relaxers, and physical therapy are used to help control pain.
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