Acute Spinal Cord Injury
A spinal cord injury (SCI) — is damage to the spinal cord resulting in a change, either temporary or permanent, in its normal motor, sensory, or autonomic function.
Prognosis or scope of improvement in weakness/ function depends on various factors like severity of injury/ time since injury/level of injury etc.
If the SCI is complete, the chances of neurological improvement are very bleak.
We have great hope that ongoing research will make the repair of spinal cord injuries possible in the near future. Presently, effective treatments and rehabilitation programs enable a number of people with spinal cord injuries to lead productive, independent lives.
The ability to control your limbs after a spinal cord injury depends on two factors: the place of the injury along your spinal cord and the severity of injury to the spinal cord.
The severity of the injury is often classified as either of the following:
Paralysis as a result of a spinal cord injury may be referred to as:
A serious injury to the head and neck calls for immediate medical evaluation for the possibility of a spinal injury. It should be assumed that the victim has a spinal injury unless proved otherwise since:
A traumatic spinal cord injury may stem from a sudden blow to the spine that fractures, dislocates, crushes or compresses one or more of the vertebrae. It may also be caused by a gunshot or knife wound that penetrates and cuts the spinal cord.
The most common causes of spinal cord injuries include:
The areas most often affected include:
Slipped vertebrae/ Spondylolysthesis
Spondylolisthesis is when a spinal vertebra slip forward over another vertebra caudal to it. There are different types of the condition, depending on the anatomical changes.
Spondylolytic lysthesis: It is caused when the crack in a pars fracture affects both sides of connection (between the lamina and pedicles). The condition can be a direct result of spondylolysis.
Degenerative spondylolisthesis: Usually seen in elderly age group, this condition is caused by the deterioration of the facet joints and discs of the spine.
Congenital spondylolisthesis: Usually seen in the younger age group, this condition is caused due to birth defects in the bony structure of vertebrae (predominantly pars).
The evaluation for this condition will usually involve a review of the patient’s medical history and a physical examination, followed by standing X-rays, which can grade lysthesis. Your doctor may advice dynamic radiographs to evaluate if the lysthesis is stable or unstable.
A CT scan may be used to evaluate a pars defect or any bony problems, while an MRI may be useful to assess the surrounding tissue, nerves and condition of the disc.
Treatment depends on the clinical symptoms.
Conservative treatment: If the person is asymptomatic or has only back pain / stiffness, then surgery is NOT the first choice. Bracing / exercises and physiotherapy may be tried, which can give satisfactory results.
Surgical treatment: Surgery is recommended if conservative treatment doesn't give good results and / or if the patient has neurological symptoms like leg pain / numbness / bladder symptoms.
Surgery involves decompressing the nerve roots and fixing the bone with or without reducing the lysthesis by using screws and bone graft.
Rehabilitation is a multidisciplinary approach working towards the common goal of making the spinal cord injured person functionally independent physically, psychologically and occupationally, as much as possible.