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:
- Complete. If all feeling (sensory) and all ability to control movement (motor function) are lost below the spinal cord injury, the injury is called complete.
- Incomplete. If there is some motor or sensory function below the affected area, your injury is called incomplete.
Paralysis as a result of a spinal cord injury may be referred to as:
- Tetraplegia Also known as quadriplegia, it means that your arms, hands, trunk, legs and pelvic organs are all affected by the spinal cord injury.
- Paraplegia. It means all or part of the trunk, legs and pelvic organs are affected.
Emergency symptoms
- Extreme back pain or pressure in neck, head or back
- Weakness, incoordination or paralysis in any part of the body
- Numbness, tingling or loss of sensation in hands, fingers, feet or toes
- Loss of bladder or bowel control
- Difficulty in balancing and walking
- Impaired breathing
- An oddly positioned or twisted neck or back
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:
- The signs of a serious spinal injury may not always be immediately obvious. If not recognized, a more severe injury may occur.
- Numbness or paralysis may occur immediately or gradually as bleeding or swelling occurs in or around the spinal cord.
- The time between injury and treatment is critical to determine the severity of complications and the extent of expected recovery.
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:
- Road accidents
- Falls - usually in the older age group
- Gunshot & knife wounds
- Injuries from sports and physical activity
- Alcohol abuse
- Diseases like cancer, arthritis, osteoporosis and inflammation of the spinal cord
The areas most often affected include:
- Bladder control. While the bladder continues to store urine from the kidneys, the brain may not be able to exercise control because the message carrier (the spinal cord) is injured. This increases risk of urinary tract infections, kidney infections and kidney or bladder stones.
- Bowel control. Even though the stomach and intestines work as they did earlier, control of bowel movements is often altered.
- Skin sensation. Loss of all or part of skin sensation, means it cannot send a message to the brain when it is affected by things such as prolonged pressure, heat or cold.
- Circulatory control. Problems ranging from low blood pressure to swelling of your extremities, may arise. Changes in circulation may also increase risk of developing blood clots, such as deep vein thrombosis or a pulmonary embolus.
- Respiratory system. If the abdominal and chest muscles are affected, it may make breathing and coughing difficult.
- Muscle tone. Patients may experience one of two types of problems: uncontrolled tightening or motion in the muscles (spasticity) or soft and limp muscles lacking muscle tone (flaccidity).
- Fitness and wellness. Patients commonly experience weight loss and muscle atrophy, but restricted mobility may also lead to a more sedentary lifestyle, place you at risk of obesity, cardiovascular disease and diabetes.
- Sexual health. Sexuality, fertility and sexual function may be affected. While men may notice changes in erection and ejaculation; women may experience changes in lubrication.
- Pain. Muscle or joint pain may be experienced due to overuse of particular muscle groups. Nerve pain can occur in those with an incomplete injury.
- Depression. The mental strain of coping with all the changes and living with the pain, may causes some to slip into depression.
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).
Symptoms
- Flat back
- Back pain and stiffness
- Pins and needle sensation in legs
- Numbness in legs
- Bladder symptoms – urinary incontinence / straining at urination
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.
