Acute Spinal Cord Injury
Overview
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.
Symptoms
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
When to see a doctor
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.
Causes
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
Causes
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.
On-site management
If you suspect that someone has a back or neck injury:
- Don't move the injured person - it may result in permanent paralysis and other serious complications.
- Call 108 / local emergency number.
- Ensure the person stays still.
- Place rolled towels on either side of the neck or hold the head and neck to prevent movement until emergency care arrives.
- Provide basic first aid, such as stopping any bleeding and making the person comfortable, without moving the head or neck.
Rehabilitation
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.
