Spinal Cord Injury: Causes, Symptoms, Diagnosis, Treatment
What Is Spinal Cord Injury?
A Spinal Cord Injury is caused when any part of the spinal cord or the nerves in the spinal canal gets damaged or injured as a result of an injury, trauma, or any underlying disease condition. A Spinal Cord Injury tends to cause variety of complications and symptoms in an individual, varying from changes in strength and sensation to various other symptoms. Complete cure of a Spinal Cord Injury is still a subject of investigation and research. It would not be wrong to state that with a Spinal Cord Injury every aspect of an individual's life get affected significantly.
What Are The Causes Of Spinal Cord Injury?
Spinal Cord Injury is caused as a result of injury or trauma to the vertebrae, ligaments, or discs of the spinal column or any trauma or injury to the spinal cord. Spinal Cord Injury as a result of trauma may be caused due to a sudden blow to the spine such as in motor vehicle accidents, gunshot wounds, or injuries caused as a result of stabbing which may cut the spinal cord, which fractures, dislocates, or compresses the vertebra of the spine. As the injury progresses, there is additional damage caused to the spinal cord due to bleeding, inflammation, and fluid buildup around the spine.
A Spinal Cord Injury can also be caused due to nontraumatic reasons as well such as due to medical conditions like arthritis, cancer, infections, or degeneration of the discs of the spine.
Some Of The Common Causes Of Spinal Cord Injury Are:
- Automobile Accidents: This is one of the leading causes of Spinal Cord Injury in the United States and accounts for approximately 40% of Spinal Cord Injuries annually.
- Falls: In the elderly population, falls is also one of the causes for a Spinal Cord Injury and account for around 25% of Spinal Cord Injuries annually.
- Violent Incidents: it is estimated that around 20% of cases of Spinal Cord Injuries are caused by gunshot and knife wounds.
- Sporting Injuries: Sporting injuries account for about 10% of Spinal Cord Injuries annually.
- Gunshot Wound: Bullets may pass through spinal cord at different level in neck, thorax and lumbar spine. The spinal cord injury in neck may result in quadriplegia and thorax or lumbar spine may cause paraplegia.
- Surgical Spinal Cord Injury: Spinal cord injury is rarely observed following back surgery because of direct trauma from sharp instruments. Ischemic spinal cord injury because of lack of blood supply is observed following aortic surgery. 1
- Pathological Conditions: Medical conditions like cancer, arthritis, osteoporosis etc. also may cause Spinal Cord Injuries
- Spondylolisthesis: Spondylolisthesis is an anterior or posterior shift of vertebral body, mostly observed in lower vertebral segment. Spondylolisthesis causes severe spinal cord injury.
What Are The Symptoms Of Spinal Cord Injury?
A Spinal Cord Injury can be classified as partial or complete injury. A complete injury is one in which the affected individual loses complete sensory and motor function below the site of the injury, and partial or incomplete spinal cord injury is one in which there is still some sensory and motor activity left in the affected individual below the site of the injury.
Some Of The Symptoms Of Spinal Cord Injury Are:
- Loss of motion- weakness, paraplegia or quadriplegia
- Complete sensory loss- numbness
- Bowel and bladder dysfunction- urinary and bowel incontinence often follows spinal cord injury. 2
- Decreased libido
- Excruciating pain at the site of the injury
- Problems with breathing.
How Is Spinal Cord Injury Diagnosed?
Once an individual has incurred any injury to the spinal region, then the individual should be taken to the emergency room immediately where the treating physician will examine the site of the injury to verify whether the individual has sustained a Spinal Cord Injury. The physician will test the sensory and motor functions of the affected individual and will take a detailed history about the injury. In case of the injured person is not fully alert and is unable to answer questions appropriately and has signs and symptoms of a neurological abnormality then the physician will order the following tests:
- X-rays: The x-rays will reveal any damage to the spinal column along with presence of fractures, spondylolisthesis and degenerative changes.
- CT scan and MRI: A CT scan will be able to better visualize the spinal column and give a better idea about the structures of the spinal column. It will better identify any degenerative changes of the disc. CT scan helps to identify the causes of spinal cord injury such as primary bone cancer, metastasis, osteoporosis and fracture of vertebrae.
- Ultrasound: Ultrasound study helps to evaluate the spinal cord and surrounding soft tissue damage.
A few days after the injury when some of the swelling and inflammation has calmed down, the treating physician will conduct a detailed neurological examination to look at the neurological function of the individual and estimate the damage incurred to the spinal cord due to the injury.
What Are Treatments For Spinal Cord Injury?
Unfortunately, as of now, a curative treatment to reverse the damage to the spinal cord due to a Spinal Cord Injury is still a matter of ongoing research but there has been some progress with some novel treatments coming up as of late like use of prosthesis and certain drugs which facilitate regeneration of the nerve cells and improve function of nerves post a Spinal Cord Injury.
As of now, the treatment of Spinal Cord Injury is aimed at preventing further damage to the spinal cord and trying to return the individual to an active lifestyle as much as possible. Patient is often hospitalized for prolonged period and then transferred to nursing home for rehabilitation therapy. The cost of treatment is extremely high.3
For traumatic causes of a Spinal Cord Injury, the treatment begins right at the accident site where the individual's neck is immobilized so as to prevent further damage to the spinal cord. In the emergency room, the following treatment will be administered:
- Maintaining adequate respirations
- Preventing the individual from going into a state of shock
- Avoiding complications like stool or urine retention and formation of clots in the extremities.
After the above, the individual will be admitted in the ICU for close monitoring and care where a team of neurosurgeons, orthopedic doctors, therapists will be caring for the individual.
Some of the Treatment for Spinal Cord Injury Include:
- Medications For Spinal Cord Injury:
- Corticosteroids- Methylprednisolone has shown to be an effective drug for treatment of Spinal Cord Injury if given within 8 hours of the injury. Initial and follow up dosage is titrated according to extend of injury and side effects.
- Pain Medications- Intractable severe pain is treated with NSAIDs or opioids. Opioids are avoided in neck and thoracic injury when patient is suffering with post injury breathing problems.
- Antibiotics: Compound fracture and open wound is treated with antibiotics to prevent infection resulting in meningitis or transverse myelitis. Urinary retention following spinal cord injury often follows bladder and kidney infection, which is treated with antibiotocs.4
- Immobilization For Spinal Cord Injury:
As stated above, immobilization is done to prevent further damage to the spinal cord.
- Surgery For Spinal Cord Injury:
In some cases, a surgical procedure may be required to remove bone fragments or foreign bodies that may be present in the spinal cord or in cases of a compression of the nerves due to the injury.
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1. Cardiovascular control, autonomic function, and elite endurance performance in spinal cord injury.
West CR1, Gee CM, Voss C, Hubli M, Currie KD, Schmid J, Krassioukov AV.
Scand J Med Sci Sports. 2014 Aug 31.
2. A Phenomenological Study of Neurogenic Bowel from the Perspective of Individuals Living with Spinal Cord Injury.
Burns AS1, St-Germain D2, Connolly M3, Delparte JJ4, Guindon A5, Hitzig SL6, Craven BC7.
Arch Phys Med Rehabil. 2014 Aug 26. pii: S0003-9993(14)00968-X.
3. Examining health-care utilization in the first year following spinal cord injury.
Skelton F, Hoffman JM, Reyes M, Burns SP.
J Spinal Cord Med. 2014 Oct 9.
4. Comparison of bacterial strains and antibiotic susceptibilities in urinary isolates of spinal cord injury patients from the community and hospital.
Yoon SB1, Lee BS2, Lee KD1, Hwang SI3, Lee HJ2, Han ZA2.
Spinal Cord. 2014 Apr;52(4):298-301.