Spinal cord injury (SCI) is an injury to the spinal cord caused by a variety of different causative factors (traffic, workplace accidents and sports accidents such as car accidents, falls and crashes, sports trauma, crush injuries and gunshot wounds), which directly or indirectly lead to spinal cord injuries causing damage to spinal cord structure and function, resulting in motor, sensory and autonomic dysfunction below the level of injury. The extent and clinical manifestations of spinal cord injury depend on the location and nature of the primary injury. Spinal cord injury can be divided into primary spinal cord injury and secondary spinal cord injury. The former refers to injuries caused by external forces acting directly or indirectly on the spinal cord. The latter refers to the spinal cord edema caused by external forces, hematoma formed by bleeding from small blood vessels in the spinal canal, compression fracture, and spinal cord compression caused by broken intervertebral disc tissue and other spinal cord compression caused by further damage to the spinal cord involves part of the two lower limbs or all of the torso of the injury is called paraplegia (paraplegia), part of the limbs or all of the torso are affected by the person is called quadriplegia (quadriplegia). Experimental studies have proved that primary spinal cord injury is often localized and incomplete, and after the injury there is a large amount of catecholamine neurotransmitters such as norepinephrine, dopamine, etc. released and accumulated locally, so that the spinal cord is localized microvascular spasm, ischemia, increased vascular permeability, and the rupture of small veins, resulting in secondary hemorrhagic necrosis. This self-destructive phenomenon of large hemorrhagic necrosis in the central part of the spinal cord after spinal cord injury is referred to as hemorrhagic necrosis, which is an important pathological process secondary to spinal cord injury. Clinical manifestations and typing Spinal cord injury mainly manifests motor disorders, sensory disorders, sphincter dysfunction and autonomic dysfunction, etc. The first two are very helpful in localizing the level of spinal cord lesions. 1.Transverse spinal cord injury During the spinal shock period, it manifests as chiropractic paralysis below the plane of injury, loss of movement, reflexes and sphincter function, loss of sensory planes and incontinence, etc. It gradually evolves into spastic paralysis after 2-4 weeks, which manifests as increased muscle tone, hyperreflexia of tendon, and pathological vertebral fasciculation sign, and the thoracic spinal cord injury manifests as paraplegia, and the spinal cord injury in the cervical segment manifests as tetraplegia, and upper The quadriplegia of cervical spinal cord injury is spastic paralysis, and the quadriplegia of lower cervical spinal cord injury is spastic paralysis of the upper limbs due to the destruction of cervical bulging part of the spinal cord and nerve roots, and the lower limbs are still spastic paralysis. Spinal cord hemisection sign: also known as Brown-Sequard sign. Loss of motor and deep sensation in the ipsilateral limb below the plane of injury, and loss of pain and temperature sensation in the contralateral limb. Anterior spinal cord syndrome: the cervical spinal cord is severely compressed anteriorly, sometimes causing occlusion of the anterior central artery of the spinal cord, resulting in tetraplegia, with the paralysis of the lower limbs being heavier than that of the upper limbs; however, the lower limbs and the perineum still retain positional and deep sensation, and sometimes even superficial sensation. The majority of pericentral spinal canal syndromes occur in cervical hyperextension injuries. The cervical spinal canal is drastically changed due to hyperextension of the cervical vertebrae, and the spinal cord is squeezed by the anterior and posterior compression of the ligamentum flavum, intervertebral discs, or bony spurs, which damages the conduction bundles around the central canal of the spinal cord, and it manifests itself as tetraplegia below the injury level, with the upper limbs being paralyzed from the lower limbs without sensory separation, and the prognosis is poor. 2.Incomplete spinal cord injury (1) spinal cord hemisection injury: cause spinal cord hemisection syndrome, mainly characterized by lesion segment below the ipsilateral upper motor neuron paralysis, deep sensory impairment and vasodilatation dysfunction, contralateral pain and temperature sensory impairment, tactile sensation is preserved. (2) Injury near the central canal: As the nociceptive fibers from the posterior horn cross at the anterior grey matter association, the lesion there produces bilateral symmetrical segmental dissociative sensory deficits, with diminished or absent nociception and preserved tactile sensation. (3) Anterior cord injury: Damage to the anterior thalamic fasciculus of the spinal cord results in coarse tactile deficits below the level of the contralateral side of the lesion, and irritating lesions produce indescribable diffuse pain below the level of the contralateral side of the lesion, often accompanied by sensory hypersensitivity. Diagnosis and differential diagnosis After spinal trauma, if there are sensory, motor, reflex or sphincter dysfunction below the injury level, the possibility of spinal cord injury should be considered; X-ray and tomography examination of the spine can help to find out whether there is spinal fracture, subluxation, or bone fragments protruding into the vertebral canal, and lumbar puncture can find out whether there is contusion and compression of the spinal cord; myelography can find out spinal cord compression factors which can not be detected in X-ray; e.g. intervertebral discs, and the spinal cord is not under pressure; and spinal cord injury can be detected in spinal cord injury. Spinal cord imaging can find out the compression factors of the spinal cord which cannot be found in X-ray film; for example, herniated disc, compression by bone fragments, etc.; CT scan can provide a definite diagnosis of fracture and spinal stenosis; MRI can clarify the degree and scope of spinal cord injury, such as hemorrhage in the vertebral canal, spinal cord edema, and compression of the spinal cord. Conventional treatment and deficiencies Basic treatment 1. Appropriate immobilization to prevent re-injury of the spinal cord due to displacement of the injured part. Generally start with maxillo-occipital band traction or continuous cranial traction. 2.Methods to reduce spinal cord edema and secondary damage (1) Dexamethasone, 10-20 mg intravenously, applied continuously for 5-7 days, then changed to oral, 3 times per hour, 0.75 mg each time, maintained for about 2 weeks. (2) 20% mannitol 250ml intravenous drip twice a day for 5-7 times. (3) Methylprednisolone shock therapy, 30mg dose per kilogram of body weight is given once, 15 minutes intravenous injection is completed, rest for 45 minutes, in the next 23 hours at a dose of 5.4mg (kg / h) continuous intravenous drip, this method is used only in the first 8 hours after the injury. (4) Hyperbaric oxygen therapy. According to animal experiments, the best effect of hyperbaric oxygen therapy is carried out 2 hours after injury, which is obviously not suitable for clinical cases, according to experimental experience, generally 4-6 hours after injury, the application can also receive good results. 3.Surgery Surgery can only relieve the compression of the spinal cord and restore the stability of the spine, but cannot restore the function of the injured spinal cord. The way and manner of surgery depends on the type of fracture and the site of the compression. The indications for surgery are: (1) vertebral fracture, subluxation with interlocking articular processes: (2) unsatisfactory repositioning of spinal fracture, or the existence of spinal instability: (3) imaging shows that there are fragments of bone protruding into the vertebral canal and compressing the spinal cord: (4) paraplegia level is rising, suggesting active hemorrhage in the vertebral canal. MRI shows that there is hemorrhage within the spinal cord can be incised in the spinal cord dorsal measurement of the spinal cord to the central sulcus, which will help to remove blood clots and fluid accumulation. Removal of blood clots and fluid accumulation will facilitate the subsidence of edema. It is difficult to predict the outcome after surgery. In general, after surgery, the paraplegia index can be expected to improve by at least one grade, which is not much of a solution for complete paraplegia, but for incomplete paraplegia, an improvement of one grade means a possible improvement in the quality of life. Physical therapy is mainly to improve the mobility of all joints of the body and to strengthen the remaining muscle strength, as well as to improve balance and coordination movements and position exchange and transfer movements (e.g., from lying to sitting, turning over, moving from bed to wheelchair, from wheelchair to toilet, etc.). 2. Occupational therapy Mainly daily life movements (such as basic skills in clothing, food, housing, and transportation), occupational labor movements, and craft labor movements (such as knitting, etc.), so that patients can adapt to their personal life, family life, social life, and labor after discharge from the hospital. In addition, the homework department provides patients with simple aids to facilitate the smooth completion of home life movements. 3.Psychotherapy A plan of psychotherapy is made for the changes in different stages of the psyche (such as denial, anger, depression, opposition to independence and adaptation, etc.), which can be carried out individually and collectively, in families, in behaviors, and in many other ways. 4. Rehabilitation works: Necessary supports can be customized to practice standing and walking, and special tools such as walkers can be provided to compensate for functional deficiencies. 5.Clinical Rehabilitation Use nursing care and medication to prevent various comorbidities from occurring, and also carry out some therapeutic clinical treatments to alleviate symptoms and promote functional recovery. 6.Recreational and Sports Rehabilitation Using recreational and sports means, the patients can have comprehensive training of the whole body and the use of wheelchair (such as endurance and skill training), and make adaptive training for social activities. Physical therapy utilizing hydrotherapy, phototherapy, biofeedback, etc. to promote rehabilitation in a targeted manner. 8.Chinese medicine rehabilitation The use of traditional Chinese medicine, acupuncture, massage, electroacupuncture, ionic introduction of traditional Chinese medicine and other means to promote rehabilitation, in addition to the treatment of comorbidities, can also be widely used in the use of traditional Chinese medicine internal and external. Nutritional therapy Formulate reasonable recipes and strengthen nutrition to meet the needs of rehabilitation training. At present, the traditional medical means can not make the spinal cord injury patients to restore the spinal cord function, the main treatment means of spinal cord injury to rehabilitation, the main purpose of rehabilitation is to give full play to the residual function of the body, in order to compensate for the loss of part of the function, such as paraplegia of the lower limbs, the loss of moving the body and the function of walking, give full play to the upper limb muscle power and torso muscle power to move the body and use the crutches to walk, it partially compensates for the function of the lower limbs. “This is the conclusion of Prof. Tendojin Shimazu, a famous Japanese spinal cord injury rehabilitation expert, at the Liverpool Rehabilitation Technology Symposium in the United Kingdom, who believes that the hope for the treatment of spinal cord injuries lies in the future, and that the development of new technologies will surely solve the problems that cannot be solved now. He believes that the hope for treating spinal cord injuries lies in the future, and that the development of new technologies will certainly solve the medical problems that cannot be solved now. “Conventional treatments cannot solve the problem of neuronal regeneration at its root,” added Prof. Tendojin Shimazu, “and recent stem cell transplantation technology should do a lot in treating spinal cord injuries.”