Spinal cord injury is a disease caused by damage or injury to the nerve tissue in the spine. The nerve tissue in the cervical and thoracic regions of the spine is called the “spinal cord”; the nerve tissue in the lower back region is called the “cauda equina. The spinal cord and cauda equina normally carry the nerve signals between the arms, legs and brain that allow us to move and feel. If nerve tissue is injured (e.g., as a result of a spinal fracture), total or partial loss of movement (paralysis) or sensation can occur.
A spinal fracture occurs when sustained injury to the spine results in the destruction or rupture of the spinal bones (vertebrae) or attached ligaments. The spine makes up the spinal column and contains and protects the spinal cord and the nerves that emanate from it.
Some injuries affect only the spine and do not destroy nerve tissue – while other more serious injuries to the spine can result in temporary or permanent damage to the spinal cord and/or nerves.
The diagnosis of these injuries relies on imaging, including X-rays, CT scans, and sometimes magnetic resonance imaging (MRI) to clarify the injury. Treatment for fractures is determined by the extent of the injury and may require bracing or surgery or both.
Who can be affected by a spinal cord injury?
Currently, spinal cord injuries (SCI) remain a devastating disease for patients and their families. These injuries also have a significant impact on our health care system and society as a whole. There are approximately 11,000 new injuries each year in the United States, and more than 250,000 patients suffer from some degree of paralysis. Approximately 80% of spinal cord injury patients are male.
Over the past few decades, much more has been learned about SCI. Some of the most important advances have been improvements in the assessment, braking and transport of patients with spinal cord injuries at the scene of accidents. In addition, new techniques in surgery and treatment have greatly improved the care, functional recovery and quality of survival of these patients. Unfortunately, to date there is still no treatment for the total functional impairment due to injury, especially paralysis.
Patients with spinal cord injuries are prone to particular problems and complications in their future lives, such as spinal cord cavitation (an abnormal and harmful accumulation of spinal fluid), progressive deformity or spinal instability, and chronic pain. There have been many improvements in the long-term treatment of spinal cord injuries, including surgical treatment of spinal cord cavitation, late post-traumatic deformity and pain control.
What causes SCI?
The types of accidents that lead to SCI have changed over the years.
In industry, motor vehicle accidents have become the leading cause of spinal cord injuries. The number of patients with spinal cord injuries due to violence is on the rise, as evidenced by an increase in the number of patients with assault-induced injuries. Of particular concern is the increased incidence of spinal cord injuries due to such penetrating injuries such as gunshot and stab wounds. Sports-related injuries have attracted a lot of media attention, and some people are engaging in horseback riding and other sports that are potentially dangerous to the spine.
How can SCI be prevented?
Most SCI’s can be prevented by avoiding dangerous or high-risk activities. The first step in prevention is education about the causes and mechanisms of action of SCI.
The importance of safe, sober driving cannot be overemphasized. Diversity education for drivers should include examples of poor driving accidents leading to potential SCI.
What can I expect?
Determining the prognosis and ultimate degree of functional recovery in patients with spinal cord injuries can be challenging in some cases. The spine specialist must consider the patient’s neurological examination (arm and leg movements, perception), age, imaging findings (x-rays, CT scans and MRI) and other clinical data to guide the patient and his or her family in understanding the expected consequences of a particular injury.
The extent or severity of spinal cord damage affects the prognosis. SCI can be described and classified using established criteria based on the degree of residual neurological function after injury.
A complete SCI means that there is no motor or sensory function in the spinal cord below the area of injury. A partial or incomplete SCI means that the spinal cord is capable of transmitting some information that enables movement of the limb or some information perceived by the skin back to the brain.
Usually, most patients admitted with an incomplete spinal cord injury may achieve partial recovery; however, when a patient presents with a complete injury, the likelihood of regaining meaningful motor or sensory function is slim.
What are the possible treatment options?
Initial treatment for patients with SCI focuses on improving the likelihood of spinal cord healing and recovery, preventing further neurological damage, and stabilizing the injured spinal structures. Depending on the type of injury, these goals may be achieved simply by fitting the patient with a cervical collar, cephalothoracic brace, or body brace. However, surgery is necessary in many cases; the decision to treat surgically may be influenced by the patient’s other non-spinal injuries.
Surgery is usually performed by an orthopedic surgeon with specialized training in spinal surgery. Surgery usually involves the placement of metal plates or nail bars, screws and bone graft material to fuse the injured spine. As part of the surgical treatment, the spine is restored to its normal sequence and bone blocks are removed from the spinal canal to relieve any pressure or impact on the spinal cord.
Following the injury and any corrective surgery, the initial focus of hospitalization is on preventing and treating secondary conditions of the SCI. These potential problems include heart rate and blood pressure fluctuations (abnormal autonomic reflexes), respiratory failure, skin pressure sores, and thrombosis of the legs.
Once the patient is stable and ready to be active, he will begin intense therapy including physical therapy and occupational therapy. This phase of treatment is best completed in a specialized rehabilitation center. Treatment includes strengthening the muscles, teaching the patient how to maximize residual function in daily life (including employment), and identifying strategies for rehabilitation of bowel and sexual function.
Spasticity (uncontrollable muscle spasms) and chronic neuropathic pain often accompany spinal cord injury. Treatment and medication options, such as implantation of a pump delivery system, should be part of the overall treatment plan of a spinal cord injury rehabilitation center. Rehabilitation centers should also be able to provide counseling services and support teams for patients and their families, which can greatly help them cope with the stress and realities of life with a spinal cord injury.
Is research being conducted?
Spinal cord injury research is the focus of academic and medical industry-supported research centers around the world. Current areas of research include the cellular level pathogenesis of the initial SCI injury, the mechanisms of secondary injury, and the optimal treatment of the acute and delayed phases of SCI.
The current research focus can be divided into two categories: pharmacological treatment and spinal cord repair through transplantation. Pharmacologic research has focused on what drugs to give during the acute phase of injury that may limit secondary mechanisms of injury or promote regeneration. In the field of transplantation, cellular therapies for chronic injury are important. Cells of interest include Schwann’s cells, olfactory nerve sheath glial cells, embryonic spinal cord, and stem cells. A combined strategy of drug and transplantation techniques has been determined to achieve optimal efficacy.