Symptomatology involved in spinal cord injury greatly depends on the level of injury. Usually there is a loss of sensation and weakness below the level of the injury. Severity of symptoms may also depend on the completeness or incompleteness of the spinal cord injury. In general, spinal cord injuries occurring at any level may presents with symptoms of spasticity, incontinence, sensory changes, pain and paralysis.
Injuries at the level of the neck may affect the arms, the legs and the middle body. Symptoms may present unilaterally or bilaterally. Injuries at the chest level can affect the legs. The co-involvement of the upper thoracic vertebrae and cervical vertebrae can cause erratic blood pressure problems, abnormal sweating, and trouble maintaining normal body temperature. Injuries sustained at the lower back or lumbar level will affect both legs and the muscles that control the bowel and the bladder.
When patients suspected with spinal cord injury is brought to the emergency room, the health care provider conducts a complete clinical examination and neurologic examination do determine the exact location of the injury. Spinal reflexes may initially diminish and may return after the swelling has subdued in time.
The following tests may be used in patients suspected of spinal cord injury:
All spinal cord injury are considered as a medical emergency that needs to be worked on immediately. Corticosteroids are usually given intravenously to control the swelling of the spinal cord. A subdural probe may be inserted to monitor intraspinal pressure during the acute phases of traumatic spinal cord injury .
Surgical intervention is indicated in the following conditions: removal of masses that impinge on the spinal cord, decompress intraspinal pressure by dissecting the lamina (laminectomy), removal of foreign objects or fragments, and fuse spinal bones.
Early surgical decompression within the first 8 hours of injury is associated with a good outlook in terms of neurologic recovery . Advances in stem cell research have implicated in recent studies that the use of umbilical cord mesenchymal stem cells in the functional restoration of spinal cord injury has proven to be very promising .
Rehabilitation, physical and occupational therapies may be needed for patients to cope up with the disability associated with the spinal cord injury .
Prognosis of patients with spinal cord injury may depend on the level of injury. Injuries sustained in the higher levels will have more neurologic symptoms compared to injuries in the lower levels of the spine. Mortality is possible if muscles of respiration are paralyzed.
Patients sustaining spinal cord injury with improvements of function within one week have a good chance of recovering some somatic and neurologic functions within the next 6 months. However, neurologic deficits that persists beyond 6 months are more likely to stay permanent. Pain control is major predictor of patient’s outlook as to the quality of living beyond 2 years of survival . Majority of spinal cord injury patients may need medical devices like wheelchairs in order to move around.
The following medical disorders are common complications seen in spinal cord injury patients:
As of 2005 in the United States, the most common cause of spinal cord injury is vehicular accidents accounting for more than 40% of cases. This is followed by falls which occurs commonly among 45 year old at a rate of more than 27% of the cases. Females with ongoing osteoporosis are at risk of vertebral fractures. Armed violence especially gunshot wounds also tops the chart at 15% of cases representing the most common cause of spinal cord injury in the urban setting.
Patients sustaining penetrating injuries with a projectile carries a poorer outcome . Diving sports and other sport injury follows this trend at 8% of cases of spinal cord injury . There are other significant causes of spinal cord injuries like tumors , vasculopathies, infectious processes, vertebral fracture, and spondylitis. Spinal cord injuries is an important medical condition because it can virtually affect patients psychologically, financially, and physically .
The National Spinal Cord Injury database in the United States, confers approximately 40 cases of spinal cord injuries per million population, or an approximated 12,000 cases per annum. As of 2010, the number of people living with spinal cord injury reaches more than a quarter of a million in the country. Spinal cord injuries have an increasing frequency in the months of July during day time hours.
The white race sustaining spinal cord injuries represents as much as 65% of all the cases recorded worldwide. Males are more predisposed in up to four folds incidence compared to females. The median age for spinal cord injury as of 2005 is slated at 40.7 years old worldwide. In pediatric cases, spinal cord injuries are more dominant in the black races scoring up to 1.53 cases per 100,000 children population .
Spinal cord injury has an evolving pathophysiology representing a dynamic process. The full effect of the injury is not apparent at first but may later evolve in the succeeding days rising 1 to 2 levels each time. Spinal cord injury can be sustained by the destruction of the spinal tissue matter caused by direct trauma, compression injury by bone fragments and hematoma, and ischemia from blocked spinal arteries.
Proper safety precaution in the work place and recreation by wearing safety gears may prevent this types of injury. A thorough inspection of the dive site before plunging may be a prudent move to prevent spinal trauma, for recreational diving is still the leading cause of sports related spinal cord injury.
Precaution by using the appropriate protective gear in contact sports like football and high risk recreational sports like rock climbing may prevent such accidents. Defensive driving with seat belts intact may prevent whiplash injury that can cause spinal cord trauma of the cervical area.
Spinal cord injury is a clinical disorder caused by any damage in the spinal cord and its nerves. This injury is brought about by direct trauma to the spinal cord or indirectly by diseases of the bones and soft tissue proximal to the spinal cord mater.
Spinal cord injury often causes permanent changes in strength, sensation and other bodily function below the level of the lesion. Most spinal cord injuries are irreversible but physical therapy may somehow restore some of the patient’s daily function and independence.
Spinal cord injury refers to any injury in the spinal cord and its spinal root nerves.
Vehicular accidents, falls, diving, armed conflict, and tumors are common causes.
X-ray, CT scan, MRI and myelography may be used to daignose a spinal cord injury.
Treatment and follow-up