Symptoma

Spinal Cord Injury

Thoracolumbar Spinal Injuries

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.

  • Fecal Incontinence

    The lack of function results in fecal incontinence, chronic constipation, or both. Bowel training (during rehab) can help regulate bowel movements but often a care provider is needed to complete the bowel maintenance process. [unitedspinal.org]

    The most important factors are the spasm, decubitus nature, insufficient motivation, deformity, urinary and fecal incontinence. [boneandspine.com]

    This is called fecal incontinence. [northshore.org]

  • Hypertension

    OBJECTIVES: To quantify diurnal blood pressure (BP) patterns and nocturnal hypertension and to measure diurnal urine production in people with chronic spinal cord injury (SCI), compared with controls without SCI. [ncbi.nlm.nih.gov]

    These discoveries are now being translated into the clinical realm and have led to targeted upfront medical management with a focus on tissue oxygenation and perfusion and include avoidance of hypotension, induction of hypertension, early transfer to [doi.org]

    Thus, peripheral arterial hypertension occurs. (C) The brain detects this hypertensive crisis through intact baroreceptors in the neck delivered to the brain through cranial nerves IX and X. [emedicine.medscape.com]

  • Muscle Spasticity

    Symptoms may include: Muscle weakness or paralysis in the trunk, arms or legs Loss of feeling in the trunk, arms, or legs Muscle spasticity Breathing problems Problems with heart rate and blood pressure Digestive problems Loss of bowel and bladder function [hopkinsmedicine.org]

    Some people with spinal cord injuries experience one of two types of muscle tone problems: uncontrolled tightening or motion in the muscles (spasticity) or soft and limp muscles lacking muscle tone (flaccidity). Fitness and wellness. [mayoclinic.org]

    The most common symptoms of acute spinal cord injury may include: Muscle weakness or paralysis in the trunk, arms, or legs Loss of feeling in the trunk, arms, or legs Muscle spasticity Breathing problems Problems with heart rate and blood pressure Digestive [massgeneral.org]

    You may also learn how to handle problems such as pressure injuries, urinary tract infections, and muscle spasticity. Do daily tasks, such as cook, brush your teeth, and move from a wheelchair to a bed or chair. [northshore.org]

    Reflexes may become exaggerated over time, causing muscle spasticity. Muscles may waste away or diminish due to underuse. If spasms become severe enough, they may require medical treatment. [web.archive.org]

  • Joint Dislocation

    Causes of spinal cord compression Trauma (including car accidents, falls and sports injuries): There is usually either vertebral fracture (most common in cervical vertebrae) or facet joint dislocation. [patient.info]

  • Muscle Twitch

    This means that when the muscle receptors are briefly stretched by the tap, the nerve impulses in the afferent pathway travel directly to the motor neurons and excite them reflexly to cause the normally visible muscle twitch. [encyclopedia.com]

  • Urinary Retention

    The latter can lead to neurogenic shock, paralytic ileus, aspiration, urinary retention, priapism and loss of thermoregulation. Clinical features depend upon the extent and rate of development of cord compression. [patient.info]

    Problems can include urinary retention or high intravesical voiding pressure due to detrusor-sphincter dyssynergy. [emedicine.com]

    Changes may be an autonomic response (urinary retention, constipation, paralytic ileus, hypotension, hypothermia, and bradycardia), a motor response (hemiplegia or hemiparesis, paraplagia or paraparesis, tetraplegia or tetraparesis), or sensory changes [medical-dictionary.thefreedictionary.com]

  • Urinary Incontinence

    It is common to experience sexual dysfunction after injury, as well as dysfunction of the bowel and bladder, including fecal and urinary incontinence. [en.wikipedia.org]

    Effect of sacral nerve stimulation in patients with fecal and urinary incontinence. Dis. Colon Rectum 44(6): 779 – 789 ; 2001. Google Scholar Medline ISI 154. Linder, S. H. Functional electrical stimulation to enhance cough in quadriplegia. [doi.org]

  • Quadriplegia

    Paraplegia and quadriplegia The main difference between paraplegia and quadriplegia relates to the extent of paralysis and loss of feeling in the limbs. [spinal.com.au]

    Level of injury Possible impairment Rehabilitation potential C2 - C3 Usually fatal as a result of inability to breathe Totally dependent for all care C4 Quadriplegia and breathing difficulty Dependent for all cares; usually needs a ventilator C-5 Quadriplegia [hopkinsmedicine.org]

    MEDLINE/PubMed, CINAHL, EMBASE, and PsycINFO were searched from inception to May 2009 for population keywords (spinal cord injury, paraplegia, tetraplegia, quadriplegia) paired with secretion removal-related interventions and outcomes. [ncbi.nlm.nih.gov]

    Data Sources and Study Selection: MEDLINE/PubMed, CINAHL, EMBASE, and PsyclNFO were searched from inception to May 2009 for population keywords (spinal cord injury, paraplegia, tetraplegia, quadriplegia) paired with secretion removal-related interventions [doi.org]

    The level of paralysis the person experiences may be referred to as Quadriplegia or Quadriplegia/Tetraplegia if the injury they have sustained is located in their neck area. [disabled-world.com]

  • Myelopathy

    We reported a patient with C5 [S(C5/C6)] ASIA Impairment Scale C SCI due to cervical myelopathy who presented CO2 retention when taking a therapeutic dosage of pregabalin. [ncbi.nlm.nih.gov]

    […] for the Management of Degenerative Cervical Myelopathy and Traumatic Spinal Cord Injury. [spineuniverse.com]

  • Hyperreflexia

    Spasticity is characterized as hyperreflexia and hypertonicity as a result of damage to the supraspinal tracts in the aftermath of SCI. Intrathecal baclofen (ITB) is the mainstay therapy for spasticity unresponsive to oral baclofen. [ncbi.nlm.nih.gov]

    Autonomic hyperreflexia Autonomic hyperreflexia (AH), or autonomic dysreflexia, is an acute, potentially lethal complication particular to patients with spinal injuries above T7. [emedicine.com]

    Complications The following medical disorders are common complications seen in spinal cord injury patients: Blood pressure fluctuation due to autonomic hyperreflexia Decubitus ulcers due to long standing immobility Deep venous thrombosis Pneumonia due [symptoma.com]

    These complications can become life-threatening: Pressure injuries (bedsores) Deep vein thrombosis Hyperreflexia caused by an irritant to nerves below the level of injury Lung conditions such as pneumonia, pulmonary blood clots, collapsing of your lung [drugs.com]

  • Unable to Walk

    Spinal pain is often present for three months and neurological symptoms for two months before paraplegia, but almost 50% of patients are unable to walk by the time of diagnosis. Of these, almost 70% remain immobile. [patient.info]

    Besides leading to physical complications such as skin breakdown, muscle atrophy, reduced cardiorespiratory capacity, and pain [ 1 ], being unable to walk also affects psychological well-being and can increase the risk of depression and reduce quality [doi.org]

  • Clonus

    Upper motor neurone signs in the lower limbs (Babinski's sign: up-going plantar reflex, hyperreflexia, clonus, spasticity). Lower motor neurone signs in the upper limbs (atrophy, hyporeflexia). [patient.info]

    Spasticity Spasticity is a velocity-dependent increase in muscle tone and occurs commonly following SCI and other types of upper motor neuron injury. [31] Spasticity causes resistance to passive motion of the limbs, exaggerated deep tendon reflexes, clonus [emedicine.com]

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:

  • Computed tomography (CT Scan)
  • Magnetic resonance imaging (MRI)
  • Myelogram
  • Somatosensory evoked potential (SSEP)
  • X-ray of the spine

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 [7].

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 [8]. 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 [9].

Rehabilitation, physical and occupational therapies may be needed for patients to cope up with the disability associated with the spinal cord injury [10].

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 [6]. Majority of spinal cord injury patients may need medical devices like wheelchairs in order to move around.

Complications

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 [1]. Diving sports and other sport injury follows this trend at 8% of cases of spinal cord injury [2]. There are other significant causes of spinal cord injuries like tumors [3], 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 [4].

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 [5].

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.

Definition

Spinal cord injury refers to any injury in the spinal cord and its spinal root nerves.

Cause

Vehicular accidents, falls, diving, armed conflict, and tumors are common causes.

Symptoms

Paralysis, spasticity, incontinence, weakness, paralysis, unstable blood pressure, and difficulty in breathing may occur.

Diagnosis

X-ray, CT scan, MRI and myelography may be used to daignose a spinal cord injury. 

Treatment and follow-up

Corticosteroids, laminectomy, and surgical removal of foreign bodies are the most common treatment options.

  1. Rhee P, Kuncir EJ, Johnson L, Brown C, Velmahos G, Martin M, et al. Cervical spine injury is highly dependent on the mechanism of injury following blunt and penetrating assault. J Trauma. Nov 2006; 61(5):1166-70.
  2. National Spinal Cord Injury Statistical Center (NSCIS). Spinal cord injury facts and figures at a glance. February 2011; Accessed August 30, 2011.
  3. Avery JD, Avery JA. Malignant spinal cord compression: a hospice emergency. Home Healthc Nurse. Sep 2008; 26(8):457-61; quiz 462-3.
  4. Krause JS, Sternberg M, Lottes S, Maides J. Mortality after spinal cord injury: an 11-year prospective study.Arch Phys Med Rehabil. Aug 1997; 78(8):815-21.
  5. Vitale MG, Goss JM, Matsumoto H, Roye DP Jr. Epidemiology of pediatric spinal cord injury in the United States: years 1997 and 2000. J Pediatr Orthop. Nov-Dec 2006; 26(6):745-9
  6. Budh CN, Osteråker AL. Life satisfaction in individuals with a spinal cord injury and pain. Clin Rehabil. Jan 2007; 21(1):89-96.
  7. Werndle MC, Saadoun S, Phang I, Czosnyka M, Varsos GV, Czosnyka ZH. Monitoring of spinal cord perfusion pressure in acute spinal cord injury: initial findings of the injured spinal cord pressure evaluation study. Crit Care Med. 2014; 42(3):646-55 (ISSN: 1530-0293)
  8. Gaebler C, Maier R, Kutscha-Lissberg F, Mrkonjic L, Vecsei V. Results of spinal cord decompression and thoracolumbar pedicle stabilisation in relation to the time of operation. Spinal Cord. Jan 1999; 37(1):33-9.
  9. Hu SL, Luo HS, Li JT, Xia YZ. Functional recovery in acute traumatic spinal cord injury after transplantation of human umbilical cord mesenchymal stem cells. Crit Care Med. 2010; 38(11):2181-9 (ISSN: 1530-0293)
  10. Van Middendorp JJ, Hosman AJ, Donders AR, Pouw MH, Ditunno JF Jr, Curt A, et al. A clinical prediction rule for ambulation outcomes after traumatic spinal cord injury: a longitudinal cohort study. Lancet. Mar 19 2011; 377(9770):1004-10.

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