Acute Spinal Cord Injury

What is an acute spinal cord injury?

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The spinal cord is a bundle of nerves that carries messages between the brain and the rest of the body.

Acute spinal cord injury (SCI) is due to a traumatic injury that either results in a bruise (also called a contusion), a partial tear, or a complete tear (called a transection) in the spinal cord. SCI is a common cause of permanent disability and death in children and adults.

About 12,000 people a year sustain a spinal cord injury. As many as 231,000 to 311,000 people in the US are living with a spinal cord injury, according to the Spinal Cord Injury Information Network. More than half of all SCIs occur among young people between the ages of 16 and 30 years. The majority of SCI victims (80.9 percent) are male.

What causes an acute spinal cord injury?

There are many causes of SCI. The more common injuries occur when the area of the spine or neck is bent or compressed, as in the following:

• Birth injuries, which typically affect the spinal cord in the neck area

• Falls

• Motor vehicle accidents (automobiles, motorcycles, and being struck as a pedestrian)

• Sports injuries

• Diving accidents

• Trampoline accidents

• Violence (gun shot or stab wounds)

• Infections that form an abscess on the spinal cord

What are the symptoms of an acute spinal cord injury?

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After a traumatic event, a person may have varying degrees of symptoms associated with the severity and location of the SCI. The location of the injury on the spinal cord will determine how severe the injury will be. For example, an injury that damages the cervical spine (in the neck area) can cause loss of muscle function or strength in all four extremities (arms and legs). This is referred to as tetraplegia (formerly called quadriplegia). An injury of this type often requires mechanical breathing assistance, as with a ventilator, as the chest muscles may also be weakened. An injury to a lower part of the spinal cord that causes paralysis and loss of function in the legs and lower body is called paraplegia.

The extent of the damage to the spinal cord determines whether the injury is complete or incomplete. A complete injury means that there is no movement or feeling below the level of the injury. An incomplete injury means that there is still some degree of feeling or movement below the level of the injury.

Initially after a spinal cord injury, the patient may experience spinal shock, which causes loss or decrease in feeling, muscle movement, and reflexes. As swelling subsides, other symptoms may appear depending on the location of the injury. Generally, the higher up the level of the injury is to the spinal cord, the more severe the symptoms. For example, an injury to the neck, at C1 or C2 (the first and second vertebrae in the spinal column), and especially in the mid-cervical vertebrae of C3, C4, and C5, affects the respiratory muscles and the ability to breathe. A lower injury, in the lumbar vertebrae, may affect nerve and muscle control to the bladder, bowel, and legs.

The following are the most common symptoms of acute spinal cord injuries. However, each individual may experience symptoms differently. Symptoms may include:

• Muscle weakness

• Loss of voluntary muscle movement in the chest, arms, or legs

• Breathing problems

• Loss of feeling in the chest, arms, or legs

• Loss of bowel and bladder function

The symptoms of SCI may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How are acute spinal cord injuries diagnosed?

The full extent of the SCI may not be completely understood immediately after the injury, but may be revealed with a comprehensive medical evaluation and diagnostic testing. Acute SCI is a medical emergency. Anytime there is a suspicion of injury to the spinal cord, emergent medical attention is absolutely necessary. The diagnosis of SCI is made with a physical examination and diagnostic tests. During the examination, the physician obtains a complete medical history and inquires as to how the injury occurred. Trauma to the spinal cord can cause neurological problems and requires further medical follow-up. Occasionally, surgery is necessary to stabilize the spinal cord after acute SCI.

Diagnostic tests may include:

• Blood tests

• X-ray - a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film

• Computed tomography scan (also called a CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

• Magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body

Treatment of an acute spinal cord injury:

Specific treatment for an acute spinal cord injury will be determined by your physician based on:

• Your age, overall health, and medical history

• Extent of the SCI

• Type of SCI

• Your tolerance for specific medications, procedures, or therapies

• Expectations for the course of the SCI

• Your opinion or preference

SCI requires emergency medical attention on the scene of the accident or injury. This is accomplished by immobilizing the head and neck areas to prevent the patient from moving. This may be very difficult since the victim and/or bystanders may be very frightened after the traumatic incident.

There is currently no way to repair a damaged or bruised spinal cord, though researchers are actively seeking means of stimulating spinal cord regeneration. The severity of the SCI and the location determines if the SCI is mild, severe, or fatal.

Surgery is sometimes necessary to evaluate the injured cord, stabilize fractured back bones, decompress (or release) the pressure from the injured area, and to manage any other injuries that may have been a result of the accident. Treatment is individualized, depending on the extent of the condition and the presence of other injuries.

Treatment may include:

• Observation and medical management in the intensive care unit (ICU)

• Medications, such as corticosteroids (to help decrease the swelling in the spinal cord)

• Mechanical ventilator, a breathing machine (to help the patient breathe)

• Bladder catheter - a tube that is placed into the bladder that helps to drain the urine into a collection bag

• Feeding tube (placed through the nostril to the stomach, or directly through the abdomen into the stomach, to provide extra nutrition and calories)

Recovery from a SCI requires long-term hospitalization and rehabilitation. An interdisciplinary team of physicians, nurses, therapists (physical, occupational, or speech), and other specialists work to medically manage the patient to control pain, to monitor the heart function, blood pressure, body temperature, nutritional status, bladder and bowel function, and attempt to control involuntary muscle shaking (spasticity). Rehabilitation focuses on preventing muscle wasting and contractures, and works to retrain the patient to use other muscles to aid in mobility and movement. Some of the important chronic complications of SCI include pressure ulcers (so-called "bed sores") and pneumonia.

Life-long considerations for a person with a SCI:

A traumatic event that results in a SCI is devastating to the person and the family. The healthcare team educates the family after hospitalization and rehabilitation on how to best care for the person at home and outlines specific clinical problems that require immediate medical attention by the patient's physician.

The disabled person requires a focus on maximizing his or her capabilities at home and in the community. Positive reinforcement will encourage him or her to strengthen his or her self-esteem and promote independence.

A person with a SCI requires frequent medical evaluations and diagnostic testing following hospitalization and rehabilitation to monitor his or her progress.