What is Spinal Cord Injury?
A spinal cord injury refers to damage sustained by the spinal cord, a part of the central nervous system that runs through the vertebral canal of the spine. It can result from either trauma, such as a fall or a car accident, or from disease and degeneration. These injuries can lead to varying degrees of temporary or permanent changes in sensation, strength, and other body functions below the injury site.
Causes of Spinal Cord Injury
Spinal cord injuries can be attributed to a range of causes, with trauma being the most common. These traumatic injuries often result from the following:
Vehicle accidents
The leading cause of spinal cord injuries worldwide involves collisions involving cars, motorcycles, and bicycles.
Falls
Particularly prevalent in people over the age of 65, falls can result in severe spinal damage.
Violence
Incidents involving gunshots and stabbings are significant contributors to spinal cord injuries, especially in young adults.
Sports and Recreation Injuries
Activities such as diving, rugby, and horseback riding carry a higher risk of injury to the spinal cord.
Diseases
Conditions like cancer, arthritis, osteoporosis, and inflammation can lead to spinal cord damage.
Degeneration of the Spine
Age-related spinal degeneration can lead to injuries over time.
Symptoms and Early Signs
The symptoms of a spinal cord injury can vary widely depending on the severity and location of the injury. Common early signs include:
- Loss of movement: An inability to move parts of the body below the level of injury.
- Altered sensation: An inability to feel heat, cold, and touch, as well as numbness or tingling.
- Loss of bladder or bowel control: Difficulty controlling bladder and bowel functions can lead to incontinence.
- Changes in sexual function: This can include changes in sexual sensitivity and fertility issues in both men and women.
- Pain or intense stinging sensation: Caused by damage to the nerve fibres in the spinal cord.
- Difficulty breathing, coughing, or clearing secretions from your lungs: Especially in injuries that occur at the neck level.
Diagnosis and Classification
Diagnosing a spinal cord injury involves clinical assessment and diagnostic tests. The process typically includes:
Medical history and Physical Examination
An initial evaluation to understand the circumstances leading to the injury and to assess neurological function. This includes examining the patient’s ability to move and feel sensations in their limbs, which helps identify the injury’s level and severity.
Imaging tests
Such as X-rays to check for vertebral problems, CT scans to provide detailed images of abnormalities, and MRI scans to reveal issues with the spinal cord and surrounding tissues.
Neurological Tests
To determine the completeness and level of the injury. The American Spinal Injury Association (ASIA) Impairment Scale is commonly used to classify the severity:
- ASIA A: Complete lack of sensory and motor function below the level of injury.
- ASIA B: Some sensory functions are below the level of injury, but there is no motor function.
- ASIA C: Some motor function is preserved below the level of injury, but more than half of the key muscles below the neurologic level have a muscle grade of less than 3.
- ASIA D: Motor function is preserved below the level of injury, and at least half of the key muscles below the neurologic level have a muscle grade of 3 or more.
- ASIA E: Normal sensory and motor function.
Treatment Options
Treatment for spinal cord injuries primarily focuses on preventing further injury and enabling people to return to an active and productive life. Key treatment options include:
Surgery
Specific surgical interventions depend on the nature and severity of the injury:
- Decompression Surgery: Removes anything pressing against the spinal cord, such as bone fragments, herniated discs, or tumours.
- Stabilisation Surgery: Involves the use of rods, screws, and plates to stabilise the spine and prevent further injury or deformity.
- Fusion Surgery: Fuses two or more vertebrae to provide additional spinal stability.
Medications
Medications are used to manage symptoms and to reduce inflammation:
- Corticosteroids: Such as methylprednisolone, may be administered shortly after the injury to reduce swelling
- Pain relievers: These include both over-the-counter and prescription medications to manage acute and chronic pain.
- Muscle relaxants: To address muscle spasticity, a common complication following a spinal cord injury.
Other Treatments
In addition to surgery and medications, patients may undergo:
- Physical therapy: Focuses on strengthening and flexibility exercises to maximise mobility and independence.
- Occupational therapy: Helps people adapt to their daily activities and work environment using adaptive tools and techniques.
Prevention Tips
While not all spinal cord injuries can be prevented, specific measures can significantly reduce the risk. These include:
Road Safety
Wear vehicle seatbelts, use appropriate child car seats, and wear helmets while riding motorcycles or bicycles.
Fall Prevention
Install grab bars and handrails in homes, particularly in bathrooms and along stairways, and ensure adequate lighting.
Sports Safety
Wearing proper gear and equipment, avoiding risky behaviours, and following safety rules and guidelines in sports and recreational activities.
Awareness of Surroundings
Be cautious around water to prevent diving into shallow areas, and be aware of the environment to avoid falls and collisions.
Maintaining a Healthy Lifestyle
Strengthening the muscles and bones through regular exercise and a balanced diet to prevent diseases that could weaken the spine.
