Brain Spine Hosptials

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SPINAL CORD TRAUMA

Spinal cord trauma is damage to the spinal cord. It may result from direct injury to the cord itself or indirectly from disease of the surrounding bones, tissues, or blood vessels.

CAUSES

Spinal cord trauma can be caused by a number of injuries to the spine, including:

  • Assault
  • Falls
  • Gunshot wounds
  • Industrial accidents
  • Motor vehicle accidents
  • Sports injuries (particularly diving into shallow water)

A minor injury can cause spinal cord injury if the spine is weakened (such as from rheumatoid arthritis orosteoporosis) or if the spinal canal protecting the spinal cord has become too narrow (spinal stenosis) due to the normal aging process.

Direct injury, such as cuts, can occur to the spinal cord, especially if the bones or the disks have been weakened. Fragments of bone (for example, from broken vertebrae, which are the spine bones) or fragments of metal (such as from a traffic accident or gunshot) can cut or damage the spinal cord.

Direct damage can also occur if the spinal cord is pulled, pressed sideways, or compressed. This may occur if the head, neck, or back are twisted abnormally during an accident or intense chiropractic manipulation.

Bleeding, fluid buildup, and swelling can occur inside or outside the spinal cord (but within the spinal canal). The buildup of blood or fluid can press on the spinal cord and damage it.

Most spinal cord trauma happens to young, healthy individuals. Men ages 15 - 35 are most commonly affected. The death rate tends to be higher in young children with spinal injuries.

Risk factors include:

  • Participating in risky physical activities
  • Not wearing protective gear during work or play
  • Diving into shallow waters

Older people with weakened spines (from osteoporosis) may be more likely to have a spinal cord injury. Patients who have other medical problems (stroke or prostate cancer, for example) that make them more likely to fall may also be more susceptible.

Symptoms

Symptoms vary depending on the location of the injury. Spinal cord injury causes weakness and loss of feeling at, and below the injury. How severe symptoms are depends on whether the entire cord is severely injured (complete) or only partially injured (incomplete).

Injuries at and below the first lumbar vertebra do not cause spinal cord injury. However, they may cause "cauda equina syndrome" -- injury to the nerve roots in this area. This type of spinal cord injury is a medical emergency and needs immediate surgery.

Injuries at any level can cause:

  • Increased muscle tone (spasticity)
  • Loss of normal bowel and bladder control (may include constipation, incontinence, bladder spasms)
  • Numbness
  • Sensory changes
  • Pain
  • Weakness, paralysis

Symptoms

When spinal cord injuries occur in the neck area, symptoms can affect the arms, legs, and middle of the body. The symptoms may occur on one or both sides of the body. Symptoms can also include breathing difficulties from paralysis of the breathing muscles, if the injury is high up in the neck.

THORACIC (CHEST LEVEL) INJURIES

When spinal injuries occur at chest level, symptoms can affect the legs. Injuries to the cervical or high thoracic spinal cord may also result in blood pressure problems, abnormal sweating, and trouble maintaining normal body temperature.

LUMBAR SACRAL (LOWER BACK) INJURIES

When spinal injuries occur at the lower back level, symptoms can affect one or both legs, as well as the muscles that control the bowels and bladder.

Symptoms

Spinal cord injury is a medical emergency that needs immediate medical attention.

The health care provider will perform a physical exam, including a brain and nervous system (neurological) exam. This will help identify the exact location of the injury, if it is not already known.

Some of the reflexes may be abnormal or missing. Once swelling goes down, some reflexes may slowly recover.

The following tests may be ordered:

  • CT scan or MRI of the spine
  • Myelogram (an x-ray of the spine after injecting dye)
  • Somatosensory evoked potential (SSEP) testing or magnetic stimulation
  • Spine x-rays

Treatment

A spinal cord injury is a medical emergency that needs to be treated right away. The time between the injury and treatment can affect the outcome.

Corticosteroids, such as dexamethasone or methylprednisolone, are used to reduce swelling that may damage the spinal cord. If spinal cord pressure is caused by a growth that can be removed or reduced before your spinal nerves are completely destroyed, paralysis may improve. Ideally, corticosteroids should begin as soon as possible after the injury.

Surgery may be needed to:

  • Remove fluid or tissue that presses on the spinal cord (decompression laminectomy)
  • Remove bone fragments, disk fragments, or foreign objects
  • Fuse broken spinal bones or place spinal braces

Spinal traction may be recommended. This can help keep the spine from moving. The skull may be held in place with tongs (metal braces placed in the skull and attached to traction weights or to a harness on the body). You may need to wear the spine braces for a long time.

The health care team will also provide information on muscle spasms, care of the skin, and bowel and bladder dysfunction. Your skin will be protected against pressure sores.

You will probably need physical therapy, occupational therapy, and other rehabilitation therapies after the injury has healed. Rehabilitation will help you cope with the disability from your spinal cord injury.

Muscle spasticity can be relieved with medications taken by mouth or injected into the spinal canal. Botox injections into the muscles may also be helpful. Painkillers (analgesics), muscle relaxers, and physical therapy are used to help control pain.

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