Spinal Cord Injuries

Causes

A spinal cord injury occurs when a trauma affects the spinal cord.  This can happen when the vertebrae that surround the spinal cord break, shatter or dislocate.  The violent movement of the vertebrae can force a piece of the vertebrae, disc material or ligament to tear into the spinal cord tissue. 

During most spinal traumas the spinal cord itself does not sever completely.  Instead, the axons, nerve cells that carry signals from the brain to the body, are crushed or destroyed.  The extent of the damage depends on how many of these axons are destroyed.

Classification of Injuries

The American Spinal Injury Association and the International Spinal Cord Injury Classification System classify spinal cord injuries in the following ways:

• A: "Complete" spinal cord injury. No motor or sensory function is preserved.
• B: "Incomplete" spinal cord injury. Sensory but not motor function is preserved. This can be a transitional stage where the injured recovers some motor function.
• C: "Incomplete" spinal cord injury. Some motor function is preserved and more than half of the key muscles have a grade less than 3.
• D: "Incomplete" spinal cord injury. Some motor function is preserved and at least half of the key muscles have a muscle grade of 3 or more.
• E: "Normal" where motor and sensory scores are normal.

Treatments

The treatment of a spinal cord injury depends on the severity of the injury.  Doctors and therapists use the above system to help guide their treatment plan.  No matter the severity of the injury treatment focuses on preventing further injury and helping people with spinal cord injuries return to an active and productive life.

Immediately following a spinal cord injury emergency personnel will work to:

• Maintain an airway and the ability to breathe
• Keep the patient from going into shock
• Immobilize the neck and back to prevent further injury

The early stages of treatment include:

• Medications: Methylprednisolone (Medrol) is given after an acute spinal cord injury. This is a corticosteroid that has been known to cause some recovery in people with a spinal cord injury if it is given within eight hours of the injury.
• Immobilization: Traction may be needed to stabilize the spine and align it properly. Sometimes metal braces are attached to the skull to hold the harness in place.
• Surgery: Emergency surgery may be needed to remove fragments of bone, foreign objects, herniated discs or fractured vertebrae that are compressing the spine.

After the initial treatments are preformed and the patient is stable, ongoing care begins.  The following basic care treatments should be performed in the weeks after a spinal cord injury:

• Range of motion exercises
• Help with bladder and bowel functions
• Application of skin lotions
• Use of soft bed coverings or flotation mattresses
• Frequent position changes

A rehabilitation plan will be devised soon after the patient is stable.  The following treatments are often used:

• Physical therapy (specific to level/areas of paralysis)
• Medications
• Assistive devices (wheelchairs and computer devices)
• Electrical stimulation devices

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