Spinal cord Injury is a term used to refer the damage to the spinal cord resulting from trauma (such as road accidents) or from disease or degeneration (such as cancer). SCI, with its resultant paralysis is one of the most devastating medical conditions of public health importance.
Every year 250000-500000 people suffer from SCI globally. Majority of these cases are due to preventable causes such as road traffic accidents, falls, violence. Premature deaths are two to five times more common in people with SCI than people without a spinal cord injury.
Spinal cord injury (SCI) resulting into paralysis has devastating physical, mental, social, sexual and vocational consequences for the injured. In addition, the injury increases the economic burden on the person who sustains an SCI and potentially his or her entire support network.
Symptoms of SCI may include partial or complete loss of sensation and movements of arms, legs and/or body. The most severe spinal cord injury affects the systems that regulate bowel or bladder control, breathing, heart rate and blood pressure.
Symptoms of spinal cord injury depend on the location of injury on the spinal cord and severity of injury. Symptoms may occur as
- partial or complete loss of sensory function
- inability to move arms, legs and/or body
- loss of control of bladder and bowel
- unnatural positioning of neck
- chronic pain
- signs of sock
The spinal cord is made of millions of nerves that carry messages between the brain and all parts of the body such as skin. muscles, organs. It is surrounded by bony rings called vertebrae or vertebral column. An injury to bony column can result in to damage to spinal cord or damage to spinal cord can also occur without damage to vertebral column.
After damage to spinal cord, the functions above the injury level continue to work but functions of spinal cord below the damage are affected. Spinal cord distributes following nerves-
- Cervical spinal nerves-C1-C8
- Thoracic spinal nerves (T1 to T12)
- Lumber spinal nerves (L1 to L5)
- Sacral spinal nerves (S1to S5)
Common causes of SCI -
- Motor vehicle accidents are major cause in younger individuals
- Falls- leading cause in elderly persons
- Sports/recreation activities are more common causes in males
- Diving into water that’s too shallow and hitting the bottom
- Electrical accidents
- Compression of the cord by a tumor, infection, or inflammation
- Aneurysm (ballooning of a blood vessel), compression of a blood vessel or a prolonged drop in blood pressure
In a trauma case the doctor will check first to make sure the patient has a working airway, proper breathing and pulse. The next step for diagnosing a spinal cord injury is to assess an individual’s neurologic function. A neurological examination includes testing for muscle strength, sensory function and movement in arms and legs/body.
Diagnostic tests for a spinal cord injury include:
- Plane x-rays-it detects vertebral misalignment or fracture though tissue masses such as injured ligaments or a bulging disc are not visible on conventional x-rays.
- Computerized tomography (CT)-it is used to detect bone fractures, bleeding, and spinal stenosis (narrowing of the spinal canal), but CT has less ability to image the spinal cord or identify ligament injury associated with an unstable spine than MRI. A CT scan may provide a better look at abnormalities seen on an X-ray
Magnetic resonance imaging (MRI)-It can detect brain and spinal trauma from injury, as well as helps in diagnosing brain and spinal cord tumors, herniated disks, vascular (blood vessel) irregularities, bleeding and inflammation that might compress the spine and spinal cord, and injury to the ligaments that support the cervical spine.
Essential measures for improving the survival, health and prevention from secondary conditions include the following.
- Timely, appropriate pre-hospital management: quick recognition of suspected spinal cord injury and first aid at the time of injury is very important in management of SCI, as proper care during transportation can minimize the further damage to the spinal cord.
- Immediate care appropriate to the type and severity of injury, rapid evaluation and initiation of injury management including immobilization of the spine, surgical intervention if required in accordance with the wishes of the patient and their family.
- Provision of providing ongoing health care to reduce risk of secondary conditions and improve quality of life.
- To provide health education to patient and their family.
- Access to skilled rehabilitation and mental health services.
- Use of appropriate assistive devices that can enable people to perform everyday activities they would not otherwise be able to undertake, reducing functional limitations and dependency.
The goal of management is to get the people with spinal cord injury to lead an inclusive life.
There are many potential complications related to spinal cord injury that may require specific treatment. These complications include:
- Urinary tract infections
- Inability to control bowel movements
- Chronic pain
- Pressure sores
- Infection in lungs
- Deep vein thrombosis,
- Osteoporosis, and
- Respiratory complications.
Effective interventions are available to prevent several of the main causes of spinal cord injury, including improvements in roads, safe vehicles and people’s behaviour on the roads to avoid road traffic crashes, and policies to stop the harmful use of alcohol and access to firearms to reduce violence.
On an individual level spinal cord injuries can be prevented by
- Always wear a seatbelt when driving or riding in a motor vehicle and use child safety restraints in the vehicle.
- Always wear a helmet when riding a motorcycle or bicycle.
- Never drive a motor vehicle under the influence of alcohol or drugs, or ride with anyone who has.
- Avoid distractions (like phone calls, texting) while driving and pay close attention to the road.
- Follow the speed limits and traffic rules.
- Keep a clean home eliminating fall hazards inside the house as slips and falls occur more frequently in the home.
- When participating in sports, always use appropriate protective equipment.
- Never dive into shallow and dirty water.
- Use window guards to prevent falls.
- Use clinical interventions for risk factors, such as visual impairment, alcohol or substance use.
- Never move someone who has a suspected spinal cord injury
Following trauma, seek immediate medical care in the following conditions:
- Severe pain in the neck, head or back
- Tingling or loss of sensation in the hands and feet
- Partial or complete loss of movements in arm/leg
- Urinary or bowel urgency, incontinence or retention
- Abnormal band-like sensations in the thorax (pain, pressure)
- Impaired breathing after injury
- Unusual lumps on the head or spine