Last modified on April 20th, 2017 at 7:42 pm

in ,

The Hard Facts of Spinal Cord Injury (SCI)

Causes and levels of spinal cord injury – treatment and rehabilitation – is there a cure?

The Hard Facts of Spinal Cord Injury (SCI)

Last updated on April 20th, 2017 at 07:42 pm

Spinal cord injury (SCI), as the name suggests, is an injury to the spinal cord which can be traumatic or non-traumatic. Most cases are the result of physical trauma or injury to the spinal cord while non-traumatic SCI can be toxic or result from lack of blood flow, a condition known as ischemia in medical terminology. Compression of the cord from tumors and infection can also cause non-traumatic spinal cord injury.

Spinal cord injury can be complete where there is minimal or no sensation and muscle function below the injury level or incomplete with partial sensation as some nervous signals from the brain can pass through the injured part of the spinal cord.

The location or level of injury is the basis on which prognosis is possible, which can be anything from total recovery – a remote possibility – to partial or total loss of sensory and motor functionality of the torso and all four limbs medically known as tetraplegia or quadriplegia. However, in quadriplegia the arms are spared – only the legs and torso are affected.

Now, having got a general idea of spinal cord injury let’s take this a step at a time to give it some chronology.

Spinal Cord – The spinal cord is a tubular shaped, long, thin and compact bundle of nerves and cells starting at the base of the brain called the medulla oblongata and extending down the vertebral column – the backbone or spine, as we know it. It does not, however, span the entire length of the vertebral column but ends at the lumbar region of the spine. The length of the cord varies according to sex, 18 inches (45 cm) long in adult males and 17 inches (43 cm) in women.

The spinal cord runs down the protective cavity of the comparatively longer vertebral column which is made up of thirty-three segmented bones called vertebrae. While the lower nine are fused together the upper twenty-four are separated by intervertebral discs that allow marginal movement of the vertebrae.

The spinal cord combined with the brain forms the central nervous system of the body. It is the lifeline that allows sensory and nervous information from the command center of the nervous system – the brain – to travel through it to the peripheral nervous system enabling normal bodily functions.

The peripheral nervous system is a network of nerves coming out from either side of the spinal cord and spreading through the entire body to carry commands from and to the brain through the main line, the spinal cord.

The peripheral nervous system together with the central nervous system allows the brain to control our bodily functions which can be classified into three categories:

Motor Function – allows the voluntary movement of the body muscles like the movement of limbs, walking, running, talking, use of hands etc.

Sensory Function – This function controls the sense of feeling – like touch, pressure, pain and temperature.

Autonomic Functions – are those functions that do not require conscious intervention in that they are the involuntary 24/7 functions of the body like digestion, respiration, heartbeat, urination, body temperature, blood pressure, etc. that are going on even while we are asleep.

Injury to the spinal cord can wholly or partially affect either or all of these three functions.

Spinal Cord Injury – Spinal cord injury can be broadly classified into three main categories: mechanical, toxic and ischemic as discussed depending on whether the SCI is traumatic or non-traumatic.

Mechanical SCI – is a traumatic spinal cord injury as a result of physical trauma to the spinal cord from a car crash, sports accident, gunshot, a fall, or any other accidental damage to the spine.

Toxic and Ischemic SCI – are non-traumatic and result from damage to the spinal cord from toxins or lack of proper blood flow respectively.

Levels of Spinal Cord Injury – As mentioned earlier, the purpose of the vertebral column comprising 33 vertebrae is to provide protection to the spinal cord. The spinal cord is housed within a cavity in the vertebral column known as the spinal canal.

.
.

Now, the 33 vertebrae in the vertebral column are divided into five sections in relation to the curves in the column. The first seven vertebrae, starting at the top, are in the cervical curve and are called cervical vertebrae (C1 – C5); the next twelve are called thoracic vertebrae (T1 – T12) as they are in the thoracic curve region; The lumbar curve has five lumbar vertebrae (L1 – L5).

The last nine vertebrae which are fused together are divided into two sections; the upper five are the sacrum vertebrae (S1 – S5) and the lower four are the coccygeal vertebrae (tailbone) and together they form the sacral curve of the spine. The last four are not assigned numbers, though.

As nerves branch out from the spinal cord to different parts of the body through gaps in the vertebrae, the higher the level of injury in the vertebral column the more severe is the resultant damage. The following table will give us a better understanding of the different levels of injury and their severity.

C1 – C4 – High Cervical Nerves

* Damage to the spinal cord at this level is the most severe and can cause paralysis in the arms, hands, legs and torso.

* Unaided breathing may not be possible and the patient is likely to lose bladder and bowel control.

* Impaired or reduced speech is another possibility with spinal cord injury at this level.

* Renders the patient incapable of daily activities like eating, bathing, dressing and getting in and out of bed and requires a dedicated caregiver 24/7.

C5 – C8 – Low Cervical Nerves

Nerves at this level control the arms and hands and the severity of the damage depends on which particular vertebrae level the nerves have been damaged.

C5 level injury

* The patient is able to raise the arms and bend the elbows with the likelihood of total or partial paralysis of the wrists, hands, torso and legs.

* Speech and use of diaphragm will remain unaffected; however, respiration will get affected resulting in breathing issues.

* Will need assistance with most day to day living activities but will be able to move unaided in a powered wheelchair.

C6 level injury

* Paralysis in hands, legs, and torso with affected wrist extension. However, the patient should be able to bend the wrists backward.

* Speech and use of diaphragm will remain unaffected; however, respiration will get affected resulting in breathing issues.

* Minimal or no voluntary control of bladder and bowel but should be able to manage independently with specialized equipment.

* Assistive equipment will be needed for moving in and out of bed and wheelchair and may also be able to drive a customized vehicle specific to the limitations of the patient.

C7 level injury

* At this level, nerves control elbow extension and some finger extension are likely, as well.

* Straightening of arms and normal shoulder movement is possible with most C7 level spinal cord injury.

* Most day-to-day activities are possible independently but assistance with more difficult tasks will be necessary.

* Minimal or no voluntary control of bladder and bowel but should be able to manage independently with specialized equipment.

* Assistive equipment will be needed for moving in and out of bed and wheelchair and may also be able to drive a customized vehicle specific to the limitations of the patient.
C8 level injury

* Nerves will control limited hand movement and patient should be able to hold and release objects.

* Most day-to-day activities are possible independently but assistance with more difficult tasks will be necessary.

* Minimal or no voluntary control of bladder and bowel but should be able to manage independently with specialized equipment.

* May also be able to drive a customized vehicle specific to the limitations of the patient.

Thoracic level injuries (mid-back region)

T1 – T5 level injury

* Injury at this level generally affects the torso and legs as the corresponding nerves affect the muscles, upper chest, abdominal muscles, and mid-back. The condition is called paraplegia and the sufferer is referred to as paraplegic.

* Use of manual wheelchair possible.

* May also be able to drive a customized vehicle specific to the limitations of the patient.

* Most can stand with the help of a standing frame while others may be able to walk using braces.

T6 – T12 level injury

* Abdominal and back muscles are likely to be affected depending on which particular T level the injury is at with resultant paraplegia being a distinct possibility.

* Normal upper body movement with relatively good torso control and balance when seated.

* Minimal or no voluntary control of bladder and bowel but should be able to manage independently with specialized equipment.

* Use of manual wheelchair possible.

* May also be able to drive a customized vehicle specific to the limitations of the patient.

* Most can stand with the help of a standing frame while others may be able to walk using braces

Lumbar level injuries (L1 – L5)

* Injury at this level results in some loss of functionality of the hips and legs.

* Minimal or no voluntary control of bladder and bowel but should be able to manage independently with specialized equipment.

* May be able to walk with braces.

Sacral level injuries (S1 – S4)

* Injury at this level results in some loss of functionality of the hips and legs.

* Minimal or no voluntary control of bladder and bowel but should be able to manage independently with specialized equipment.

* High likelihood of being able to walk

Steps followed for diagnosis of spinal cord injury

* The attending doctor will collect as much information as possible with the emphasis on the medical history of the patient, the circumstances and time of the injury. The amount of time elapsed since the injury is important to know as a spinal cord injury is a medical emergency that requires immediate attention to limit the damage and enhance the chances of recovery.

* Details of previous injuries or surgeries to the head, neck or spine will be asked for.

* Pain in the back or neck areas, weakness in the limbs, loss of bladder or bowel control, loss of sensation in the limbs, details of other previous medical conditions suffered by the patient will have to be provided to the physician.

* The diagnostic procedure will include a thorough physical examination to check and gauge sensation to touch, muscle strength and reflexes in the limbs.

* The next logical step in the diagnosis is x-rays of the neck or back or both to identify the level and nature of the injury such as vertebrae fracture.

It must be noted that fracture or dislocation of the vertebrae may occur in traumatic SCI but if the spinal cord injury is the result of non-traumatic causes, ischemic or toxic, the x-rays will not show any crack or dislocation of the vertebrae. However, x-rays can help identify the presence of these non-traumatic causes, as well, such as a tumor or infection or even chronic and severe arthritis which can cause SCI.

The more advanced and sophisticated computer tomography, popularly known as CT scan, is a better alternative to x-rays in that it provides a better and enhanced view of the vertebrae to the doctor and has the ability to show injuries that are not visible on regular x-rays.

The magnetic resonance imaging or MRI scan is an even better option than the previous two because of its ability to evaluate soft tissue like nerves, ligaments, intervertebral discs and the spinal cord itself.

Treatment of spinal cord injury

* The first step involves checking if the patient is able to breathe and whether the heart is beating and accordingly the physician decides whether a breathing tube and ventilator are needed or not.

* Immobilization is the next step in treating SCI. This should be done at the paramedic level before the patient is transferred to the hospital. The idea is to ensure minimal or no movement, if possible, to avoid chances of further aggravating the injury. For this purpose, the patient may be put in a cervical collar or on a backboard.

* Once the diagnosis is complete and if spinal cord injury is detected the patient might be put on high potency steroids to reduce inflammation which can further damage the spinal cord. As steroids have a risk factor attached to their use in spinal cord injury patients the final decision lies with the physician. Steroids can make some difference only if administered within eight hours of the trauma.

* The patient is then placed in traction or a halo-like device around the head in order to provide stability to the spine and prevent further injury.

* Some cases may require surgery for two main purposes, basically. The first and foremost goal of surgery in SCI is to remove the presence of any pressure on the spinal cord. For example, broken vertebrae may be pressing against the spinal cord and need to be removed.

The second and main purpose of surgery is stabilizing the vertebral column itself if weakened by broken vertebrae or by disease. It is the major goal because stability and strength in the vertebral column are integral to the health of the spinal cord. Screws, plates, and rods may be necessary to repair the damage to the vertebral column.

.
.

After the first up treatment, which is basically to save the life of the patient or minimize further damage to the spinal cord, the patient needs to go through a long drawn rehabilitation program to help the patient enhance bodily functions through various therapies and assistive devices.

Cure

There is no known or definite cure for spinal cord injuries, yet. However, constant work is going on in this regard by dedicated and devoted physicians and medical scientists whose research include treatment through stem cell implants, engineered materials for tissue support which involves the potential use of silk-fiber matrix material for tissue engineering anterior cruciate ligaments (ACL), and robotic exoskeletons which can be worn by an SCI patient for a better quality of life.

A lot of advancement has been witnessed in the treatment of spinal cord injuries over the years and considering the kind of work being put in by researchers and scientists towards finding a cure for SCI, it’s a distinct possibility that we may soon have a cure for this debilitating affliction.

Leave your vote

6 points
Upvote Downvote

Total votes: 6

Upvotes: 6

Upvotes percentage: 100.000000%

Downvotes: 0

Downvotes percentage: 0.000000%

Leave a Reply

Your email address will not be published. Required fields are marked *