Spinal cord injury

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Spinal cord injury is a traumatic condition that can cause permanent changes in sensation, strength and other bodily functions below an injured spot in the spinal column. Read and know all about Spinal cord injury, including its various causes, symptoms, treatment options and rehabilitation.

What is Spinal cord injury?

Spinal cord injury (SCI) is the name given to any injury to the spinal cord resulting from causes other than disorders, such as trauma.

Spinal cord injury ICD9 Code

The ICD9 Code for the disorder ranges from 952.0 – 952.9.

Spinal cord injury Statistics

Approximately 8 out of every 10,000 individuals in the United States are affected by this condition every year.

Spinal cord injury Types

Injuries of the spinal column are classified into two categories:

Complete Spinal cord injury

In a complete Spinal cord injury, the cord fails to relay messages under the level of injury. Due to this reason, patients are paralyzed below the level of trauma.

Incomplete Spinal cord injury

In an incomplete Spinal cord injury, affected individuals experience some sensation and have the ability of movement in the area under the region of injury.

Spinal cord injury Causes

This type of injury generally arises after a hit or blow that dislocates or fractures the vertebrae – or the bone disks that constitute the spine. It may also arise as a result of a knife or gunshot wound that cuts or penetrates the spinal cord. Additional damage generally occurs over a period of days or weeks due to inflammation, accumulation of fluids and bleeding in and around the spinal cord. The majority of such injuries do not sever the spinal cord. Rather, they result in damage when bits of vertebrae press down on the sections of the nerves that transport signals or tear into cord tissue.

A non-traumatic Spinal cord injury may result from factors like:

  • Arthritis
  • Cancer
  • Inflammation
  • Infections
  • Disk degeneration of the spine

The injury arises due to the following factors:

  • Motor vehicle accidents (responsible for 45% of all cases)
  • Acts of violence (17%)
  • Falls (18%)
  • Sports injuries (12%)

Spinal cord injury Risk Factors

The condition generally arises due to an accident or trauma. Anyone can suffer from this disorder. However, certain factors may predispose an individual to this type of injury. These include:

Being male

Injuries of the spinal cord affect many males. Traumatic spinal cord injuries are found to affect only about20 percent females in the United States.

Being young

These injuries are mainly seen in individuals aged between 16 and 30 years of age. In people under the age of 65 years, motor accidents are the main cause of injuries of the spinal cord. In older adults, falls are responsible for most injuries of this type.

Engaging in potentially injurious activities

Diving into extremely shallow water or engaging in sports activities without wearing proper safety gear or taking adequate precautions can increase susceptibility to spinal cord injuries.

Having a bone or joint disorder

An injury of the spinal cord may also originate from a comparatively minor injury if affected people are already suffering from another disorder that affects the joints or bones, such as Osteoporosis or Arthritis.

Spinal cord injury Symptoms

Any type of injury of the spinal column may lead to one or more of the following signs and symptoms:

  • Loss of movement
  • Loss of bladder or bowel control
  • Exaggerated spasms or reflex activities
  • Loss of sensation, including the ability to feel heat, cold and touch
  • Changes in sexual sensitivity, sexual function and fertility
  • Difficulty in breathing, coughing or clearing secretions from the lungs
  • Pain or acute stinging sensation resulting from damage to the nerve fibers in the spinal cord

The symptoms of emergency cases of injury of the spinal column after an accident may involve:

  • Loss of bladder or bowel control
  • Impaired breathing after injury
  • Difficulty in walking and maintaining balance
  • Odd positioning or twisting of the neck or back
  • Extreme back pain or pressure in the back, neck or head
  • Weakness, paralysis or incoordination in any area of the body
  • Tingling, numbness or loss of sensation in the fingers, hands, toes or feet

Injurious conditions of the spinal cord may also lead to Paralysis. When the injury affects the hands, arms, trunk, pelvic organs and legs, Quardiplegia or Tetraplegia may occur. If the injury affects all or part of the pelvic organs, legs and trunk, Paraplegia may originate.

Spinal cord injury Diagnosis

In an emergency setting, physicians may be able to differentiate an injury to the spinal cord with the aid of inspection, testing movement and sensory function, and asking patients some questions about the accident that might have resulted in the injury.

However, emergency diagnostic exams may be required if the injured individual is not completely awake, complains of neck pain and has obvious symptoms of neurological injury or weakness. Such tests may involve the following:

X-rays

Medical professionals generally recommend X-rays for people who are suspected of suffering from an injury of the spinal cord after an accident or trauma. These tests can show various problems in the spinal column, such as degenerative changes, tumors, fractures or other issues.

Computerized tomography (CT) scan

Problems in the spinal column can be better detected with a CT scan than an X-ray exam. CT scan makes use of computers to construct a series of cross-sectional images that can specify problems in the spinal disks or bones.

Magnetic resonance imaging (MRI)

MRI scans make use of radio waves as well as a strong magnetic field to render computer-generated images. These scans are extremely assistive in assessment of the condition of the spinal column and detecting blood clots, herniated disks or other lumps that could be pressing on the spinal cord.

When some of the inflammation may have reduced a few days following the actual injury, a physician is likely to carry out a neurological exam to assess the level and wholeness of the trauma. This includes a pinprick on the region, testing the ability of affected individuals to sense light touch and also determining their muscle strength.

Spinal cord injury Differential Diagnosis

The differential diagnosis of this disorder involves distinguishing the signs of a spinal cord injury from those of Spinal abscess, which leads to difficulties that are similar in nature.

Spinal cord injury Treatment and Rehabilitation

The cure for this disorder aims at preventing further injury to the spinal cord as well as empowering sufferers to return to a productive and active life.

Spinal cord injury management mainly aims at providing relief from any type of pressure on the spinal cord as well as stabilization and realignment of any dislocations or fractures. This may be done with the aid of traction and/or surgical intervention. Before any surgical intervention, sufferers must be stabilized.

Skeletal traction may be the initial choice for the treatment of dislocations or fractures of the neck (cervical) vertebrae. Crutchfield tong, which is a tight-fitting tong, may be placed on the head to realign the neck vertebrae with the help of weighted traction. In order to assist in maintaining spinal alignment, special beds such as Kinetic therapy bed or Stryker frame may be used until the stabilization of the vertebrae. These beds allow patients to turn safely from one side to another without disturbing proper alignment of the injured spine. Physicians may administer Corticosteroid medications to reduce inflammation in the spinal cord.

The damages to the spinal cord cannot be reversed. As yet, researchers are constantly trying to develop new treatment measures, including prostheses and drugs that may promote regeneration of the nerve cells or better the function of the nerves that persist after a Spinal column injury.

Spinal column injury sufferers are generally admitted to ICU (Intensive Care Unit) for treatment. Treatment basically includes:

Medications

The drug Methylprednisolone (Medrol) is usually a curative option for an acute spinal cord injury. If the medication is administered within eight hours of injury, it can bring about mild improvement in the condition of some patients. It seems to yield benefit by lowering damage to nerve cells and reducing swelling close to the injured spot.

Immobilization

Patients may require traction to stabilize the spine and bring it into proper alignment. In some cases, traction is performed by securing metal braces (affixed to a body harness or weights) to the skull of patients to avoid the movement of their heads. In certain patients, a rigid neck collar may be effectual. A special bed may also be effective in immobilizing the body.

Surgery

Operative treatment is often necessary for removal of bone fragments, herniated disks, fractured vertebrae or any foreign objects that seem to be pressing on the spinal column. Operation may also be required to stabilize the spine and avoid the risk of any pain or deformity in the future.

Experimental treatments

Researchers are still trying to find out ways that can stop the destruction of cells, promote nerve regeneration and manage swelling in patients. Patients or their family members should ask physicians about the availability of these types of treatment options.

Spinal cord injury Recovery

The outcome is based on the extent and location of the injury to the spinal column. Between 10-20% people with traumatic spinal cord injury tend to die prior to hospitalization. Death is possible even after hospitalization, especially in cases where the breathing muscles suffer paralysis.

In others, recovery of sensation or movement within one week generally indicates eventual recovery of the majority of functions. However, this may take 6 months or even more. Serious cases of injury reduce life expectancy in sufferers. In such patients, Pneumonia is the main cause of death. Mental adjustment to this type of disability can be slow in nature. In affected individuals under 25 years of age, the rate of suicide is higher than average.

Spinal cord injury Complications

The complications of injury in the spinal column include:

  • Loss of bowel control
  • Loss of bladder control
  • Problems in muscle tone
  • Nerve pain
  • Depression
  • Sexual health issues, such as changes in ejaculation (in men) and lubrication (in women)
  • Difficulties in breathing and coughing
  • Circulatory problems, ranging from low blood pressure to inflammation of the extremities

A rehabilitation team is likely to assist patients develop strategies to address the changes resulting from injury to the spinal column.

Spinal cord injury Prevention

The following measures can reduce the risk of injury to the spinal column and even avoid the occurrence of the condition altogether.

Driving safely

As car crashes are one of the major causes of this type of injury, it is important to wear a seat belt every time while riding in or driving a car. It is important for parents to ensure that their children wear a seat belt or use a proper seat safe for their age and weight. Children who are less than 12 years old should always ride in the rear seat to prevent health hazards due to air-bag injuries.

Checking the depth of water before diving

It is also important to avoid diving into shallow water that can increase the risk of this type of injury. One should avoid diving into an aboveground pool, pools that are less than 9 feet deep and water of uncertain depth.

Preventing falls

It is best to use a step stool with a grab-bar to get objects located in high regions. Other measures to avoid falls include placing nonslip mats in shower, tub and on tile floors; adding handrails along stairways; and installing window guards and placing safety gates to block stairs to prevent falls in young children.

Taking proper precautions while playing sports

It is recommended to always wear safety gear and protect head during sports activities. Baseball players should not slide headfirst, nor should football players tackle by using the top of the helmet. For fresh moves in gymnastics, one should always use a spotter.

Not driving while being drunk

It is always recommended not to drive under the effect of drugs or while being intoxicated. One should not ride with a driver who has been drinking.

 

If you are experiencing severe trauma to the head or neck after an activity, you should seek immediate medical evaluation for possible Spinal cord injury. Early determination and treatment can help you avoid further complications and reverse the condition while it is still in the early stages.

References:

http://www.nlm.nih.gov/medlineplus/spinalcordinjuries.html

http://www.mdguidelines.com/spinal-cord-injury

http://www.mayoclinic.com/health/spinal-cord-injury/DS00460

http://en.wikipedia.org/wiki/Spinal_cord_injury

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