Human spine is a bony vertebral column situated in the back and the neck. Spinal cord inside the vertebral column is made up of number of nerve cells and nerve fibers. The main function of spinal cord is to carry messages to and fro, from the brain to different parts of the body.
Spinal injury is injury to the bony spine and the spinal cord inside it. Spinal injuries are considered serious because they can damage the delicate nerves of the spinal cord, and cause loss of sensation and/ or loss of movement.
What Are The Causes Of Spinal Injuries?
Spinal injuries can result due to number of reasons, such as road accidents, fall from a height, diving into shallow water, gunshot wounds, accident while working in a factory, sports injury, assault, or due to complication following a spine surgery.
Diseases and infection such as polio myelitis, tumors compressing the spinal cord, spina bifida etc. are other causes of spinal injuries.
Among the traumatic injuries to the spine, road accidents are considered as the largest accountable cause all over the world. Sports related spinal injuries are considerably less as compared to other traumatic spinal injuries.
Most of the spinal injuries occur in younger age group. The risk factors for spinal injuries include; performing high risk physical activities, diving in shallow water, and not wearing protective gear while playing or working in industry.
Symptoms Of Injury To Spinal Cord
The symptoms of spinal injury depend on its location. The injury can occur in the cervical, thoracic lumbar or sacral spine. The spinal cord runs through the cervical, whole of thoracic and ends in the first lumbar spine. Injury below the first lumbar spine does not affect the spinal cord; however it may affect the nerve roots arising from this area.
The injury can be complete, meaning complete damage to the spinal cord or incomplete meaning there is partial damage to the nerve cells in the spinal cord.
Spinal cord injury causes loss of sensation and weakness of the affected part, below the point of injury.
Cervical spine injury: It is the injury in the neck area and it can affect organs of middle part of the body, arms and leg. Main symptoms include:
- Weakness, numbness and tingling in the arms and legs.
- Difficulty in breathing due to paralysis of the muscles of the respiratory tract.
- Loss of bladder control.
- Loss of bowel control.
- Difficulty in walking straight.
- Paralysis of all four limbs or lower limbs depends on the lesion in the spinal cord.
Thoracic spine injury: it is the injury to the spinal cord at chest level, where thoracic spine is situated. Common symptoms are:
- In complete spinal cord damage, there is loss of bowel and bladder control.
- Numbness and tingling in the lower extremity.
- Pain radiating from back to the front of abdomen.
- Loss of sensation.
- Paralysis of lower limbs.
Lumbar spine symptoms
- Loss of bowel control.
- Loss of bladder control.
- Numbness.
- Pain in lower legs.
- Difficulty in walking.
- Difficulty in balancing.
- Paralysis.
Diagnosis of Spinal Cord Injury
- Plain X-ray spine anterior-posterior and lateral view will suffice for immediate localization of injury.
- MRI will help to evacuate the exact degree of spinal cord damage and type of injury.
Treatment For Spinal Injuries
Spinal injury needs an urgent medical attention. It is necessary to know the severity of damage to the spine and spinal cord. So that further complications can be prevented.
Doctor will advise for an urgent X-ray of the spine or MRI of the spine to know the extent of damage. If the injury is limited to the spine without damaging the spinal cord, the physician advises to take rest and use braces to support the spine. Rest helps to fuse the injured spinal bones without causing further damage.
If there are symptoms indicating damage to spinal cord, an emergency treatment in the hospital is necessary to prevent deterioration of health.
- The first step is to immobilize the patient.
- Access the extent of damage.
- Give the necessary life support.
- Medications are given to reduce the inflammation.
- Surgery may be necessary to remove the fluid or tissue compressing the spinal cord and remove the bone fragments. The surgeon fuses the broken spinal bones.
- Spinal brace may be needed to be worn for a long period of time.
- Physiotherapy, occupational therapy, may be necessary for long period.
Management and Rehabilitation of Spinal Cord Injury
- Management of patient begins at the scene and moment of accident.
- Transport of patient must be done with utmost care, to avoid further damage to the cord by even slight movement of vertebral column.
- The patient must be placed flat on a hard surface.
- Basic physiological parameters must be monitored and the patient should be taken to a hospital immediately.
- After careful evaluation, surgical decompression is undertaken if indicated.
- Effect of mannitol and other methods in medical management is not clear.
- At present, methyl prednisolone is used for complete and incomplete lesions and started within 8hrs of injury.
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