Spinal Cord Injury | Know Symptoms, Diagnosis and Rehabilitation

What Is Spinal Cord Injury and How It Occurs?

• Injury to the spinal cord is the result of road accidents, industrial and sports accidents, direct injury to cord with high velocity objects or a sharp instrument.
• It may result in total and irreversible damage or the outcome may be more favorable; depending on degree of structural damage and functional deficit.
• Often the vertebral column is also involved in the injury.
• Injury to the cord may be a contusion, stretch, laceration or crush injury.

Symptoms of Spinal Cord Injury

Spinal cord injury may cause a variety of syndrome, depending on the extent of cord involvement.

• Complete transaction- it begins with a stage of spinal shock, when there is total motor and sensory loss below level of lesion, paralysis of sphincter and absence of tendon reflexes.
  Within one to 6 weeks minimum reflex activity appears. After few weeks, tendon reflexes get exaggerated and plantars become extensor.
• Brown-Sequard syndrome- this is a hemi-cord syndrome with ipsilateral paresis (same side) and impairment of vibration and joint position sensation and contra-lateral loss of pain and temperature sensation; usually touch sensation is preserved.
• Central cervical cord syndrome is an incomplete lesion of the cord which involves mainly the grey matter around the central canal. It is often due to hemorrhage into the canal.
• Anterior cervical cord syndrome- it involves the anterior part of the spinal cord with acute total paralysis and impairment of touch and pain sensation but preservation of vibration and position sense.
• Posterior cervical cord syndrome- it is characterized by symmetrical paresthesia (an abnormal sensation) of burning nature. This condition is reversible. Clinical findings indicate the level of lesion in spinal cord. ‘Sensory levels’ and tendon reflexes are good indicators of level of lesion.
• Conus medullaris lesions produce early signs of urinary retention, constipation, back pain, hypoesthesia or anesthesia over sacral region, impotence and lax anal sphincter. Sometimes there may be weakness of lower limbs.

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.

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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