Spinal cord injury (SCI): Treatment, symptoms, advice and help
About spinal cord injury
Spinal cord injury (SCI) is an injury to the spinal cord resulting in a temporary or permanent loss to its normal motor, sensory, or autonomic function.
Spinal cord injury: Incidence, age and sex
The incidence of spinal cord injury ranges from 27 to 47 cases per million population, per year. Males constitute about 80% of persons with SCI. More than 50% of all cases of SCI occur in persons aged 16-30 years.
Causes and prevention of spinal cord injury
Road traffic accidents remain the leading cause of spinal cord injuries worldwide. The other causes include falls, violence and sports injuries. A sudden, traumatic blow to the spine fractures or dislocates vertebrae and injures the cord. For prevention, it should be assumed that every trauma patient has a spinal injury until proven otherwise and all assessment and procedures must be performed with full spinal immobilization.
Signs & symptoms of spinal cord injury: Diagnosis
The signs and symptoms depend on the level and extent of injury. In a conscious patient, spinal injury can be excluded if: there is no pain, palpation of the spine is non-tender, neurological examination is normal and there is a pain-free range of movement.
The entire spine must be palpated and the overlying skin inspected. Motor function is assessed using a grading system (0-5) and sensory function is assessed using the dermatome map. A rectal examination is performed to assess anal tone, voluntary anal contraction and per anal sensation. Preservation of the perianal sensation indicates an incomplete cord injury and suggests that there should at least be some recovery.
Diagnostic imaging: 85% of significant spinal injuries will be seen on the standard lateral cervical spine radiograph recommended at the resuscitation of polytraumatised patients. Significant loss of vertebral body height, sagittal deformity and widening of the interpedicular distance (on the anterioposterior view) may signify an unstable injury of a vertebra.
CT scanning remains the most sensitive imaging modality in spinal trauma. Complex fracture patterns can be understood and an accurate assessment of spinal canal compromise by bony fragments can be made. Sagittal reconstruction is an important modality in assessing posterior column stability.MRI is best at visualizing the soft – tissue elements of the spine. It is possible to see spinal cord haemorrhage and epidural and pre-vertebral haematomas.
Spinal cord injury: Complications
Spinal cord injury can lead to loss of motor function like paraplegia or quadriplegia as well as loss of sensory and autonomic function. The leading causes of death in patients following SCI are pneumonia and other respiratory conditions.
Spinal cord injury: Treatment
About one-third of those with injury to the neck area will need help with breathing and require respiratory support. The steroid drug methylprednisolone appears to reduce the damage to nerve cells if it is given within the first 8 hours after injury.
Spinal realignment – in cases of cervical spine subluxation or dislocation, skull tongs are used to apply traction. Stabilisation – Many spinal injuries can be managed non-operatively with external support but, when possible, internal fixation should be used. Decompression of the neural elements – compression of the cord by bone and/or disc material requires surgical removal.