What is the Spinal Cord ?

The group of nerves travelling from the base of the brain reaching down the back is known as the spinal cord. There are 31 pairs of nerves which run off from the spinal cord and reaching to the abdomen, legs, chest and arms. The commands are then given to the brain by these nerves to the muscles that in turn results in the movement of legs and arms. The nerves controlling legs leave from the lower part of the spinal cord, while the nerves controlling arms leave from the upper part of the spinal cord. The function of the organs such as lungs, heart, bladder and bowels are also controlled by these nerves.

What is Spinal Cord Injury ?

Any trauma or damage to the spinal cord resulting in impaired or loss of function due to reduced feeling or mobility is termed as spinal cord injury (SCI). Gunshot, car accident and sport injuries are the traumas that can cause damage to the spinal cord. Polio, Spina Bifida, Transverse Myelitis and Friedreich's Ataxia are the diseases that can cause damage to the spinal cord. It has been seen that the spinal cord is intact in many people who are suffering from SCI, though it results in loss of functioning as cellular damage is caused to the spinal cord. The SCI is dissimilar to other back injuries that include pinched nerves or spinal stenosis and ruptured discs.

Types of Spinal Cord Injury (SCI)

Spinal cord injuries (SCI) are of two types- complete spinal cord injuries and incomplete spinal cord injuries. When the injuries cause complete loss of function below the point of injury is termed as complete spinal cord injuries. On the other hand, when the injuries cause some feeling and sensation below the level of injury is termed as incomplete spinal cord injuries.

Complete Spinal Cord Injury

Complete tetraplegia or complete paraplegia is caused by complete spinal cord injuries. The permanent loss of nerve and motor function at T1 stage or below that result in loss of movement and sensation in the bladder, sexual region, legs and bowel is termed as complete paraplegia. People suffering from complete paraplegia have limited trunk movement that enables them to stand or walk short distances with the help of walking equipment.

Incomplete Spinal Cord Injury

As compared to complete injuries, incomplete injuries are considered as most common. Incomplete injuries involve some degree of movement and sensation below the level of injury. These injuries can cause some movement but no or little feeling, or some feeling but no or little movement. These injuries can be classified in five different types -

• Brown-Sequard Syndrome
• Anterior Cord Syndrome
• Cauda Equina Lesion
• Posterior Cord Syndrome
• Central Cord Syndrome

Symptoms of Spinal Cord Injury

• Loss of bladder or bowel control
• Difficulty in coughing, breathing or clearing secretions through the lungs
• Exaggerated reflex spasms or activities
• Loss of movement
• Intense stinging or pain caused by damage to the nerve fibers in the spinal cord
• Loss of sensation that include the ability to feel cold, heat and touch
• Changes in sexual function, sexual fertility and sensitivity

Emergency Symptoms of Spinal Cord Injury after an Accident

• Loss of bowel or bladder control
• Twisted or odd position of the back or neck
• Tingling, loss of sensation or numbness in the fingers, hands, toes or feet
• Difficulty in walking
• Difficulty with balancing
• Extreme pressure or back pain in the head, back or neck
• Impaired breathing after injury
• Weakness or paralysis in any body part

Causes of Spinal Cord Injury

The broken bones or damage in the neck or back causes spinal cord injuries that also damage the nerves of the spinal cord. This usually results in traumatic injury caused by -

• Violence
• Motorcycle or car accidents
• Surgery
• Sports injuries
• Accidents at work or at home

Non-traumatic injury can also cause spinal cord injuries that include -

• Medical conditions like spina bifida and multiple sclerosis
• Viral or bacterial infection of the spinal nerve cells
• The problem of blood supply to the spinal cord
• Growths pressing on the spinal cord

Effects of Spinal Cord Injury

• Loss of numbness or sensation
• Erectile dysfunction
• Breathing difficulties
• Constipation and faecal incontinence caused by loss of bowel control
• Pain
• Paralysis or muscle weakness
• Reduced control of body temperature
• Incontinence caused by loss of bladder control

Diagnosis of Spinal Cord Injury

Spinal cord injury is a serious condition that requires urgent medical attention. Physical exam and neurological exam (brain and nervous system) of a patient is performed. These tests help in determining the exact location of the injury if the injury is unknown. The different tests include -

• Spine X-rays
• MRI or CT scan of the spine
• Somatosensory evoked potential (SSEP) magnetic or testing stimulation
• Myelogram is the X-ray of the spine after injecting dye

Treatment of Spinal Cord Injury

This is medical urgency that requires immediate treatment. Time in between the injury and treatment is the crucial factor that affects the result of the treatment. Methylprednisolone or dexamethasone is the corticosteroids that are used for reducing the swelling that can cause damage to the spinal cord. Paralysis may improve if the spinal cord pressure is due to growth which can be removed before the spinal nerves are totally damaged.

Surgery is performed for -

• Removing disc fragments, foreign objects and bone fragments
• Fusing the broken spinal bones or placing of the spinal braces
• Removing tissue or fluid that presses on the spinal cord (decompression laminectomy)

Complete bed rest is recommended for allowing the bones of the spine to heal. Sometimes spinal traction is also suggested that can help in moving the spine. A patient is required to wear spine braces for a long period of time.

After the injury has healed, occupational therapy, some rehabilitation therapies and physical therapy may also be required. Medications can be used for relieving muscle spasticity. These medications are injected or taken by mouth into the spinal canal.

Recovery from Spinal Cord Injury

When the condition of a patient has stabilized, it is important to begin the rehabilitation process soon so that muscles do not atrophy. The physical therapists can provide the best care for recovery due to advancement in the technology.

In the initial stage of rehabilitation, emphasis in given on regaining arm and leg strength as communication and mobility are the two most significant functional areas. In some patients, mobility is provided with the help of wheelchair, walker or leg braces. The redevelopment of motor skills is done by the means of occupational therapy. On the other hand, physical therapy improves muscle strengthening.

Cost of Spinal Cord Injury Treatment

Spinal cord injury treatments in India are very cost-effective as compared to other countries in the western hemisphere.