Spinal Cord Injuries
Causes of spinal cord injuries include motor vehicle accidents (39%), acts of violence (14%), falls (30%), and sports (most of these are from diving accidents). Summer is the worst time for spinal cord injuries, with July having the highest incidence in the US. They happen more frequently on weekends and at nights. Most people who get spinal cord injuries are male (82%) and the median age at the time of injury is 31.7 years. Alcohol plays a big role in SCI; it is involved in cause of twenty five percent of cases. The National Spinal Cord Statistical Center estimates 12,000 Americans suffer SCI every year and 270,000 Americans are living with some form of SCI.
Preexisting spinal disease can cause some people to be more susceptible to getting SCI. These include:
- Atlantoaxial instability
- Cervical spondylosis
- Congenital conditions
- Spinal Arthropathies
There are several types of sci or spinal cord injury treatment. Even though SCI is often not curable, medicine can lessen the burden on the body and supportive care can lessen complications. Like most injuries, SCIs can be temporary or permanent, but unfortunately most are permanent and leave the patent with a disability.
Scientists are engaged in exciting research to develop SCI therapies, including new medications, using the patient’s own white blood cells (macrophages), and transplantation of amniotic or embryonic cells into the injured area. While these treatments are not yet available for the treatment of SCI patients, on-going progress gives hope to those with SCI and their families.
Life expectancy is lower for SCI patients. A lot of deaths happen in the first year as the body struggles to adjust. For people who get past the first year, life expectancy averages 90% that of the non-SCI patients. The most common causes of death are respiratory ailments and cardiovascular illnesses. Injuries above the T6 level are often complicated by autonomic dysreflexia. This condition usually appears within a year of the injury and causes many cardiovascular problems.
High-up spinal cord injuries cause respiratory problems. Impaired cough makes it difficult to discharge lung secretions so patients are at increased risk for pneumonia. Pulmonary embolism - caused by a blood clot in the main artery of the lung - is very dangerous and unfortunately common. Neurogenic bladder means the SCI patient has trouble storing and discharging urine.
About 30% of spinal cord injuries are incomplete and the patient may have movement capabilities below the injury point. The most common type of incomplete SCI is central cord syndrome, Many people with this syndrome can walk with some competence.
Osteoporosis in SCI patients
Bones in the body are constantly in a process of renewal. The mineral content is being re-absorped into the bloodstream and new mineral is being deposited. When the mineral content and bone density declines over time, the person is diagnosed with osteoporosis.
Osteoporosis is common in SCI patients. Although scientists aren’t sure why osteoporosis happens, sedentary behavior appears to contribute to the onset. SCI patients obviously do not move their paralyzed areas as much as other people. The nervous system may also play a part in osteoporosis.
SCI patients’ osteoporosis develops differently from other patients’. The leg bones have rapid loss of minerals while the spinal cord is less affected. Patients with quadriparesis also lose bone mass in their arms. Heterotopic ossification is the deposition of bone around peripheral joints. This happens very frequently and is a cause of degraded quality of life in SCI patients.
Pathophysiology and Presentation of SCI
A majority of spinal cord injuries are due to injury to the vertebral column. This can include:
- Fracture of the bony material
- Dislocated joints
- Torn ligaments
- Herniated discs.
The injuries show the force and the direction of what happened to produce the injury. Spinal injury mechanics display flexes, extension, rotation, and/or compression. Most vertebral injuries in older people involve dislocation and fractures.
The timeline of a spinal cord injury can be split into primary and secondary injury. Primary injury refers to the immediate effects of the trauma which may include compression, contusion, and a shear injury to the spinal cord. In the absence of a frank hemorrhage (which is rare in non penetrating injuries), the cord may appear to be completely normal right after the event occurred. Penetrating injuries, such as a stabbing, or a gunshot wound, usually result in partial or complete transection of spinal cord. A remarkable action is when a spinal cord injury occurs following a gunshot wound that does not penetrate the spinal canal. The injury is therefore caused by kinetic energy caused by the bullet. .
A secondary injury usually follows, starting within minutes and evolving over the course of hours after the injury occurred. The process that drives this is complex and not fully understood. The possible mechanisms are ischemia, hypoxia, edema, inflammation, ion homeostasis, and apoptosis. The occurrence of secondary injuries is sometimes manifested clinically by neurological deterioration over the course of eight to twelve hours.p>
Within hours after the injury, spinal cord edema develops due to the secondary injuries. The edema peaks between day three and day six, and then begins to fade away after day nine. This is eventually replaced by a central hemorrhagic necrosis.
A person who has an injury to the spinal cord often experiences pain at the site of the fracture, but not all do, and lack of pain does not rule out SCI. People with SCI often have related systemic and brain injuries that limit their ability to tell the doctor about any pain. Doctors find this to be an obstacle in evaluation of the patient, and the missed communication could affect the prognosis. Most SCI patients have have sleep-disordered breathing, too.
Almost half of the SCIs include the cervical cord and result in quadriparesis (weakness in all four limbs) or quadriplegia (paralysis). The seriousness of the cord syndromes is determined using the American Spinal Injury Association (ASIA) Scale or the Frankel scale:
Complete injury - (grade A) - There is some sensation in the next caudal level, and no sensation at all in all levels below. There will also be a lower muscle power in the level below the injury, followed by paralysis in the caudal myotomes. Reflexes are nonexistent in acute injury; there is no response to stimulation, and muscle tone is flimsy. Men with TSCI may experience priapism. Urinary problems will happen.
Incomplete injury - (Grade B - D) - There are varying degrees of motor function in the muscles that are controlled by the spinal cord below the injury. Sensation is partly saved in areas below the injury. Typically sensation is saved over motor function because sensory tracts are in a less vulnerable place of the spinal cord. Anal sensation and the bulbocavernosus reflex are usually present to some degree.
The ratio of complete versus incomplete injuries has increased over the years because of improved care and systems that recognize the importance of immobilization after the injury occurs. The number of incomplete injuries has declined.
Transient paralysis and spinal shock - Following a spinal cord injury, there could be loss of all activity in the spinal cord. In men, especially those who have a cervical cord injury, priapism may occur. There could also be bradycardia and hypotension. This altered state could last for several weeks, which is why it is referred to as spinal shock. It is believed that function loss is due to the lack of potassium in the injured cells in the spinal cord. As the potassium levels increase, the shock wears off. Clinical manifestations will normalize somewhat, typically replaced by a spastic paresis.
A transient paralysis accompanied with a full recovery occurs the most in young people with a sports-related injury. These people should be fully evaluated for any underlying conditions before they engage in athletic activities.