Spinal cord injuries

What is a spinal cord injury?

Spinal fractures occur when an injury is sustained to the spine resulting in a break or disruption of the spinal vertebrae or the attached ligaments. The spinal column contains and protects the spinal cord and exiting nerve roots. Some injuries affect only the spinal column without disturbing the nerve elements – while other, more severe injuries to the spine can result in temporary or permanent damage to the spinal cord and/or exiting nerve roots. The diagnosis of such injuries relies upon radiological studies including x-rays, CAT scans and sometime magnetic resonance imaging studies (MRI) to visualize the damage. Treatment of such fractures may require a brace or surgery or both depending on the degree of instability.

Spinal cord injuries (SCI) remains a devastating condition for both patients and their families. There are approximately 10,000 new injuries in the United States each year with more than 200,000 people suffering from either paralysis of the arms or legs or both secondary to spinal cord injury. Males account for roughly 75% of patients treated with spinal cord injuries.

Improvement in the quality of care over the last few decades has dramatically improved the outlook and survival for patients with such injuries – but as yet there are no cures to treat all aspects of the injury including paralysis. Advances in acute treatment of spinal cord injury include more sophisticated prehospital care, prompt recognition of the signs of spinal cord injury, safer transportation methods and active resuscitation both in the field and in the emergency department. Improvements in the treatment of the chronic stages of the disease include the surgical management of syringomyelia, late post-traumatic deformity, and pain control has also been achieved.Increased survival for patients with spinal cord injury has focused the health care industry to develop strategies to enhance the quality of life via improvements, which range from lighter wheel chairs to development of fertility programs for the spinal cord injured patient

What causes spinal cord injuries?

The causes of spinal cord injury are varied. With industrialization, motor vehicle accidents (MVA) have become the leading cause of spinal trauma. Spinal cord injury due to violence is on a dramatic rise as manifested by the proportion of individuals injured by assault including penetrating injuries such as gun and knife wounds. Sports related injuries, which include football, horseback riding, and hockey, often receive recent media attention.

Preventive programs, which encourage children and young adults to modify risky behaviors, have the greatest prospect of reducing the incidence of spinal cord injuries. These include, but are not limited to, the Think First program sponsored by the American Association and Congress of Neurological Surgeons and the “Feet First, First Time” program initially developed in Northern Florida which encourages water enthusiasts to jump feet first into unknown waters. Also, driver’s education courses and police patrols which arrest drivers in command of vehicles while under the influence of drugs or alcohol can contribute to a decrease the number of these unfortunate events. Finally, regulation of handguns and assault weapons, which have resulted in intentional and accidental injuries, can potentially reduce the number of injuries.

How are spinal cord injuries treated?

Determining the prognosis for a spinal cord injured patient on admission remains challenging. The clinician uses the patient’s neurological exam, age, magnetic resonance imaging (MRI) appearance of the spinal cord, and other clinical data to guide the patient and his family on the expected outcome for a specific injury. Some recovery is the rule for most patients who enter hospital with an incomplete spinal cord injury; however, when patients present with complete injuries, the chance of regaining ambulatory function remains slim. A complete spinal cord injury means that the spinal cord has absolutely no motor or sensory function below the affected area. While a partial or incomplete spinal cord injury means that the spinal cord transmits some information to move the limbs or provides some sensory information from the skin.

Treatment for patients with spinal cord injury often involves stabilizing the injured spine. This may accomplished by an external orthosis – such as collar, halo-vest or a body brace – but often may require surgical intervention. Surgery is usually performed by a neurosurgeon or orthopedic surgeon who has a special interest in spinal surgery. The surgical procedure often involves the placement of titanium plates or rods and screws and bone graft material to fuse the injured spine. As part of the surgical treatment the spine may be re-aligned or bone may be removed from the spinal canal to decompress the spinal cord. The acute stay in the hospital after the injury is focused on preventing and treating secondary issues which may surface as a result of the spinal cord injury, such as low blood pressure, respiratory failure, pressure sores of the skin, blood clots in the legs, etc. As soon as the patient is medically stable and is ready to be mobilized, he or she will start intensive therapy which includes physical and occupational therapy which is often best accomplished in a specialized rehabilitation center for such injuries. Objectives of these centers include muscle strengthening, teaching patients how to maximize their functional capacity and determining strategies for bladder and bowel care as well as sexual function. Treatment of spasticity and pain which frequently accompanies such injuries is also a priority. Counseling and support groups are extremely helpful in having the patient and the family cope with the stresses of the new situation.

Spinal cord injury research

Spinal cord injury research is an absolute priority of the National Institutes of Health. Models of spinal cord injury, mechanisms of secondary injury, treatment of the acute phase of spinal cord injury, as well as the development of transplantation strategies to repair the damaged spinal cord are on-going across the continent and around the world. Research focusing on treatment can be divided into two categories:

• drugs which can be given during the acute phase of injury and which may limit secondary injury mechanisms or promote regeneration.
• cellular therapies to treat the chronic injury. Cells of interest include Schwann cells, olfactory ensheathing glia, embryonic spinal cord and stem cells.

Strategies, which combine a number of the aforementioned treatments, are most likely to have a beneficial effect in the future.