Spinal Cord Injury: Causes, Symptoms & Treatment
Spinal cord injury is a serious damage to the spinal cord resulting in complete or partial loss of motor function, sensation, and organ control below the level of injury.
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Spinal cord injury is a serious damage to the spinal cord resulting in complete or partial loss of motor function, sensation, and organ control below the level of injury.
What is a Spinal Cord Injury?
A spinal cord injury (SCI) refers to damage to the spinal cord that results in a temporary or permanent loss of motor, sensory, and autonomic function below the level of the injury. Depending on the location of the damage, a distinction is made between paraplegia (paralysis of the lower body) and tetraplegia (also called quadriplegia, affecting all four limbs and the trunk). SCI can be classified as complete (total loss of function) or incomplete (partial preservation of function).
Causes
Spinal cord injuries can result from a wide range of causes:
- Traumatic causes: Road traffic accidents, falls from height, sports injuries (e.g. diving accidents), acts of violence
- Non-traumatic causes: Spinal tumors, severe disc herniation with cord compression, inflammatory conditions (e.g. transverse myelitis), vascular events (e.g. spinal cord infarction), multiple sclerosis
Symptoms
The symptoms depend on the level and completeness of the spinal cord injury:
- Complete or partial loss of motor function below the injury level
- Loss or impairment of sensation (touch, pain, temperature)
- Dysfunction of the bladder and bowel
- Impairment of sexual function
- In high cervical injuries: breathing difficulties, blood pressure instability
- Spasticity (involuntary muscle spasms) or flaccid paralysis
- Chronic neuropathic pain
Diagnosis
Diagnosis is based on clinical and imaging assessments:
- Neurological examination: Assessment of motor and sensory function using the ASIA Impairment Scale (American Spinal Injury Association)
- MRI (Magnetic Resonance Imaging): Gold standard for visualising spinal cord and soft tissue damage
- CT (Computed Tomography): Used to assess bony structures and vertebral fractures
- X-ray: Initial assessment for suspected vertebral fractures
- Electrophysiological testing: e.g. evoked potentials to evaluate residual nerve function
Treatment
Acute Management
In the acute phase, treatment focuses on stabilising the spine and preventing further neurological damage. This may include surgical decompression or stabilisation of the vertebral column.
Rehabilitation
Rehabilitation is the cornerstone of long-term management and typically involves:
- Physiotherapy: Preserving and improving residual function, reducing spasticity, and promoting mobility
- Occupational therapy: Training in daily living activities and independence
- Speech and language therapy: For swallowing and breathing issues in high-level injuries
- Neurourology: Management of bladder and bowel dysfunction
- Psychological support: Addressing the psychosocial impact of the injury
Assistive Devices
Depending on the extent of paralysis, patients may use wheelchairs, orthoses, ventilators, or other assistive technologies.
Pharmacological Treatment
Medications are used to manage spasticity (e.g. baclofen, botulinum toxin), pain (e.g. gabapentin, pregabalin), and to prevent or treat secondary complications.
Complications
People with spinal cord injuries are at increased risk for secondary complications, including:
- Pressure ulcers (decubitus) due to prolonged immobility
- Deep vein thrombosis and pulmonary embolism
- Urinary tract infections
- Autonomic dysreflexia (a potentially life-threatening spike in blood pressure in high-level injuries)
- Pneumonia, especially in cases of respiratory paralysis
- Osteoporosis due to lack of weight-bearing
Prognosis
The prognosis depends on the type (complete vs. incomplete), the level of the lesion, and the speed of medical intervention. Incomplete injuries generally offer a better chance of recovery. With modern rehabilitation, many individuals with SCI can achieve a high quality of life. Emerging therapies such as neuroprosthetics, epidural electrical stimulation, and stem cell research are offering new hope for the future.
References
- Kirshblum S et al. - International standards for neurological classification of spinal cord injury. Journal of Spinal Cord Medicine, 2011.
- World Health Organization (WHO) - International Perspectives on Spinal Cord Injury. WHO Press, Geneva, 2013.
- Fehlings MG et al. - A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury. Global Spine Journal, 2017.
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Related search terms: Spinal Cord Injury + Spinal Cord Paralysis + Transverse Myelopathy