What Is Spinal Cord Injury?
Spinal cord injury is an injury that leaves the victim and family members devastated. The injury results in physical, mental, and emotional trauma to the patient. To date, no confirmed treatment is available all over the world to reverse the neurological deficit. Still, there are possibilities that such patients can lead normal lives and fulfill their dreams. In this article, we have broadly explained spinal cord injury and the possible management of such patients.
What Is the Spinal Cord?
The spinal cord is a thick bundle of nerves that extend from the base of the brain to the L1 vertebrae in adults (in children below 1 year of age, it extends till L3). Below the L1 vertebrae, there are nerve roots that originate from the spinal cord itself and travel down to supply lower limbs. In the course of the spinal cord, it supplies upper limbs via nerve roots originating in the neck, and lower limbs are supplied as described above. The nerve roots supplying lower limbs also supply the bladder and bowels. The spinal cord is protected in the spinal canal formed by vertebrae stacking on each other. It is well covered on all sides with bone.
What Causes Spinal Cord Injury?
Whenever there is an injury to the vertebrae, there are possibilities of injury to the spinal cord. The damage to the vertebrae could be due to:
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Road traffic accident.
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Fall from a height.
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Shallow water diving.
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Minor injury in osteoporotic patients (usually in older women).
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Involvement of a person in a fight.
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Bullet injury.
The reasons listed above are responsible for most of the cases. There could be many more reasons which are beyond the scope of this article.
Spinal Cord Injury Could Be At:
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Cervical level.
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Thoracic level.
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Lumbar level.
The level of spinal cord injury is very important because this changes the whole scenario. If the injury is at the cervical level, then there could be a weakness in all four limbs, commonly known as tetraparesis (partial weakness) or tetraplegia (complete weakness). Also, the nerve to the diaphragm (musculotendinous structure in between the chest and abdomen responsible for breathing) originates from the cervical spine (precisely C4). So, injury at this level can also jeopardize the breathing capability of the person. The person will be more dependent on others, and if not correctly managed, chances of survival are reduced.
In contrast to the cervical spine, injury to the thoracic and lumbar spine spares the upper limb. It only results in weakness in the lower limbs. The diaphragm is also spared, and in turn, a person has no or less difficulty with breathing. The weakness in the lower limbs is known as paraparesis (partial weakness) or paraplegia (complete weakness).
In all the levels of injury, there could be involvement of the bladder and bowel, which may present as incontinence of urine or retention of urine, leading to overflow incontinence. This depends on the level of injury.
How to Manage Spinal Cord Injury?
The most important thing to mention here is that the management of such a person starts right at the site of injury. Every individual should know this fact, even the layman, who may be the first person to suspect the injury.
The person should always suspect possible damage to the spinal cord at the injury site. Hence, after injury, the victim should not be handled immediately, that means do not just lift the person with your hands. The victim should be kept straight and the upper and lower body in line. The victim should not be made to sit without ruling out a vertebral column fracture. The reason to keep the above things in mind is if there is a fracture of the vertebral body, which has not displaced or injured the spinal cord, then the wrong way of handling it might just displace the fracture and damage the spinal cord.
Depending upon the kind of fracture of the vertebral body and the status of the patient, the decision to operate or manage it conservatively is made. The trained spine surgeon will take that decision. Well, for most people, treatment stops here. But they are entirely wrong. The actual treatment starts after the patient has been operated on and all preliminary work is done.
Understanding the Spinal Cord Injury:
The patient’s neurological status after spinal cord injury is divided into five types, known as the ASIA impairment scale (American spinal injury association). There is no need to understand the scale completely. The only thing a layman should understand is that the injury is divided into A, B, C, D, and E. The person with injury ‘E’ has all limbs perfectly moving with no deficit. On the other hand, a person with injury ‘A’ has no power in the limbs, no sensation below the injury, and even the bladder and bowel are involved.
This scale is made to understand the prognosis. As the injury progresses from ‘E’ to ‘A,’ the chances of recovery decrease. The person with injury ‘A’ has less than a 1 % chance that he will improve in terms of power and sensation in limbs.
Rehabilitation:
The main part of the treatment of spinal cord injury is rehabilitation. This starts right after the patient arrives in the hospital. Proper rehabilitation begins after the surgery is done (if indicated). This part of the treatment continues for the entire lifetime of the patient. The central part of rehabilitation is:
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To make the patient aware of the type of injury he has, prognosis, and course of treatment.
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To assure the patient that he or she can lead a normal life and pursue his or her dreams.
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To strengthen the muscle power to some extent to make it useful.
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To teach patients the modifications that are required to stay independent in their routine day-to-day activities.
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To guide the patient about how to prevent complications like bedsores, deep venous thrombosis, infection, etc.
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To teach the patient about self-management of bladder and bowel so that they can have a normal social life.
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Young and married patients should be guided about the possibility of physical enjoyment.
Also, the patient’s attendants are educated and psychologically prepared for the challenges.
These are the main goals of rehabilitation, and there is no fixed plan possible for every patient. The protocol needs to be customized according to the type of injury, the mental status of the patient, the age of the patient, and further requirements of the patient.
Conclusion:
All the goals are not uniform in every kind of injury. For example, in a cervical spine injury, the patient has to stay with a catheter lifelong, as his upper limbs are also weak, and he cannot self-catheterize himself periodically. Till-date, there is no treatment available for spinal cord injury patients. Though researchers are continuously working on the same, and it might be possible in the near future.
