Incomplete Spinal Cord Injuries

Introduction

Spinal cord injuries often lead to significant impairments in a person's daily life. These injuries can be broadly categorized into two main types: complete and incomplete. When someone has a complete spinal cord injury, they lose all movement and feeling below the area that was injured. In incomplete spinal cord injuries, there may be some movement and feeling still present, but it can vary in how much is preserved.

What Is an Incomplete Spinal Cord Injury?

An incomplete spinal cord injury happens when there is partial damage to the spinal cord, disrupting communication between the brain and muscles. This means motor signals from the brain might not reach areas below the injury, causing a loss of muscle control, and sensory signals from below the injury might not reach the brain, leading to reduced feeling. In incomplete injuries, some neural pathways at the injury site remain intact, preserving some sensation and muscle control below the injury.

What Causes an Incomplete Spinal Cord Injury?

Incomplete spinal cord injuries can occur due to a wide range of traumatic and non-traumatic causes.

Traumatic Causes

• Motor vehicle accidents, like car crashes, motorcycle accidents, and pedestrian accidents, are among the leading causes of traumatic incomplete SCIs.

• Falls are a common cause of incomplete spinal cord injuries, particularly in older adults. Falls from heights, such as ladders or stairs, and slips on uneven surfaces can result in spinal cord trauma.

• Sports-related injuries, especially those involving high-impact or contact sports like football and rugby, can lead to incomplete SCIs.

Non-Traumatic Causes

• Tumors within or near the spinal cord can exert pressure on the cord tissue, leading to varying degrees of injury.

• Infections, such as abscesses or meningitis, can affect the spinal cord and surrounding tissues.

• Certain vascular conditions, like aneurysms or arteriovenous malformations, can disrupt blood flow to the spinal cord. This reduced blood supply can damage spinal cord tissue, leading to incomplete SCIs.

What Are the Signs and Symptoms of Incomplete Spinal Cord Injuries?

Symptoms of incomplete spinal cord injuries can be different for each person depending on where and how much damage there is to the spinal cord.

Common symptoms and manifestations of incomplete SCIs include:

• One of the primary symptoms is impaired motor function. Some individuals may experience weakness, while others may have partial or complete paralysis below the level of injury.

• Incomplete SCIs often result in sensory disturbances like tingling, numbness, or hypersensitivity in the affected areas. Patients may also experience difficulty with proprioception, the ability to sense the position of their body parts in space.

• Individuals may experience neuropathic pain characterized by burning, shooting, or electrical sensations.

• Muscle spasticity may result from disrupted communication between the spinal cord and the brain. Spasticity can lead to muscle stiffness, involuntary contractions, and difficulty with coordination and movement.

• Incomplete SCIs can also impact autonomic functions, including blood pressure regulation, bowel and bladder control, and sexual function.

How Are Incomplete Spinal Cord Injuries Classified?

Incomplete spinal cord injuries can be classified into different clinical types based on the specific pattern of sensory and motor deficits.

The two most commonly recognized clinical types are:

• Anterior Cord Syndrome - In this type, damage primarily affects the front part of the backbone. Individuals with anterior cord syndrome experience a loss of motor function and sensation, including pain and temperature sensation. However, they often retain some degree of proprioception and light touch sensation.

• Posterior Cord Syndrome - Posterior cord syndrome is rarer than other types. It involves damage to the back part of the spinal cord. In this condition, individuals usually maintain motor function and the sense of pain and temperature. But, they may lose proprioception and fine touch sensation.

Brown-Sequard Syndrome is another type of incomplete spinal cord injury characterized by damage to one side (hemisection) of the spinal cord.

Incomplete SCIs are further classified based on the American Spinal Injury Association (ASIA) Impairment Scale, which grades the injury's severity.

The ASIA Impairment Scale classifies incomplete spinal cord injuries into five categories:

• Grade A - Individuals classified as Grade A have no motor or sensory function below the level of injury. They have no motor or sensory sparing in the sacral segments.

• Grade B - Individuals have no motor function below the level of injury, but they do have sensory function preserved.

• Grade C - Individuals have motor function below the level of injury, but more than half of the key muscles below the level of injury cannot function against gravity.

• Grade D - Individuals have motor function below the level of injury, and more than half of the key muscles below the level of injury can function against gravity. This indicates they have at least 50 percent of the motor strength required for normal function.

• Grade E - This indicates that the individual has normal motor and sensory function. This category is not considered an incomplete SCI.

What Are the Treatment Options Available for Incomplete Spinal Cord Injuries?

Diagnosing incomplete spinal cord injuries involves a comprehensive process that includes clinical assessment, imaging studies like X-rays, CT scans, and MRI, neurological evaluation, electrophysiological tests, and consultation with specialists. The management of incomplete spinal cord injuries involves a multidisciplinary approach to address the various physical, functional, and psychological challenges faced by patients.

Treatment and rehabilitation strategies may include:

Acute Medical Care - In the immediate aftermath of an incomplete SCI, acute medical care is crucial. This involves stabilizing the patient, preventing complications, and addressing life-threatening issues.

Rehabilitation - Rehabilitation plays a major role in the recovery of individuals with incomplete SCIs. The goal is to maximize functional independence and enhance the patient's quality of life. Rehabilitation programs may include physical therapy, occupational therapy, neuropsychological rehabilitation, and speech therapy.

Assistive Devices - Assistive devices such as wheelchairs, braces, and mobility aids are often essential for individuals with incomplete SCIs. These devices help with mobility and promote independence in daily life.

Medication Management - Pharmacological interventions can help manage pain, spasticity, and autonomic dysfunction. Medications are prescribed as per each case.

Functional Electrical Stimulation (FES) - FES is a therapeutic technique that uses electrical impulses to stimulate muscles and facilitate functional movements. It can be beneficial for improving motor function in patients with incomplete SCIs.

Surgical Interventions - In some cases, surgical interventions are necessary to address specific issues, such as stabilizing the spine, decompressing the spinal cord, or treating complications like pressure sores.

Psychological Support - Individuals with incomplete SCIs may benefit from counseling and psychological support to cope with the challenges of their condition.

Conclusion

The prognosis for individuals with incomplete spinal cord injuries varies widely. Recovery from incomplete SCIs can be ongoing and may continue for months or even years. Some individuals regain substantial function and independence, while others may experience more limited progress.