Spinal Cord Injuries
Spinal cord injury (SCI) occurs when a traumatic event results in damage to cells in the spinal cord or severs the nerve tracts that relay signals up and down the spinal cord. The most common types of spinal cord injury include:
*Contusion (bruising of the spinal cord)
*Compression (caused by pressure on the spinal cord)
Other types of spinal cord injury include lacerations (severing or tearing of nerve fibers) and central cord syndrome (specific damage to the cervical region of the spinal cord).
There is a wide variety of spinal injuries that can cause spinal cord trauma. These include, but are not limited to, traffic accidents, sports-related injuries, work-related mishaps, hunting injuries involving firearms, physical battery, and virtually any sudden and severe shock to the spinal cord. In fact, even a relatively minor injury can result in spinal cord trauma, especially if the spinal cord is compressed or unstable.
The most common causes of serious spinal cord injury occur following trauma. In this situation, the bones of the spine may fracture or the discs may be dislodged leading to trauma to the delicate spinal cord that is surrounded by the bone and discs of the spine.
Fluid accumulation, bleeding, and swelling can occur either inside or outside the spinal cord (but still within the spinal canal). This accumulation of fluid or blood can damage the spinal cord through compression.
Spinal cord injuries occur in approximately 12,000 to 15,000 people per year in the U.S. About 10,000 of these people are permanently paralyzed, and many of the rest die as a result of their injuries. Young, healthy, and active males between the ages of 15 and 35 are most often the victims of spinal cord trauma.
Only about five percent of spinal cord injuries occur in children. The fatality rate is higher with pediatric spine injuries.
Spinal cord injuries in older individuals are more likely to occur due to spines weakened by osteoarthritis and osteoporosis. In addition, those patients may have problems with balance problems due to illness or medication, or clumsiness (from the after effects of a stroke, for instance) and thus may be significantly more susceptible.
Treatment
Treatment begins with the emergency medical personnel who make an initial evaluation and immobilize the patient for transport. Immediate medical care within the first 8 hours following injury can be critical to the patient's recovery.
When injury occurs and for a period of time thereafter, the spinal cord responds by swelling. Treatment starts with steroid drugs such as methylprednisolone. These drugs reduce inflammation in the injured area and help to prevent further damage to cellular membranes that can cause nerve death. Sparing nerves from further damage and death is crucial.
Each patient's injury is unique. Some patients require surgery to stabilize the spine, correcting any misalignment and removing compression to the spinal cord caused by bone or disc that presses on the injured cord. Spinal stabilization can also be important to prevent further damage in the future.
Surgery
Depending on the circumstances, when surgery is required, it may be performed early or later. Each case requires careful consideration to define the course of treatment that will lead to the greatest benefit for the patient.
When fusion of the spine is required, bone is made to grow between the injured vertebrae. Spinal instrumentation is often implanted to restore the stability to the spine and assist in the healing of the spinal fusion. Instrumentation may include rods, wires, hooks and/or screws depending on the case.
Whiplash
Whiplash, also called neck sprain or strain, is an injury to the soft tissues of the neck. It is usually caused by sudden extension (backward movement of the neck) and flexion (forward movement of the neck). This type of injury is often the result of rear-end car crashes. Severe whiplash can also include injury to the intervertebral joints, discs, ligaments, cervical muscles, and nerve roots.
Treatment
Fortunately, whiplash is treatable and most symptoms resolve completely. Initially, whiplash is treated with a soft cervical collar which may be worn for 2 to 3 weeks.
Other treatments for individuals with whiplash may include the following:
*Heat therapy to relieve muscle tension and pain
*Pain medications such as analgesics and non-steroidal anti-inflammatory drugs (NSAIDs)
*Muscle relaxants
*Range of motion exercises and physical therapy
For most patients, the symptoms of whiplash usually subside in 2 to 4 weeks.
If symptoms continue or worsen, further X-rays and other diagnostic testing may be necessary to see if the patient suffered a more severe injury. Severe extension injuries like whiplash can damage the intervertebral discs. If this occurs, surgical repair of the discs may become necessary. |
