News

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).

Spinal cord trauma can be caused by any number of injuries to the spine that can result from motor vehicle accidents, falls, sports injuries (particularly diving into shallow water), industrial accidents, gunshot wounds, assault, and others. A seemingly minor injury can cause spinal cord trauma if the spine is weakened (such as from rheumatoid arthritis or osteoporosis).

Direct injury, such as cuts, can occur to the spinal cord, particularly if the bones or the discs have been damaged. Fragments of bone (from fractured vertebrae, for example) or fragments of metal (such as from a traffic accident) can cut or damage the spinal cord. Direct damage can also occur if the spinal cord is pulled, pressed sideways, or compressed. This may occur if the head, neck, or back are twisted abnormally during an accident or injury.

Bleeding, fluid accumulation, and swelling can occur inside the spinal cord or outside the spinal cord (but within the spinal canal). The accumulation of blood or fluid can compress the spinal cord and damage it.

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. Most spinal cord trauma occurs to young, healthy individuals. Males between 15 and 35 years old are most commonly affected.

Only about 5% of spinal cord injuries occur in children. The fatality rate is higher with pediatric spine injuries.

Risk factors include participating in risky physical activities, not wearing protective gear during work or play, or diving into shallow water.

Older people with weakened spines (from osteoporosis) may be more likely to have a spinal cord injury. Patients who have other medical problems that make them prone to falling from weakness or clumsiness (from stroke, for example) may also be more susceptible.

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 is 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, correct a gross misalignment, or to remove tissue causing cord or nerve compression. Spinal stabilization often helps to prevent further damage.

Depending on the circumstances, when surgery is required, it may be performed within 8 hours following injury. Surgery may be considered if the spinal cord is compressed and when the spine requires stabilization. The surgeon decides the procedure that will provide the greatest benefit for the patient.

Different tissue and bony structures including vertebrae misaligned from the force of injury, a herniated intervertebral disc, or a hematoma can cause spinal cord compression. An unstable spine may require spinal instrumentation and fusion to build in support.

Spinal instrumentation and fusion can be used to provide permanent stability to the spinal column. These procedures correct, join, and solidify the level where a spinal element has been damaged or removed (e.g. intervertebral disc).

Instrumentation uses medically designed hardware such as rods, bars, wires, and screws. Instrumentation is combined with fusion (bone grafts) to permanently join two or more vertebrae.

Whiplash, also called neck sprain or neck 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.

Fortunately, whiplash is treatable and most symptoms resolve completely. Initially, whiplash is treated with a soft cervical collar. This collar may need to 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. Patients who continue to have symptoms despite treatment may find temporary relief by keeping the neck immobilized using a halter in the office or at home. This is referred to as cervical traction. Local anesthetic injections may also be helpful.

If symptoms continue or worsen after 6 to 8 weeks, 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.