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Spinal Cord Injury

  • Brain and spinal cord

Definition

Spinal cord injury, or SCI, is damage to the spinal cord. The spinal cord is protected by the bones of the spine, called vertebrae. Vertebrae are stacked on top of each other. A tunnel goes through the bones. The spinal cord and nerves go from the brain to the tailbone in this tunnel. Nerves branch off from the spinal cord between each of the bones of the spine. Spinal cord trauma occurs when that protection is damaged.

Risks

What are the causes and risks of the injury?

Spinal cord trauma can be caused by:
  • fractures to the vertebrae
  • injuries that cause the vertebrae to move out of alignment
  • penetrating injuries such as stabbing or gunshot
  • severe stretching of the spine
Each year in the United States, there are about 10,000 spinal cord injuries that people survive. Of these injuries, half result in paraplegia and half in quadriplegia. The causes of these injuries are:
  • motor vehicle accidents (44%)
  • acts of violence (24%)
  • falls (22%)
  • sports (8%)
  • other reasons (2%)
Of those injured each year, 82% are male. The most common age at the time of injury is 19 years old. Sports produce a special set of risk statistics. Diving accidents cause 2/3 of spinal injuries during sports. Ninety-two percent of sports injuries result in quadriplegia. Alcohol in the bloodstream worsens spinal cord injuries. This is because bleeding can cause the alcohol to come into contact with spinal cord tissue.

Prevention

What can be done to prevent the injury?

A number of actions can help prevent spinal cord injury. They include:
  • driving defensively and using seat belts
  • following sports safety guidelines for children, adolescents, and adults
  • jumping, rather than diving, into water
  • limiting use of medicines that lower blood-clotting ability, such as aspirin
  • not driving after drinking alcohol

Diagnosed

How is the injury recognized?

Diagnosis of a spinal cord injury begins with a medical history and physical exam. Various imaging studies, such as MRI or CT scans, may be used.

Treatments

What are the treatments for the injury?

Treatment of an SCI is tailored to the injury, because each case is unique. Steroids, such as methylprednisolone, can reduce swelling. If the spine is fractured, spinal fusion, or joining the bones of the spine with surgery, may be needed. This can stabilize the injury and shorten the recovery period. Rehabilitation often takes a long time. The goal is to achieve the most function and independence possible. Some experimental medicines are being used to reduce scarring at the injury site. They may improve regrowth of nerves.

Side Effects

What are the side effects of the treatments?

Steroids can cause high blood glucose levels and increased risk for infection. Surgery may cause bleeding, infection, or allergic reaction to anesthesia.

After Treatment

What happens after treatment for the injury?

Without proper treatment, many complications can occur.
  • People with an SCI are at high risk for bedsores because they lack sensation and movement below the injury level.
  • Kidney infections and kidney stones may result from a loss of bladder control.
  • Respiratory problems, such as pneumonia, are sometimes seen when the injuries involve the neck.
  • People with quadriplegia may have trouble controlling body temperature, blood pressure, and heart rate.
With treatment, people can relearn ways to control their body and how to do activities. It is possible to go back to normal activities, such as school, work, marriage, and having children.
Usually, the person will use a wheelchair. There are special tools that help with tasks such as eating and getting dressed.
Doctors who work in rehabilitation, urology, orthopedics, neurology, and other specialties may be needed to provide complete treatment. The person may benefit from physical therapy and occupational therapy.
The financial and emotional costs to individuals and society of spinal trauma are great. Medical costs during the first year after leaving the hospital can be more than $50,000 per person. These costs decrease only slightly after the first year.
Because of complications, only 85% of people with cord injury are alive 10 years after being injured. This compares to 98% of uninjured people of similar age and gender.
Only 35% of paraplegics and 25% of quadriplegics are employed 8 years after the injury. Marriage rates are lower. Divorce rates are higher.
People with SCIs can feel isolated. They may need psychological counseling.
Many laws have been created to give more help to people with disabilities. These laws will continue to make it easier for them to work and be productive members of society.

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