Spinal Cord Injuries (SCI) occurs when a traumatic event results in damage to cells within the spinal cord or severs the nerve tracts that relay signals up and down the spinal cord. 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.
A Spinal Cord Injury (SCI) is damage to the spinal cord that results in a loss of function such as mobility or feeling. The spinal cord does not have to be severed in order for a loss of functioning to occur. In fact, in most people with SCI, the spinal cord is intact, but the damage to it results in loss of functioning. SCI is very different from back injuries such as ruptured disks, spinal stenosis or pinched nerves.
A person can "break their back or neck" yet not sustain a spinal cord injury if only the bones around the spinal cord (the vertebrae) are damaged, but the spinal cord is not affected. In these situations, the individual may not experience paralysis after the bones are stabilized.
The effects of SCI depend on the type of injury and the level of the injury. SCI can be divided into two types of injury - complete and incomplete.
Complete: A complete injury means that there is no function below the level of the injury; no sensation and no voluntary movement. Both sides of the body are equally affected.
Incomplete: An incomplete injury means that there is some functioning below the primary level of the injury. A person with an incomplete injury may be able to move one limb more than another, may be able to feel parts of the body that cannot be moved, or may have more functioning on one side of the body than the other. With the advances in acute treatment of SCI, incomplete injuries are becoming more common.
• - Injury to the spinal cord in the cervical region with associated loss of muscle strength in all 4 extremities
• - Injury in the spinal cord in the thoracic, lumbar, or sacral segments, including the cauda equina and conus medullaris
Anterior Lumbar Interbody Fusion - is the placement of bone or cages between vertebrae from an anterior approach.
The outer portion of a disc in the spinal column, the annulus provides structure and strength to a disc and is comprised of a complex series of interwoven layers of fibrous tissues, which hold it's nucleus in place.
Refers to the frontal or ventral surface of the body.
PLD using an endoscope for visualization.
This refers to bone taken from the patient, usually the hip, to be used as graft.
An option for fusing the spine. This requires either moving bone from one part of the body (autograft) or using bone from an outside source (allograft).
Computerized x-ray system which provides cross-sectional images of the spine or other parts of the body. Sometimes is done following a myelogram or discogram.
Pertains to the neck.
Method of relieving pain with bed rest, analgesics and chiropractic and physical therapy.
Deterioration in disc structure and function, which commonly causes pain and loss of function.
Test or process used to determine the source of a problem, i.e., a diagnosis.
Discs serve as shock absorbers between the vertebrae of the spinal column. The center of the disc is known as the nucleus and the outer ring of the disc is called the annulus.
The procedure where a disc is removed surgicaly.
Provocative discography is the instillation of sterile saline (not dye) into the disc to try and reproduce the patient's pain.
Refers to a position toward the posterior or back side of the body.
Growth of bone where bone does not normally grow, as in replacing a disc with a bone graft. The bone graft is normally taken from the patient or a donor.
AKA a slipped disc, is a condition in which nucleus tissue is moved from the center of a disc into the spinal canal. Herniated discs cause great pain in the low back and leg or the neck and arm and they create pressure against one or more of the spinal nerves. Other names for herniated discs are prolapsed discs or ruptured discs.
Placing of a graft or cages between vertebral bodies.
A surgical procedure designed to stop the pain caused by the bone fracture, stabilize the bone, and to restore the lost vertebral body height due to the compression fracture.
Surgery technique in which part of the back of the vertebra is removed in order to reach to the nerves and discs. This may or may not require the disc be removed as part of the procedure.
This is bands of fibrous tissue that connect bones or cartilages that support and strengthen the bone joints. Ligaments surround the spine on all sides.
This refers to the lower back.
Surgical technique for removal of a disc via a small opening using a microscope.
Refers to postoperative pain and complications from to surgery.
Computerized magnetic imaging system that provides cross-sectional images of the spine or other body parts.
Diagnostic procedure in which an iodine is injected as a dye into the spinal canal and shows up on x-rays that are taken.
The center part of a disc and is made of a soft, rubber-like material that takes the shock of movement such as standing, walking, running, etc.
Invlolves placing bone screws into the spine from a posterior approach through what is known as the pedicle. Screws are then used with a rod or plate to keep the spine stable following bone grafting.
An outpatient procedure that uses minimally-invasive suction to remove herniated cervical discs.
PLD using an endoscope for visualization.
Stand for Posterior Lumbar Interbody Fusion, which is the placement of bone or cages between vertebrae from a posterior approach.
Stands for Posterior Lateral Inter-Transverse Process Fusion, which involves the placement of bone graft on and between transverse process of vertebrae to promote bone fusion.
Surface area amount which allows for bone growth from the implant.
This term refers to the back or dorsal surface of the body.
AKA a slipped disc, is a condition in which nucleus tissue is moved from the center of a disc into the spinal canal. Herniated discs cause great pain in the low back and leg or the neck and arm and they create pressure against one or more of the spinal nerves. Other names for herniated discs or ruptured discs.
See above
This is the lower portion of the spinal column.
See Ruptured Disc.
This is the primary nervous system, that runs from base of the skull to the lower back via the spinal canal. Problems or impingement of bony or soft tissues on cord or nerve roots is primary reason for spine surgery.
Surgical treatment for back pain in which the disc between two adjacent vertebrae is removed. Then two vertebrae are fused using bone graft and instrumentation methods.
This is the structure composed of vertebrae, discs, and ligaments. It contains 26 vertebrae in five separate regions. There are 7 cervical, 12 thoracic, 5 lumbar, 1 sacral, and 1 coccygeal vertebrae. The primary function of the spine are body support and spinal cord protection.
Longitudinal skeletal axis of the human body that is composed of 26 distinct bones which are called vertebrae.
A procedure which is related to the treatment of disease in the human body.
The twelve vertebrae in mid-torso that are attached to the rib cage.
The portion of the chest composed of the spine, ribs and, breast bone.
This is a very bio-compatible material with great fatigue strength and good imaging characteristics.
This a bone that is used as a building block for the spinal column.
The longitudinal skeletal axis of the body that is composed of 26 distinct bones which are called vertebrae.
The types of disability associated with SCI vary greatly depending on the severity of the injury, the segment of the spinal cord at which the injury occurs, and which nerve fibers are damaged. Most people with SCI regain some functions between a week and 6 months after injury, but the likelihood of spontaneous recovery diminishes after 6 months. Rehabilitation strategies can minimize long-term disability. The level of injury is very helpful in predicting what parts of the body might be affected by paralysis and loss of function. Remember that in incomplete injuries there will be some variation in these prognoses.
: Cervical (neck) injuries usually result in quadriplegia.
: These very high injuries (C-1, C-2) can result in a loss of many involuntary functions including the ability to breathe, necessitating breathing aids such as mechanical ventilators or diaphragmatic pacemakers.
: C-5 injuries often result in shoulder and biceps control, but no control at the wrist or hand.
: C-6 injuries generally yield wrist control, but no hand function.
: Individuals with C-7 and T-1 injuries can straighten their arms but still may have dexterity problems with the hand and fingers. Injuries at the thoracic level and below result in paraplegia, with the hands not affected.
: At T-1 to T-8 there is most often control of the hands, but poor trunk control as the result of lack of abdominal muscle control.
: Lower T-injuries (T-9 to T-12) allow good truck control and good abdominal muscle control. Sitting balance is very good. Lumbar and Sacral injuries yield decreasing control of the hip flexors and legs.
Besides a loss of sensation or motor functioning, individuals with SCI also experience other changes. For example, they may experience dysfunction of the bowel and bladder,. Men with SCI may have their fertility affected, while women's fertility is generally not affected. Other effects of SCI may include low blood pressure, inability to regulate blood pressure effectively, reduced control of body temperature, inability to sweat below the level of injury, and chronic pain.
• Motor vehicle accidents (44.5%) are the major cause of SCI in the United States. SUV are prone to flip over resulting in SCI.
• Falls (18.1%) are most common in persons aged 45 years or older.
• Violence (16.6%) is the most common cause of SCI in some urban settings in the United States, with a trend showing a slight decrease in violence as a cause of SCI.
• Sports injuries (12.7%) cause many cases of SCI. Diving is the sport in which SCI occurs most commonly.
• Vascular disorders
• Tumors
• Infectious conditions
• Spondylosis
• Developmental disorders
Incidence of traumatic SCI in the United States is 30-60 cases per million population. Some sources cite 8 cases per 10,000 population/year. Figures on estimated prevalence vary from approximately 183,000 to 230,000 cases in the United States, the equivalent of 700-900 cases per million population.
A spinal cord trauma is a medical emergency requiring immediate treatment to reduce the long-term effects. The time between the injury and treatment is a critical factor affecting the eventual outcome.
Corticosteroids, such as dexamethasone or methylprednisolone, are used to reduce swelling that may damage the spinal cord. If spinal cord compression is caused by a mass (such as a hematoma or bony fragment) that can be removed or brought down before there is total destruction of the nerves of the spine, paralysis may in some cases be reduced or relieved. Ideally, corticosteroids should begin as soon as possible after the injury.
Surgery may be necessary. This may include surgery to remove fluid or tissue that presses on the spinal cord (decompression laminectomy). Surgery may be needed to remove bone fragments, disc fragments, or foreign objects or to stabilize fractured vertebrae (by fusion of the bones or insertion of hardware).
Bedrest may be needed to allow the bones of the spine, which bears most of the weight of the body, to heal.
Anatomic realignment is important. Spinal traction may reduce dislocation and/or may be used to immobilize the spine. The skull may be immobilized with tongs (metal braces placed in the skull and attached to traction weights or to a harness on the body).
Extensive physical therapy, occupational therapy, and other rehabilitation interventions are often required after the acute injury has healed. Rehabilitation assists the person in coping with disability that results from spinal cord trauma.
A Spinal Cord Injury often provokes a profound emotional response in the patient, family members and friends. Denial, depression, a feeling of hopelessness, and fear are normal and usual reactions. No single response is either expected or unexpected.
A lack of understanding of what's in store, the unknown, and what's next should be met by thoughtful, straightforward, and frequent discussions between physician, nurse, patient and family. An inability to work, tend to business affairs, care for one's family and interact with friends in the usual manner, all contribute to emotional distress. Thorough explanations and the plans for future may bring emotional relief as the patient focuses on the treatment ahead and the prospect of rehabilitation and recovery.
Family members or loved ones may have questions about alternative methods of treatment. It is best to speak directly with physicians regarding specific medical questions. Family members or loved ones should discuss any problems or reactions they may have. Nurses and other health professionals understand the complexity of emotions and special ongoing needs of those living with a spinal cord injury. They also will spend much time with patients, become their confidants and can be very helpful in their emotional support.
Rehabilitation Units are places where those injured can find hope, strength, inspiration and the specialized medical care needed for spinal cord rehabilitation.
A Rehabilitation Unit should provide long-term rehabilitative care and intensive physical, occupational and recreational therapy, to help those with spinal cord injuries to relearn the basic skills of everyday life. Counseling is also provided to the patients, helping patients learn to cope with their injury and rediscover the fulfilling life that lies ahead for them. The rehabilitative programs are intense. Patients spend several hours each day relearning the skills of everyday life - how to dress, brush their teeth and feed themselves.
Developing independence is especially important. Many SCI Rehabilitation Units include kitchens and laundry facilities and other equipment so patients can learn independent living skills, such as cooking meals or ironing clothes.
After a spinal cord injury, many things change. It's not just being unable to walk or move your arms. A spinal cord injury can also affect the nerves and muscles and can cause bowel and bladder problems and skin problems. Patients should be taught the self-care skills needed to deal with these problems. Spouces, parents or family members of spinal cord injured patients should not be left out; they, too, must learn how to take care of their loved one. Children have special needs and so it is important that these needs are addressed. There are a number of programs that specifically address SCI injuries for pediatric patients.
Having a spinal cord injury doesn't mean that those injured have to stop participating in fun activities. Many hospitals have recreational therapists on staff to show patients that the fun times have just begun or can begin again. From wheelchair basketball, volleyball and tennis, to specially adapted Nintendo games, all that's required is a little ingenuity.
Resources include, an index of SCI terms to search for information, a table of contents of SCI topics; a directory of spinal cord injury organizations; SCI research projects; public surveys and others.
ASIA works to promote and establish standards of excellence for all aspects of health care of individuals with spinal cord injury from onset throughout life. They also educate members, other healthcare professionals, patients and their families as well as the public on all aspects of spinal cord injury and its consequences in order to prevent injury, improve care, increase availability of services and maximize the injured individual's potential for full participation in all areas of community life.
Provides International Standards for Neurological Classification of SCI in PDF format. A pocket-sized booklet that defines for SCI a standard method of assessing the neurological status of the patient, as well as a standard approach to using such data for classifying/quantifying the injury.
If you are suffering with pain and/or have a back or neck injury find out information and links to help you with your health. From your About Guide to Back and Neck Injuries and Chronic Pain - Cindy Rehberg
Dedicated to the mission of being the most comprehensive Internet portal for information on the spine. We seek to educate the public to the full range of technologies, services, treatments and research available on the subject of spinal disorders.
(All information comes from http://www.spinal-cord.org/index.htm)