The spinal cord is an elongated and cylinder-shaped collection of nerves that arise from the end of the brain and extends into the neck and back region. It forms a primary communication channel between the brain and the body.

Injury to the delicate spinal cord or its surroundings is known as a spinal cord injury.

What is the prevalence of spinal cord injury?

The World Health Organization estimates that about 2-5 lakh people suffer a spinal cord injury every year, primarily attributed to accidents or trauma. A spinal cord injury increases the risk of death by 2-5 folds in the general population, making it a serious medical issue. The prevalence of spinal cord injuries is estimated to be about 1.5 million in India, with an increase of 20,000 cases, year on year.

What causes spinal cord injury?

The most common cause of spinal injury is trauma owing to,

Vehicular or road accidents
Falls
Violence
Sports injury

Causes of spinal injury, other than trauma include:

Cancers
Arthritis
Infections
Deterioration of the spine
Congenital disabilities
Injury during birthing

Who are at risk of spinal cord injury?

Anyone who is at a higher risk for of injury is at high risk for spinal cord injuries.

People who have smaller than regular spinal cords are also at a higher risk for spinal cord injury
Engaging in risky behaviour, sportspersons and presence of a bone disorder may also increase the risk of spinal cord injury

What are the types of spinal cord injury?

Based on severity

Complete: A result of a severe injury leading to complete loss of sensation and movement below the site of injury
Incomplete: A result of injury leading to a partial loss of sensation and movement below the site of injury

Based on the part of the body affected

Tetraplegia: A severe type of spinal cord injury wherein there is a loss of sensation, function or movement in the head, neck, arms, hands, shoulders, upper chest or legs, impacting daily functions.
Paraplegia: Loss of sensation, function or movement in the legs or lower parts of the body.
Triplegia: Loss of sensation and movement in one arm and both legs, and is usually seen in incomplete spinal cord injury.

The American Spinal Injury Association (ASIA) classifies spinal cord injuries into the following types

ASIA A: A complete spinal cord injury with complete loss of movement and sensation
ASIA B: A complete spinal cord injury with complete loss of movement
ASIA C: An incomplete spinal cord injury with limited movement preserved, with less than half muscles are unable to lift extremities
ASIA D: An incomplete spinal cord injury with limited movement preserved, with more than half muscles are unable to lift extremities
ASIA E: Normal movement and sensation preserved

Spinal concussions: A trauma to the spinal cord leading to temporary dysfunction of the spinal cord. They can be complete or incomplete and generally resolve in 24 to 48 hours. Football players are prone to head collisions, leading to neck injuries and hence may be frequent victims to spinal concussions.

What are the symptoms of spinal cord injury?

The symptoms of spinal cord injury depend on the type, degree and level of injury and hence can be extremely variable. However, some of the common symptoms that suggestion a spinal cord injury include:

Loss of movement
Loss or tingling sensation, including the ability to feel heat, cold and touch
Loss of bowel or bladder control
Exaggerated muscle movement or spasms
Changes in sexual function, sexual sensitivity and fertility
Pain or an intense stinging sensation
Difficulty breathing or coughing
Balance issues

How is spinal cord injury diagnosed?

The symptoms of a spinal cord injury may not be evident immediately post the damage and hence needs immediate medical attention to identify the problem and its extent.

The immediate step is the assessment of breathing and pulse rate, to ensure the patient is stable. Commonly, a comprehensive medical history and physical examination help identify the areas of movement and sensation loss. The area of the spinal cord injury is generally immobilised using medical equipment like collars.

Moreover, a few tests help take pictures of the site of injury and confirm the condition. They help in identifying fractures, abnormalities, blood clots and masses among others.

The routine assessments include:

Blood test
X-Ray
CT scan
MRI scan

When to seek emergency care?

Overall, spinal cord injury is a critical medical emergency and begins at the site of the accident. Any damage to the head and neck region need immediate medical attention to check for spinal cord injuries. Immobilisation is the key to the overall management and is taken care of by the emergency personnel with the help of a neck collar.

It is essential to evaluate for spinal cord injury at the earliest because:

The symptoms may manifest later on and worsen the injury
The damage may get severe with every passing second, exacerbating the injury
Immediate treatment may help reduce the possibility of a complication and expected early recovery

The treatment in the hospital begins with:

Maintaining and stabilisation breathing and heart function
Preventing shock
Immobilisations
Avoiding complications like breathing failure and heart damage

How is spinal cord injury treated?

The overall treatment plan depends on:

Age, overall health, and medical history
The extent of the spinal cord injury
Type of spinal cord injury
The extent of the spinal cord injury

The nature of treatment for spinal cord injuries is aggressive and long-lasting. It includes a long duration of ICU care, surgeries, use of bladder catheters, ventilator care, feeding tubes, among others.

The first step to treatment includes immobilization of the spine to avoid any further injury to the spinal cord. It is primarily carried out at the accident site by paramedics. Vitals, like breathing and heart health, is checked and managed.

The person is also checked for the possibility of other injuries and is generally taken care of in the intensive care unit (ICU). Traction or collars are used to align and uphold the spine. The other essential of care includes blood pressure stabilization, heart function, lung function, preventing infections, maybe in the treatment plan.

Surgeries are also an important treatment option for spinal cord injuries. It is dependent on the type, extent and degree of the injury. It also dictates the possible outcome during recovery. Sometimes, surgery may not reverse the damage but helps in preventing worsening of the injury.

Follow-ups are generally a part of the treatment plan to monitor progress and prevent complications. Complete spinal cord injuries may not lead to the recovery of functions when compared to incomplete spinal cord injuries. However, it is imperative to know that full recovery is rare with spinal cord injuries and often associated with a lifelong physical and emotional impact. It is also known to be fatal.

What are the complications of spinal cord injury?

Spinal cord injuries are associated with multiple complications. Hence, long term treatment may be required post fixing of the damage. Some of them include:

Urinary tract infections
Loss of bladder control
Loss of bowel control
Pressure ulcers due to long term immobilization
Pneumonia
Chronic pain
Depression
Loss of skin sensation
Development of blood clots
Life-threatening rise of blood pressure
Swelling of extremities
Muscle problems
Impact on sexual health

Complete tetraplegia increases the risk of complications such as pneumonia, pressure ulcers and clots in the extremities.

What is the role of rehabilitation in managing spinal cord injury?

The process of recovery after a spinal cord injury is long and draining. Early rehabilitation helps optimize recovery and support physical and physiological health. The program generally includes a team of healthcare professionals, along with the family members to ensure the well-being of the patient.

Rehabilitation plays a crucial role in:

Dealing with the incident
Pain management
Improve physical, mental and emotional health
Regain muscle strength and maintain bone health
Provide education on condition and management

Is exercising beneficial in recovering from spinal cord injuries?

Exercise is a part of the rehabilitation process and can be beneficial in regaining some of the lost functions. However, the type and intensity of the exercise must be regulated, adhering to the doctor’s instructions.

Exercise helps to:

Stretch the muscles
Encourage breathing
Regain muscle control and strength
Benefit the posture
Support mental health
Reduces the possibility of chronic pain
Keep chronic diseases at bay

Commonly recommended exercises include:

Yoga
Water aerobics
Rowing
Walking
Weightlifting
Seated aerobics

What first aid is offered to a person with suspected back or neck injury?

The rule of thumb is not to move the person suspected with a spinal cord injury. Any movement can increase the risk of further damage and life-threatening complications. It is vital to ensure the neck region is supported with towels or pillows to avoid movement and call the hospital right away.

Can spinal injury cause paralysis?

Depending on the type, degree and level, spinal cord injury can lead to paralysis.

Can acute spinal cord injuries be prevented?

It is essential to take steps to lower the risk of an accident to avoid spinal cord injuries. A few ways include:

Avoid drinking and driving or rash driving
Follow traffic etiquettes and rules
Wear a seat belt while driving and helmet while riding vehicles
Avoid risky movement or behaviour
Practise safe sporting measures

What are the latest technologies available to help patients with a history of spinal cord injury to perform various day to day activities?

Spinal cord injuries can impact a person’s life. With advances in technology, it is possible to improve the quality of life as well as the independence of a person after a spinal cord injury. These include:

Modern wheelchairs: They are lighter and comfortable and can help navigate swiftly.
Computer adaptations: They include voice recognition and use- friendly keyguards, helping people with limited hand function
Electronic aids to daily living: These devices use electricity and are facilitated with remote or voice controls.
Electrical stimulation devices: These are advanced products that use electrical stimulators to control hand or leg functions, helping people regain some ability to walk, hold on to items, etc.
Robotic gait training: A robotic instrument used to help regain walking

When to expect recovery?

The nature of the injury makes it difficult to provide duration to recovery. However, depending on the condition, recovery starts 1 week to 6 months after the injury. However, this can extend up to 2 years or more, and still have unfavourable outcomes

What to expect and how to cope post spinal cord injury?

A spinal cord injury can be a life-changing event. It can lead to a lifelong disability, multiple surgeries, and rehabilitation, follow-ups which in turn can be emotionally daunting. It can also have a grave impact on daily activities, relationships and work. It is important to be hopeful and seek optimum support to rise again and adapt to the new normal.

Feeling such as anger, grief, sadness, denial is common in the patient and his/her loved ones. However, it’s important to note that all these feelings are a normal reaction to such a disastrous event. It’s important to let these feelings in to help accept the situation.

A few ways to cope with life after a spinal cord injury include:

Learning about the condition

Seeking out for help from loved ones and the care team
Finding a support group
Talking to a psychologist
Avoiding blame game
Not succumbing to negative coping methods like alcohol, smoking, etc.
Taking control of the surroundings
Attempting to regain control and independence
Learning about newer advances than can be helpful
Staying connected with friends and family
Seeking medical advice about regaining sexual health
Motivating self to live life to the fullest

References:

Spinal cord injury. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/spinal-cord-injury/symptoms-causes/syc-20377890. Accessed on April 20, 2020.
Spinal cord injury. AANS. https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Spinal-Cord-Injury. Accessed on April 20, 2020.
Spinal cord injury. WHO. https://www.who.int/news-room/fact-sheets/detail/spinal-cord-injury. Accessed on April 20, 2020.
Eck JC. Spinal cord injury. https://www.medicinenet.com/spinal_cord_injury_treatments_and_rehabilitation/article.htm. Accessed on April 20, 2020.
Chin LS. Spinal cord injuries. https://emedicine.medscape.com/article/793582-overview. Accessed on April 20, 2020.