Comprehensive Package for the Newly Spinal Cord Injured!!

Surgical Intervention

Now that the individual has been stabilized, surgical intervention can now be discussed with the individual or family of the individual.

Surgery will more than likely now be necessary to remove the cause of what is compressing the spinal cord and nerves.

This could involve the removal of bony fragments, foreign objects, blood clots, fractured vertebrae, herniated discs, spinal tumors and/or anything that may be compressing the spinal cord will need to be removed so further damage is prevented.

Surgery is ideally performed as soon as is possible but there is different opinion on what is an ideal time period as it varies between 8 and 48 hours.The surgeon will decide when it is best to perform the operation and what procedure will be carried out.

Surgical intervention may even be delayed beyond 48 hours if the individual is not yet stable.

In some cases the spine will need to be stabilized. The common procedure is Spinal Fusion. Spinal fusion is the procedure of correcting problems with the vertebrae (small bones of the spine).

This procedure fuses the bones together into one solid bone to relieve pain. Grafting will sometimes be performed where bone is used from another part of the body, they will then be positioned in between the vertebrae and fused (similar to welding) and this will immobilize the spine in that area. Bone grafting helps the bones heal together into one piece of bone.
Artificial bone graft material is also sometimes used.

Immobilization:

Metal plates, screws, wires and/or metal rods may be fixed into position to help hold the spine in place sometimes the surgeon may suggest wearing a brace. In the case of cervical injuries surgery may be performed through the throat or the neck or both. Lumber surgery can either be performed through the abdomen or the back. Not all spinal emergency operations will involve fusion, some procedures will involve decompression surgery and no fusing of the bones. It depends on the injury and cause as to what procedure will be required.

Decompression Surgery - Diskectomy:

This is the procedure of removing a portion of a disk to relieve pressure on the nerve roots that are nearby.

Laminotomy:

This procedure involves removing a small part of the bony arches of the spinal canal, called the lamina. During this procedure a section of the lamina is removed.

Laminectomy:

During a laminectomy, the entire lamina is removed. Removing the lamina increases the size of the spinal canal, relieving pressure.

Foraminotomy or Foraminectomy:

Both procedures are carried out to expand the openings for the nerve roots to exit the spinal cord by removing some bone and other tissue.
Foraminectomy refers to a procedure that removes a large amount of bone and tissue.

Osteophyte Removal:

This procedure involves removing bony growths called osteophytes or bone spurs.

Possible Surgical Complications
As with all surgery there are potential risks involved due to complications from surgery and post operative complications.

Infection:
Antibiotics are regularly given to the patient before, during, and often after surgery to lessen the risk of infections.

Bleeding:
A certain amount of bleeding is expected, but this is not typically significant.

Pain at graft site:
A small percentage of people will experience continued pain at the graft site

Recurring symptoms:
Some patients may experience a recurrence of their original symptoms.

Pseudarthrosis:
Patients who smoke are more likely to develop a pseudarthrosis. This is a condition where there is not enough bone formation. If this occurs, a second surgery may needed in order to obtain a solid fusion.

Nerve damage:
It is possible that the nerves or blood vessels may be injured during these operations. These complications are very rare.

Blood clots:
Another uncommon complication is the formation of blood clots in the legs. These pose significant danger if they break off and travel to the lungs.

We have some information on the forum that discusses further the issue of blood clots and how to look out for them and management, please click on the link below.

'Inspired' Information on Blood Clots

Dural Tears:
A Dural Tear is a tear in the covering of the spinal cord and nerve roots.which leaks fluid.

So now at this point, the patient has received emergency intervention, been medically stabilized, taken to the specialist hospital and operated on. This is a daunting time for the individual and for the family. So many feeling, emotions, fear, questions and concerns will be running through their/your head.

It is fair to say that this is just the start of the journey with a Spinal Cord Injury.

During this post operative period the individual and immediate family will most likely begin to become more aware of the associated problems that come with a Spinal Cord Injury.

I will shortly explain further and go into detail the associated health problems that come with a Spinal Cord Injury but I would like to make you aware that at this point it is more than likely that your source of information or source of information the family will receive will in fact be the information that is being provided from the medical staff/your consultant at the hospital.

The information that is received at this point should always be correct and unbiased, ideally but i cannot stress enough to you that every person's injury is unique to them.

My advice to you at this point is to take the all the advice that is offered but then do some of your own research and if you are unable to research yourself then ask a family member to find out.

Always question, question and question...keep an open mind to the potential for recovery. If you have a high level cervical injury that is complete then there will more than likely be limited function but remember that you are in a recovery period. You may have potential for return of recovery still to come even if you are presented with the worst case scenario

The individual will have already been assessed as to their injury level and if he/she is complete or incomplete with the injury (as discussed earlier) So you there will be some idea of what function is affected.

In some cases a good return of function can be expected after rehabilitation and during the recovery period, in some cases return of function is limited.

There are many people who go on to lead productive lives even with high level injuries and being complete...I say this because it has been known for some families of a high level injured family members to be offered the option of ending life support at this point of their treatment.

I am going to link you to a discussion on our forum that highlights some of the issues i have raised...please click on the link below

'Inspired Discussion' Ending life Support

From this discussion we opened a Poll on the forum that further highlights issues around this. If you would like to take a read please click on this link below

'Inspired Poll and Discussion: Post Op Care

Next we will go on to look at the associated health issues that are associated with a Spinal Cord Injury.

Secondary health Issues relating to a Spinal Cord Injury

So at this point we have covered the primary issues that are associated with a Spinal Cord Injury but now we will take a look at the secondary ones. These are issues that may arise as a consequence of being Spinal Cord Injured.

Maybe you are thinking there is already enough to deal with but try not to be too overwhelmed because with correct management each of the risks can be reduced with each issue.

That's not to say some will not happen, some may but at least you wil be informed and have some understanding of what to look out for, how to minimize the potential and have an action plan to deal with each. With regard to dealing with a Spinal Cord Injury, ignorance is not bliss! Be informed and armed with knowledge as it's the best way forward.

Blood Clots

We have already looked at blood clots but as these are an associated issue I still wanted to include them in this section. Following the months after injury and at other periods it can be common for the individual to potentially suffer with a blood clot (also referred to as a Deep Vein Thrombosis D.V.T). Once detected they are very treatable.

We have some additional information on the forum on how to prevent and detect a D.V.T. Please click on the link below to read:

'Inspired' Information on Deep Vein Thrombosis

Autonomic Dysreflexia

Autonomic Dysreflexia (often referred to as AD) is mainly an issue for those at the T6 level and above. It is a very serious condition and can be a medical emergency. In basic terms it is caused by over activity of the nervous system which causes a dangerous rise in blood pressure.

There is always a 'trigger' for AD so the trigger needs to be found and dealt with or/and emergency medication administered. Without intervention and in extreme cases AD can cause stroke and potential death.

It is therefore very important to find what is triggering this reaction and treat it. We have some further detailed information on the forum which discusses Autonomic Dysreflexia and its triggers.

Please click on the link below for more information.

'Inspired' Information on Autonomic Dysreflexia

Pressure Sores:

Pressure sores (also referred to as pressure ulcers) are a serious and troublesome issue for individuals at all levels of Spinal Cord Injury. As most people with Spinal Cord Injury are likely to spend more time immobile or parts of their body below injury level are less mobile and with additional loss of sensation/numb areas they have increased issues with pressure sores.

They are caused by pressure between parts of the body/skin and a surface, they can also be caused by shearing. Long periods of pressure can cause a reduction in circulation to the area and this causes cells to die, this is how a sore develops.

Often an individual will not 'feel' or be as aware when pressure is becoming a problem for their skin but it is very important to keep to a management regime of pressure releasing and checking for sores. The ideal management is to practice prevention because once a sore is developing or developed they can become very difficult to heal.

We have more information on Pressure Sores on our forum that can be read by following the link below, it will explain a little further the causes, prevention, identifying and managing a Pressure Sore

'Inspired' Practical Information on Pressure Sores

Respiratory Complications:

Following a Spinal Cord Injury all individuals are at risk from respiratory complications. Individuals at mid thoracic injury levels and higher are at risk because they don’t have use of abdominal or intercostal muscles. Risk for complications is greater for persons with a complete injury and for individuals with high level tetraplegia (C5-C1).

We will look at each complication individually.

Pneumonia:

Pneumonia is a possible complication for individuals at mid thoracic injury levels and above, mainly due to secretions that can build up in the lungs as a result of inability to inhale and exhale forcefully or cough effectively. This can then cause bacteria to build up and develop infection in the lungs.

Pneumonia is the leading cause of death for individuals with a Spinal Cord Injury

Symptoms of Pneumonia include shortness of breath, pale skin, fever, and increased chest congestion. To help prevent Pneumonia it is important to manage build up of secretions.

Atelectasis:

Atelectasis is where there may be a total or partial collapse of the air sacs (alveoli) in the lung causing a lack of air to the affected area of the lung. Many individuals are at risk of this complication. Long periods of bed rest without being correctly turned, failure to take deep breaths, inability to cough can be contributing factors.

Symptoms of Atelectasis include shortness of breath, thick secretions with change in color, possible pain, feeling of tightness in chest, fever and/or blueness of the lips or nails.

Pulmonary Embolism:

Pulmonary embolism is a blood clot that causes a blockage in the blood vessels in the lungs and individuals at any injury level are at risk of pulmonary embolism.

This is the primary disease of pulmonary circulation and the second leading cause of death for persons with a spinal cord injury within the first year after their injury.

Pulmonary embolism is often caused by a blood clot (D.V.T - deep vein thrombosis) travelling from the leg to the lungs. Please see earlier information on Blood Clots within this section.

Symptoms of Pulmonary Embolism include chest or upper back pain – a sharp, stabbing pain that may be worse when breathing in, shortness of breath which may come on suddenly or develop gradually, coughing which is usually dry, but may include coughing up blood or mucus that contains blood, feeling light-headed or dizzy, fainting. Sometimes small cots can be hard to detect as symptoms may be not be noticed.

Respiratory management is the most effective way to help lessen the risk of respiratory complications.

Here are some points to consider in preventative management (advice from the NSCIA)

- Visiting a doctor at least once per year and getting vaccinated against pneumonia.

- Avoiding buildup of secretion in the lungs by coughing or receiving cough assist treatments.

- Maintaining proper posture and mobility to prevent build up of congestion.

- Wearing an abdominal binder to help assist your intercostal and abdominal muscles

- Following a healthy diet and managing a healthy weight.

- Drinking plenty of water to keep congestion from becoming thick and difficult to cough up.

- Not Smoking! The harmful effects smoking include a decrease of oxygen in the blood, an increase in congestion in the chest and windpipe, a reduction in your ability to clear secretions from your lungs, a destruction of lung tissue, and an increase in the risk for respiratory infections such as pneumonia and bronchitis.

- Breathing Exercises.

The links below offer some further information:

Link to Information on Respiratory Health

'Inspired' link to Improving Controlled Breathing

Sexual Dysfunction

Many individuals with a Spinal Cord Injury will also suffer with sexual dysfunction. This is caused by damaged nerves that lead to the sex organs. For men it tends to affect the ability to have an erection, ejaculation and sensation, for women it tends to affect sensation and ability to orgasm.

This is both daunting and concerning for the newly injured individual and often it isn't until some time after injury that they realize that this is a problem area. In the case of men and erections there are medications/vibrators that can help so there are ways to still enjoy being sexually active.

We have some useful information on the forum which explain sexual dysfunction in more detail. Please click on the links below to read more.

'Inspired' information on Sexual Dysfunction in Men

'Inspired Information on Sexual Dysfunction in Women

Just to add: the link for women also covers some information on menstruation and fertility.


Depression

The impact that suffering a Spinal Cord Injury has on an individual is huge and can never be underestimated. In many cases its devastating. The loss of mobility and body functions leads to worries/concerns for the individual. Independence is affected...loss of the old life and accepting the new one.

Many individuals live with these worries and do their best to remain positive and find coping strategies that help but some go on to suffer with depression.

'Depression is found two or three times more often among people who are paralyzed than among the non disabled' (according to the Christopher and Diana Reeve Association)

On our forum we talk about depression i a little more detail, if you would like to take a read please clink on the link below:

'Inspired' information on Staying Mentally Healthy


Shoulder Joint Issues

As time lengthens with a Spinal Cord Injury issues can arise with the shoulder joint such as osteoarthritis, tendinitis, dislocations and rotator cuff tears. There is emphasis on the importance of taking care of this joint especially as if it becomes damaged then there will be restricted use and then can lead to a loss of function and independence. The ability to self wheel, transfer, pressure release are some of the activities that can be affected.

If you begin to experience pain in this joint, it is a sign that you need to look at preventative measure to avoid further issues.

Please click on the link below to further information on this subject on our forum:

'Inspired' Information on Taking Care of Your Shoulders


Bone Density Loss:

Bone density loss starts immediately following the onset of SCI and continues for at least 12 to 16 months, then it plateaus, bone loss increases the risk for fractures, and this risk continues to increase over time. There are ways to help preserve bone density, our forum provides some information on how this can be achieved.

Please click on the link below to read:

'Inspired' Information on Bone Density Loss

Excellent information package Lαrα, it's better than anything else I've read online! Other than reviewing/editing the posts, all credits go out to Lαrα

Im bumping this as it is such a great resource for everyone, not just newly injured!