Post by Lαrα on Nov 17, 2013 10:50:04 GMT -8
Firstly, what is a Spinal Cord Injury?
We first need to look at the the Spinal Cord and how it works. The link below links to an excellent video on our forum that explains this very clearly.
'Inspired' informational video on the Spinal Cord
A Spinal cord injury refers normally to an injury that is caused by a trauma rather than disease that fractures or dislocates your vertebrae, the bone disks that make up your spine. However its important to recognize that people can become Spinal Cord Injured from degenerative disc disease, syndromes and spinal tumors.
Further information on Spinal Conditions can be found here on our forum:
'Inspired' information on Spinal Conditions
Most injuries tend not to cut through your spinal cord. Instead, they normally cause damage when pieces of vertebrae tear into cord tissue or press down (compress) on the nerve parts that carry signals from the brain to parts of your body.
Spinal Cord Injuries are described as either Complete or Incomplete and depend on where the injury occurs/what level along the spinal cord determines whether the injury may result in Quadriplegia (also known as Tetraplegia) or Paraplegia .
For a more detailed explanation of what Complete or Incomplete Quadriplegia and Complete or Incomplete Paraplegia means please click on the links below:
'Inspired' Information on Quadriplegia/Tetraplegia
'Inspired' Information on Paraplegia
A Spinal Cord Injury is an emergency but not all people who have acquired a Spinal Cord Injury will have been in an emergency situation. For example, from an accident/trauma and some will have become injured from medical conditions. Most individuals will have needed emergency operations and some may not have.
Most will have been an emergency because of the way compression will lead to further damage of the spinal cord and the nerves leading from it so decompression is often needed urgently. More damage can therefore result in further loss of function than necessary.
The information we now go on to discuss starts with the point of emergency from a trauma and onward although individuals who were not in this type of emergency will still relate to much of this newly injured information pack and find a lot of relevant information to them and their treatment/rehab.
Emergency Medical Procedures following a suspected Spinal Cord Injury:
When medical assistance is at the scene the first priority will be to stabilize the patient. This is achieved by stabilizing the breathing, blood pressure and spinal column. The spinal column is normally stabilized with a cervical neck collar and a back board.
Some individuals with a higher level injury may have function impaired with their breathing due to associated nerve damage. They will therefor need assistance to help them breath. In some cases this function will improve but in some it may not and they may always need a ventilator to assist their breathing.
Once the patient is stable he/she can then be taken to or moved to a specialized trauma hospital where they are specialized in dealing with this type of injury and can offer the very best surgical care to the patient. The patients emergency care that he/she receives within the first 8 hours from the onset of injury is critical to his/her potential recovery. Incorrect intervention at this point can worsen the injuries.
Shortly, within minutes after injury the body goes into Spinal Shock. Spinal shock normally lasts for up to 12 weeks but on some occasions can last for months. Spinal shock is the term used for the neurological changes that are taking place below the injury level. Damage causes the inability to transmit signals and this affects function, movement, sensation, breathing, heart, blood vessels, vasomotor response, body temperature.
After several weeks the body adjusts and some improvements may occur with return of function.
A variety of medication are sometimes used to help control the extent of damage to the spinal cord during the early days of injury. Medication will also be administered to help relieve pain, treat infections and any other related health issues relating to the Spinal Cord Injury.
Some patients are sedated and then put into traction to prevent any further damage. Halos are sometimes used to keep the head and neck limited in their movements. Metal bracing attached to weights or a body harness may also be used too.
Reducing and/or stopping immediate body responses such as swelling to the injury area should now be addressed as swelling can cause further damage to the spinal cord . Emphasis is at preventing further damage as further damage can lead to further loss of function. This is called neuroprotective therapies.
(It has long been recognized that much of the post-traumatic degeneration of the spinal cord following injury is caused by a multi-factorial secondary injury process that occurs during the first minutes, hours, and days after spinal cord injury (SCI).
A steroid drug called Methylprednisolone (Medrol) is sometimes used within the first few hours following injury as it is thought to reduce inflammation and assist in recovery. This drug is sometimes administered at the scene.
It should be noted that ideally this drug should be given within 8 hours of the injury. It works by reducing damage to nerve cells and decreasing inflammation..it isn't a cure but it is thought to offer the opportunity of of mild improvements.
Another treatment that could be used at this point is Therapeutic Hypothermia (spinal cord cooling). This is the procedure of lowering the body temperature in order to protect cells and can be achieved by using catheters filled with saline to cool a patient's blood as it leaves the heart. This lowers the temperature of the whole body and is described as an invasive method.
Non-invasive techniques use special blankets which have cold water running through them. The blankets can be used with ice packs or cold fans in order to achieve more speedy temperature decline.
(Although there are media reports that support the benefit of this procedure, at this point there isn't enough evidence to prove or disprove that patients with a Spinal Cord Injury benefit from having the procedure carried out)
A physician/physicians will need to determine the extent of the injury, x-rays, MRI's or CT scans will be used as part of this evaluation. Neurological examination will also be used. Neurological assessment involves measuring sensation (pin prick test), muscle tone, range of motion and reflexes of the limbs and trunk. The patient will then be graded on the ASIA scale. For more information on the gradings, please visit the link below.