Our spinal cord is a long bundle of nerve tissues extending from the brain, responsible for transmission of nerve impulses between the brain and other areas of our body. This long cord is divided into segments made up of sensory (sight, smell, hearing, touch) and motor nerve cells (muscle control). It is protected by a bony structure called vertebral column or popularly known as our spine.

Spinal cord injury starts with traumatic events such as bruising, stretching and laceration that break the vertebral bones. The resulting bone fragments may tear into and lead to puncturing of the exposed spinal cord. Any segment or level of the spinal cord may be involved but the most common part affected is the lower part of our neck (i.e. C-4, C-5 and C-6 levels).

A spinal cord injury is categorized either as complete or incomplete. Patients who sustained incomplete injuries retain certain sensory and motor functions below the level of the injury. This is because the spinal cord still has its function of transmitting nerve messages. Patients who sustained complete spinal cord injury, on the other hand, has total loss of sensory and motor functions below the level of injury. They also experience loss of urinary and bowel control and persistent pain.

Causes and Risk Factors

Vehicle accidents are the leading cause of spinal cord injuries, accounting for 42% of reported cases. Other causes include falls (27.1%), acts of violence (15.3%) and sports (7.4%). Injuries due to falls continue to increase while those due to violence and sports are decreasing. Other events that may lead to spinal cord injuries include tumors, multiple sclerosis (progressive damage to myelin sheath, the layer surrounding some nerve cells that is responsible for efficient nerve transmission) and ischemia (temporary interruption of blood supply due to obstruction of blood vessels).

Spinal cord injuries usually involve adults with an average age of 38, affecting mostly men than women with a 4:1 ratio. However, reported cases of spinal cord injuries among adults over 60 years of age have increased over the last few years. In fact, cases involving seniors increased by 11.5% since year 2000.

Diagnosis

A neurological examination is required to assess sensory and motor functions. This is needed in order to determine the neurologic level of injury, defined as the segment of the spinal cord with normal sensory and motor functions on both sides of the body.

Prognosis

Prognosis highly depends on the age of the patient and severity of the injury. Severe injury at the C-1 and C-2 levels of the spinal cord can lead to interruption in breathing and result to immediate death. Mortality rate is higher in the first year of injury. Complications such as septicemia (infection of the blood), pneumonia (inflammation or swelling of the lungs mainly due to infection) and pulmonary emboli (blood clots in veins become dislodged and block pulmonary arteries causing breathing difficulty) are the leading causes of death or reduced life expectancy among those severely injured.

Some patients, on the other hand, recover to full health. Most of the patients (87.9%) who survive spinal cord injuries are sent home while a few (5.6%) are discharged to nursing homes. Most patients ultimately return to work.

Treatment

Do not move your loved ones who sustained a spinal cord injury. Seek emergency help right away. Those who sustained injuries in the neck require respiratory support. Steroid medications such as methylprednisolone, given within eight hours may reduce swelling and thus decrease further damage. Surgery may also be recommended. It is critical to stop hemorrhage and swelling which are initially caused by spinal cord injuries. If not treated immediately, damage slowly increase and extend to several areas over the next few hours. The spinal cord may be completely destroyed, resulting to paralysis.

Care Plan

Caring for your loved depends on the level of injury that he/she sustained. Discuss with your doctor or a trauma specialist the proper care plan tailored to needs of your loved ones. Although some needs are specialized, the care plan is generally supportive. It is important to take precautionary steps against complications usually associated with spinal cord injury, such as pressure sores, edema, and pain.

Your loved one is especially prone to pressure ulcers or bed sores since their skin devoid of sensation. Reposition them every two hours. Let your loved ones wear comfortable clothes, removing belts and bulky buttons that may put pressure on their skin and soft tissues when they are lying on bed.

Prevent edema or swelling of feet, legs and ankles. Limit the amount of salt in your loved one's diet. In case of edema, inform your doctor. Meanwhile, you may elevate your loved one's feet and provide support when lying down.

Some patients survive spinal cord injuries but emerge with limited physical movements. Discuss with your physician and physiotherapist about the proper rehabilitation program to restore neurological functions. Recovery may take months to years. It is therefore important for you and your loved ones to be patient and positive in order to achieve therapeutic goals.