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The spinal cord is a column of nerve tissues averaging about 18 inches in length, extending from the base of the brain to the waist. The spinal cord is enclosed by the vertebrae column, which consist of 33 vertebral bones: Seven cervical, 12 thoracic, five lumbar, five sacral fused to form one, and four coccyx fused into one. The nerves to trunk and limbs branch out from the spinal cord, exiting at each vertebral level.
- These nerves transmit the messages from the brain to the muscles, stimulating the movement while transmitting sensations from the body such as pain, temperature, position and touch. The spinal cord is the important pathway of communication between the brain and the body. Spinal cord damage interrupts the spinal cord's ability to send and receive information from the brain to the each part of the body, causing paralysis below the level of injury.
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The
symptoms and signs of spinal cord trauma usually appear immediately after the injury. They may include complete or incomplete paralysis below the level of the injury, numbness or pain. Loss of bowel and bladder control or sexual dysfunction is accompanied in many cases.
- The symptoms and the extent of
paralysis can vary depending on the location and the
severity of the injury.
- Complete vs. incomplete spinal cord injury
The spinal cord can be
damaged totally or partailly, depending on the type and
degree of the injury. Complete injury may result in
the permanent and total loss of motor and sensory functions
below the level of the injury. In incomplete
injuries, motor and sensory functions are partially
preserved below the level of injury, and show a partial recovery of movement and sensation after the injury.
- Level (location) of the injury -- Cervical cord injuries cause the paralysis of the upper and lower limbs, along with the trunk. Breathing difficulties can accompany high cervical cord damage. Throacic level injuries usually affect the trunk and lower limbs. Lumbar and sacral level injuries cause the paralysis of the lower limbs.
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Usually, paralysis and numbness may
appear immediately after the injury, but the symptoms can
get worse slowly as well, because of the gradual swelling of
the spinal cord. A neurologic examination indicates
the level and severity of the spinal cord injury.
- Spine X-Rays or a CT scan shows the fracture of the spine
- A spine MRI shows the exact location of the spinal cord injury
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- Loss of bladder and bowel control
- Sexual dysfunction
- Muscle spasm below the level of injury
- Pressure sore
- Urinary Tract Infection
- Progressive loss of kidney function, leading to renal failure
- Heterotopic ossification (the formation of new bone deposits in the soft tissue that surrounds the joints)
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A
spinal cord trauma is an emergency. Immediate treatment is important for a good prognosis.
- Immedate treatment after injury
- Stabilization of the spine is needed to maintain anatomic alignment and prevent further damage by any broken bony fragments. Transfer of patient with proper spine protection is especially important at the time of the injury.
- Immobilization -- bed rest and traction of spine.
- Corticosteroids are effective to reduce swelling of the spinal cord and surrounding tissues, minimizing the spinal cord damage. Corticosteroid shots should be administered within 8 hours after the injury.
- In the case of an unstable fracture, surgery may be needed to stabilize the broken spine and relieve the pressure to the spinal cord by removing bony fragments, surrounding tissues and hemorrhagic fluid.
- Other treatment to prevent medical complications include:
- Proper bladder care with catheterization and antibiotics, skin care and frequent position changes to prevent Pressure Sores, prophylactic drugs for Deep Vein Thrombosis, psychiatric counseling and pain control.
- Rehabilitation -- physical therapy and occupational therapy improves the functional ability, and prevents the contracture of the joints.
- Skin care --Pressure Sores are
one of the most common complications after a spinal cord injury. Frequent position changes are needed. Special beds can be helpful.
- Bladder and bowel management -- the type of bladder and bowel dysfunction depends on the level of injury, so the ideal method of voiding is different from person to person. The physicians will recommend the proper voiding method after evaluation of the bladder and kidney function. Inappropriate voiding methods and bladder care may result in kidney dysfunction, so the regular follow-up of bladder and kidney function is important.
- Pain control -- Anti-depressants or anti-seizure medications are effective in relieving the central pain and tingling sensation resulting from spinal cord damage.
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Recovery of function depends upon the severity of the initial injury. Unfortunately, the paralysis resulting from a complete spinal cord injury is permanent. Incomplete injuries show some recovery over time, but this varies with the degree of the injury.
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