Brain & Spine Trauma/Injury Surgery
What is an acute spinal cord injury?
Your spine is made of many bones called vertebrae. Your spinal cord runs downward through a canal in the center of these bones. The spinal cord is a bundle of nerves that carries messages between the brain and the rest of the body for movement and sensation.
Acute spinal cord injury (SCI) is due to a traumatic injury that bruises, partially tears, or completely tears the spinal cord. SCI is a common cause of permanent disability and death in children and adults.
What causes an acute spinal cord injury?
Many things can cause SCI. The more common injuries occur when the area of the spine or neck is bent or compressed, as in the following:
- Motor vehicle accidents (automobiles, motorcycles, and being struck as a pedestrian)
- Sports injuries
- Diving accidents
- Trampoline accidents
- Violence (gunshot or stab wounds)
- Infections that form an abscess on the spinal cord
- Birth injuries, which typically affect the spinal cord in the neck area
What are the risk factors for acute spinal cord injury?
Some people are at higher risk for SCI than others. Average age at the time of injury has increased over the past few decades and is currently 42 years. Most people who suffer SCIs are male. Non-Hispanic whites are at higher risk for SCI than any other ethnic group.
What are the symptoms of an acute spinal cord injury?
Symptoms of an acute SCI can vary widely. The location of the injury on the spinal cord determines what part of the body is affected and how severe the symptoms are.
Right after a spinal cord injury, your spine may be in shock. This causes loss or decrease in feeling, muscle movement, and reflexes. But, as swelling eases, other symptoms may appear depending on the location of the injury.
Generally, the higher up the level of the injury is to the spinal cord, the more severe the symptoms. For example, an injury to the neck, the first and second vertebrae in the spinal column (C1, C2), or the mid-cervical vertebrae (C3, C4, and C5) affects the respiratory muscles and the ability to breathe. A lower injury, in the lumbar vertebrae, may affect nerve and muscle control to the bladder, bowel, and legs, and sexual function.
- Quadriplegia is loss of function in the arms and legs.
- Paraplegia is loss of function in the legs and lower body.
The extent of the damage to the spinal cord determines whether the injury is complete or incomplete.
- A complete injury means that there is no movement or feeling below the level of the injury.
- An incomplete injury means that there is still some degree of feeling or movement below the level of the injury.
These are the most common symptoms of acute spinal cord injuries:
- Muscle weakness
- Loss of voluntary muscle movement in the chest, arms, or legs
- Breathing problems
- Loss of feeling in the chest, arms, or legs
- Loss of bowel and bladder function
The symptoms of SCI may look like other medical conditions or problems.
How are acute spinal cord injuries diagnosed?
Acute SCI is a medical emergency. Emergency evaluation is needed anytime there is a suspected injury to the spinal cord.
The effects of an SCI may not be clear at first. A full medical evaluation and testing are needed. The diagnosis of SCI starts with a physical exam and diagnostic tests. During the exam, the healthcare provider will ask about your medical history and how the injury occurred. A spinal cord injury can cause ongoing neurological problems that require further medical follow-up. Sometimes, surgery is needed to stabilize the spinal cord after acute SCI.
Diagnostic tests may include:
- Blood tests
- X-ray. This test uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
- Computed tomography scan (also called a CT or CAT scan). An imaging test that uses X-rays and computer technology to produce detailed images (often called slices) of the body. A CT scan shows images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
- Magnetic resonance imaging (MRI). This test uses large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body.
How is an acute spinal cord injury treated?
SCI requires emergency medical attention on the scene of the accident or injury. After an injury, your head and neck will be immobilized to prevent movement. This may be very hard when you are frightened after a serious accident.
Specific treatment for an acute spinal cord injury is based on:
- Age, overall health, and medical history
- Extent of the SCI
- Type of SCI
- How you respond to initial treatment
- The expected course of the SCI
- Your opinion or preference
There is currently no way to repair a damaged or bruised spinal cord. But, researchers are actively seeking ways to stimulate spinal cord regeneration. The severity of the SCI and the location determines if the SCI is mild, severe, or fatal.
Surgery is sometimes needed to evaluate the injured spinal cord, stabilize fractured backbones, release the pressure from the injured area, and to manage any other injuries that may have been a result of the accident. Your treatment may include:
- Observation and medical management in the intensive care unit (ICU)
- Medicines, such as corticosteroids (to help decrease the swelling in the spinal cord)
- Mechanical ventilator, a breathing machine (to help you breathe)
- Bladder catheter. A tube that is placed into the bladder that helps to drain urine into a collection bag.
- Feeding tube (placed through the nostril to the stomach, or directly through the abdomen into the stomach, to provide extra nutrition and calories)
Recovery from a SCI often requires long-term hospitalization and rehabilitation. An interdisciplinary team of healthcare providers, including nurses, therapists (physical, occupational, or speech), and other specialists work to control your pain and to monitor your heart function, blood pressure, body temperature, nutritional status, bladder and bowel function, and attempt to control involuntary muscle shaking (spasticity).
Can acute spinal cord injuries be prevented?
There is no sure way to prevent SCI, but there are many steps you can take that might lower your risk, including:
- Don’t drive when you are under the influence of alcohol or drugs.
- Always wear a seat belt while in a vehicle.
- Take precautions to avoid falls around your home.
- Keep firearms unloaded and locked away.
- Wear a helmet when riding a motorcycle or participating in any sports or activities that may result in head injury (bike riding, skiing, hockey, football, etc)
Living with an acute spinal cord injury
Recovery from a SCI often requires long-term hospitalization and rehabilitation. Physical therapy will likely be a very important part of your rehabilitation. In this treatment, specialists will work with you to prevent muscle wasting and contractures, and to help you retrain other muscles to aid in mobility and movement. Another type of therapy is occupational therapy, which helps you learn new ways of doing everyday tasks in spite of your new physical limitations.
A traumatic event that results in a SCI is devastating to both you and your family. The healthcare team will help educate your family after hospitalization and rehabilitation on how to help care for you at home and understand the specific problems that require immediate medical attention.
You will need frequent medical evaluations and testing after hospitalization and rehabilitation to monitor your progress.
It’s important to focus on maximizing your capabilities at home and in the community.
You may feel sad or depressed after your injury. If this happens to you or a loved one, your healthcare provider may recommend that you see a mental health professional. Antidepressants and psychotherapy, or “talk therapy,” are both available to help treat depression.
When should I call my healthcare provider?
Depending on the severity of the injury, some people might recover some of their lost function, but others might continue to have long-term problems. Be sure to talk with your healthcare provider about when you would need to call them.
Your healthcare provider will likely advise you to call them if any problems you are having become worse, including weakness, numbness or other changes in sensation, or changes in bladder or bowel control.
People who have serious long-term effects from a spinal cord injury can also develop a number of other complications. Your healthcare provider might advise you to call them if you have problems such as:
- Skin sores or infections
- Trouble breathing
- Fever, cough, or other signs of infection
- Severe headache
- Not urinating regularly or having severe diarrhea or constipation
- Severe muscle cramps or spasms
- Increasing pain
- An acute spinal cord injury is caused by trauma to the spinal cord. It is a medical emergency that needs to be treated right away.
- The severity of symptoms (such as weakness, paralysis, and loss of feeling) depends on how badly the spinal cord is damaged and where on the cord the injury occurs. Damage to the cord in the middle of the back might affect only the legs, whereas damage to the spinal cord in the neck might also affect the arms and even the breathing muscles.
- Treatment might include surgery, medicine , and other treatments as needed. Some people might recover some function over time, but others might continue to have long-term problems. Physical and occupational therapy can help you adapt to new ways of doing things.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.
Why is cervical disk replacement surgery needed?
Loss of space between your cervical vertebrae from cervical disk degeneration, or wear and tear, is common. Cervical disks begin to collapse and bulge with age; this happens to most people by age 60. But health care providers don’t know why some people have more symptoms from cervical disk degeneration than others.
Symptoms may include:
Pain that travels down into your shoulders or into your arms
Weakness of your shoulders, arms, hands, or legs
Numbness or "pins and needles" feeling in your arms
What are the risks of cervical disk replacement surgery?
While any surgery carries some risk, disk replacement surgery is a relatively safe procedure. Before you have surgery, you will need to sign a consent form that explains the risks and benefits of the surgery.
Disk replacement is a new type of spine surgery so there is little information on possible long-term risks and outcomes. Discuss with your surgeon the risks and benefits of disk replacement surgery compared with more traditional types of cervical spine surgery.
Some potential risks of cervical spine surgery include:
Reactions to the anesthesia
Spinal fluid leak
Failure to relieve symptoms
There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your surgeon before the procedure
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