A spinal cord injury is a serious situation that requires immediate medical care. This condition causes damage to part of the spinal cord or to the nerves at the end of the spinal canal. This injury, which is complete or incomplete, affects, among other things, strength, sensation and movements, although the clinical presentation is very variable. After the patient has stabilized, an extensive treatment program follows with medication and rehabilitation therapy. The patient may experience physical, mental, emotional and social consequences of the damage to the spinal cord.

• Epidemiology of spinal cord injury
• Causes of spinal cord injuries
• Risk factors of spinal cord injury

• Traumatic damage to spinal cord
• Non-traumatic damage to spinal cord

• Species

• Completely
• Incomplete
• Tetraplegia
• Paraplegia

• Symptoms
• Diagnosis and examinations
• Treatment for damage to the spinal cord

• First aid in case of accidents (first aid)
• Professional medical help

• Prognosis of spinal cord injury
• Complications of serious condition

Epidemiology of spinal cord injury

About 80% of patients are male. Furthermore, people between the ages of 16 and 30 are at greater risk of developing a spinal cord injury. Damage to the spinal cord is also more common in people over 65 as a result of falls.

Causes of spinal cord injuries

The spinal cord is a bundle of nerves that runs along the middle of the back. The signals back and forth between the body and the brain pass through the spinal cord. A spinal cord injury disrupts these signals. The spinal cord injury results from damage to the vertebrae, ligaments or discs of the spinal column or an injury to the spinal cord itself. Spinal cord injuries usually start with a blow that fractures, crushes, compresses, or dislocates the patient’s vertebrae. Most injuries do not severe the spinal cord. However, they do cause damage when pieces of vertebrae tear off in connective tissue or put pressure on the nerve parts that carry signals. Furthermore, additional damage sometimes occurs after a few days or weeks as a result of bleeding, swelling, inflammation and fluid accumulation in and around the spinal cord.

Risk factors of spinal cord injury

Traumatic damage to spinal cord

Spine damage is more common in athletes, divers, alcohol drinkers, the elderly, and people involved in a vehicle accident. The following risk factors may lead to a spinal cord injury:

• occupational hazards, such as working with mechanical tools or equipment
• a car accident
• a gunshot
• a violent force that twists half the body
• a blow from a heavy object hitting the back
• a stab wound
• a fall (especially from a great height)
• electric shock
• injuries during sports or fast racing

Alcohol also plays a role in 25% of patients with spinal cord injury.

Non-traumatic damage to spinal cord

In a number of patients, a non-traumatic spinal cord injury is the result of arthritis (inflammation of the joints), osteoporosis (loss of bone mass with risk of fractures), myelitis (inflammation of the spinal cord), cancer, infections or disc degeneration of the spine.

Species

Completely

Spinal cord injuries are complete (complete) or incomplete (incomplete). In a complete spinal cord injury, the spinal cord no longer sends signals to areas below the injury. This leaves the patient completely paralyzed under the injury. Motor function (ability to control movements) is completely lost.

Incomplete

With an incomplete spinal cord injury, the patient still has some movement and sensation below the injury because some nerves below the injury still have some function. There are various degrees of this. In general, incomplete injuries result in less loss of function than complete injuries at the same site.

Tetraplegia

Tetraplegia (quadriplegia) is a condition in which spinal cord injuries affect the arms, hands, trunk, legs and pelvic organs.

Paraplegia

Paraplegia is a form of paralysis in which part or all of the trunk, legs and pelvic organs are affected. A loss of sensation in the lower body is also one of the possible symptoms.

Symptoms

The severity and location of the damage determine the clinical presentation and severity.The following signs are possible:

• (extreme) pressure in the neck, head or back
• breathing problems
• loss of consciousness
• bleeding and bruising at the site of the injury
• fractions
• coordination disorders
• an obvious physical deformity, such as an abnormally twisted head or body position, an oddly positioned or twisted neck or back
• a shock
• a loss of control over the legs and arms
• a loss of bowel control (fecal incontinence) or bladder control (urinary incontinence)
• balance problems (ataxia)
• sensory disturbances such as numbness, tingling, and the inability to feel cold, heat, or touch
• moderate to intense pain in the back (back pain) or neck (neck pain) (this is due to damage to the nerve fibers in the spinal cord
• difficulty moving or getting up and walking normally
• difficulty coughing / difficulty coughing up phlegm
• exaggerated reflex activities or spasms
• changes in sexual function, sexual sensitivity and fertility
• paralysis in an area of the body
• weakness

Diagnosis and examinations

The doctor thoroughly inspects and examines the patient. He performs a neurological examination on the patient, testing the reflexes, sensation, movements and function of the limbs in particular. In case of neck pain, changes in consciousness, clear signs of weakness or neurological damage, the doctor immediately initiates imaging tests such as an X-ray, an MRI scan and a CT scan. A more extensive neurological examination is necessary after a few days because some of the swelling has disappeared. He then tests the muscle strength and the ability to feel touches and stimuli. This allows the doctor to detect the severity of the spinal cord injury.

Treatment for damage to the spinal cord

A spinal cord injury is a medical emergency. The damage from a spinal cord injury is permanent, but immediate treatment reduces long-term complications.

First aid in case of accidents (first aid)

The attendant (helper) may not move the patient if there is suspicion of spinal cord injury or damage to the head or neck. If the patient has to vomit, the attendant tilts the patient’s body. If necessary, he supports the patient with pillows or towels, or holds the head and neck to prevent moving from position. The supervisor supports the patient until the care providers arrive. The patient is therefore not allowed to move under any circumstances. Even if the patient is wearing a helmet or other safety clothing, the supervisor may not remove these materials. The supervisor may resuscitate the patient if necessary. If blood comes from other wounds, the attendant must apply pressure to regulate the blood flow. Upon arrival, the care provider will immobilize the patient with a cervical collar and carrying board, which they also use to transport the patient safely and quickly to the hospital.

Professional medical help

It is important to stabilize the spine. This is done with medications, braces, traction (exerting sustained pulling force to maintain the position or correct the deformity) and/or surgery. At a later stage, medication treatment follows and usually also rehabilitation therapy. The patient then learns to use mobility aids and receives physiotherapy and occupational therapy so that he can learn to move around and also perform some daily tasks.

Prognosis of spinal cord injury

The doctor is often not immediately able to give a prognosis because the body’s recovery only begins one week to six months after the damage. Most patients recover quickly within the first six months and do not improve much after that. Other patients recover little by little over one to two years. Depending on the severity of the damage, a spinal cord injury can lead to brief paralysis or permanent complications.

Complications of serious condition

The patient experiences many changes to the body due to the spinal cord injury. Some complications are possible such as:

• a depression
• an infection
• an increased risk of blood clots such as deep vein thrombosis (pain and swelling in the leg or pelvis) or pulmonary embolism (blockage of an artery in the lungs)
• a loss of bladder control
• a loss of bowel control
• reduced skin sensation, causing pressure ulcers / pressure sores (decubitus) to develop more quickly
• a swelling of the limbs
• weight loss/muscle atrophy (muscle loss)
• obesity, cardiovascular disease and diabetes mellitus (diabetes) due to a sedentary lifestyle (a referral to the dietitian is necessary in combination with physiotherapy and occupational therapy)
• orthostatic hypotension (suddenly dizzy after standing up)
• pain: muscle pain, joint pain, nerve pain
• sexual health problems
• problems with the respiratory system
• muscle spasticity (muscle stiffness) or hypotonia (reduced muscle tone)

read more

• Autonomic dysreflexia: Symptoms due to spinal cord injury
• Paraplegia: Lower body paralysis with loss of sensation
• Paralysis (paralysis): Types, causes and symptoms