Spinal Cord Injuries (SCI)

Introduction.

Spinal cord injuries, typically damage to part of the spinal cord and/or nerves at the end of the spinal canal, can cause life altering changes in strength, movement, sensation and other body functionality immediately below the point of the injury.

Generally, such injuries give rise to what has commonly become known as ‘Paraplegia’ the loss of motor and sensory functions in the lower body and sometimes part of the trunk, and ‘Tetraplegia” the loss of the same functions as paraplegia but additionally the whole trunk, arms and hands. (Tetraplegic is known as Quadriplegic in the US)

Scientists are hopeful that research into these types of injuries will ultimately lead to the ability to repair spinal cord injuries. In the meantime, advances in treatment and rehab with the use of mobility tools helps SCI affected people lead productive and independent lives.

Typical causes of spinal cord injuries are trauma (such as a traffic collision, diving into shallow water, a fall, a sports injury), disease (such as transverse myelitisGuillain–Barré syndromemultiple sclerosis, or polio), or congenital disorders (such as muscular dystrophy).

Spinal Cord Injuries

Following such an injury, one’s ability to control one’s limbs is dependent upon two factors: The point of injury and the severity of the injury.

The neurological level of the spinal cord injury is the lowest part of the body which has normal sensation and motor ability.  “The Completeness” is how the severity of the injury is classified.

  • Complete: if all sensory and motor ability below the point of the SCI is lost, it is termed complete.
  • Incomplete: should some sensory or motor ability remain, the SCI is termed incomplete. (Obviously there will be varying grades of incomplete injuries)

Medical professionals perform a series of examinations to assess the neurological severity and completeness of the SCI.

The Mayo Clinic in the US lists a number of signs that indicate a spinal cord injury:

  • Loss of movement
  • Loss or altered sensation, including the ability to feel heat, cold and touch
  • Loss of bowel or bladder control
  • Exaggerated reflex activities or spasms
  • Changes in sexual function, sexual sensitivity and fertility
  • Pain or an intense stinging sensation caused by damage to the nerve fibres in your spinal cord
  • Difficulty breathing, coughing or clearing secretions from your lungs

The Mayo also outlines emergency signs and symptoms one might be displaying following an accident or trauma.  These may include:

  • Extreme back pain or pressure in your neck, head or back
  • Weakness, incoordination or paralysis in any part of your body
  • Numbness, tingling or loss of sensation in your hands, fingers, feet or toes
  • Loss of bladder or bowel control
  • Difficulty with balance and walking
  • Impaired breathing after injury
  • An oddly positioned or twisted neck or back
Cervical Collar

Clearly, if one is experiencing any of the above symptoms it is crucial that you see your doctor for immediate evaluation. In Rugby for instance, one often sees the head and neck of an injured player immobilised with a cervical collar as a precaution and to prevent further injury.

Spinal injuries are not always immediately obvious. If there is any delay in diagnosis it is possible that what may be a clinically manageable injury could become more severe with life changing results.  Numbness or partial paralysis may occur at the time of the injury or possibly come on gradually as the area around the injury becomes inflamed.  Irrespective of the severity of the SCI, the time between injury and treatment can be crucial in learning the extent of the SCI and in turn, the possibility of recovery.

Should you suspect someone to have a spinal cord injury, the St John’s Ambulance gives the following advice:

If Responsive:

  • Reassure the casualty. Do not move them and tell them not to move, unless they are in immediate danger. Call 999 or 112 for emergency help or ask someone else to call for you. 
  • Steady and support their head, so that their head, neck, and spine are in a straight line to try and prevent further damage. To do this, kneel or lie behind their head, resting your elbows on the ground or on your knees to keep your arms steady. Hold each side of their head, spreading your fingers so that you do not cover their ears as they need to be able to hear you. Support their head in this neutral position. 
  • If there is someone who can help you, ask them to put rolled-up blankets, towels, or clothes on either side of the head while you keep the casualty’s head in the neutral position. Continue to support their head until emergency help arrives and can take over, no matter how long it takes for them to come. 
  • Keep monitoring their breathing and level of response while waiting for help to arrive. 

If unresponsive:  

  • Reassure the casualty. Do not move them unless they are in immediate danger. Call 999 or 112 for emergency help or ask someone else to call for you.
  • Steady and support their head so that their head, neck, and spine are in a straight line to try and prevent further damage. To do this, kneel or lie behind their head, resting your elbows on the ground or on your knees to keep your arms steady. Hold each side of their head, spreading your fingers so that you do not cover their ears as they need to be able to hear you. Support their head in this neutral position.
  • Open their airway using the jaw-thrust technique. To do this, put your fingertips at the angles of the jaw and gently lift the jaw to open the airway. Do not tilt their neck
  • Check the casualty’s breathing. Place your ear above their mouth, looking down their body. Look, listen, and feel for 10 seconds.
  • If they’re breathing, continue to support their head, monitor their breathing, and level of response.
  • If they are unresponsive and not breathing, make sure you have called 999/112 for emergency help and start CPR straight away. Ask a helper to find and bring a defibrillator (AED).

Are You at Risk?

Generally, a Spinal Cord Injury is the result of an accident and can happen to anyone. However, there are certain factors that increase the risk of suffering such an injury:

  • Being a man. Sorry to report that guys account for nearly 80% of spinal cord injuries. So stop that larking about and look after you back/neck!
  • Whilst the average age of an SCI is approximately 43 years, you’re more at risk if you’re between the ages of 16 and 30.
  • Being older than 65: there’s no getting around it, as we get older we’re more prone to injurious falls.
  • Risky behaviours: generally, a combination of ‘being a man’ and ‘being aged between 16 and 30’. Dangerous and high-risk sports such as rugby, skiing or skydiving; or carelessness, like diving into too shallow water.
  • Joint and Bone Disorders: arthritis or osteoporosis can mean small or minor injuries lead to a more severe SCI.

As usual, despite the excellence of the NHS, the US leads the way in research for SCI’s. Some excellent information can be found at the American Association of Neurological Surgeons (AANS) , Medicine Net and Health Line. Nevertheless, the NHS is a good source of information and a resource to help find local support centres and care. More information can be found at the Royal National Orthopaedic Hospital .

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