Definition

Spinal cord trauma refers to damage inflicted on the spinal cord or the nerve fibers forming the cauda equina. Globally, approximately 250,000 to 500,000 individuals suffer spinal cord injuries annually. These injuries can result from trauma or medical conditions such as joint inflammation. However, this article specifically addresses spinal cord injuries resulting from trauma. Whether caused by trauma or not, spinal cord injuries often lead to permanent disability.

Causes

The spinal cord, along with the brain, constitutes the central nervous system. It comprises soft tissue shielded by spinal bones, extending from the base of the brain to the lower back. The spinal cord terminates in a cone shape, referred to as the conus medullaris. Nerve fibers branching from the spinal cord continue to innervate the lower body, extending from the lower back to the toes, resembling a horse's tail, hence termed the cauda equina. Nerves emanating from the spinal cord connect the brain to various body parts. The brain dispatches motor signals for movement, while the body relays sensory signals like temperature, touch, pain, and body position information to the brain.

Spinal cord trauma commonly arises from motor vehicle collisions, falls, physical violence, and sports activities. Among these, motor vehicle collisions stand as the predominant cause, typically afflicting individuals aged 16 to 30. In contrast, falls are the leading cause of spinal cord trauma among older adults (over 65 years old). These incidents inflict damage upon the spinal bone structure or even the spinal cord itself, precipitated by blunt force trauma or penetrating wounds such as stabbings or gunshot wounds.

Risk factor

Risk factors for spinal cord trauma correlate with its causes. Males face a fourfold higher risk due to their higher frequency of motor vehicle operation and engagement in extreme sports like shallow water diving, often without protective gear. These activities, predominantly pursued by adolescents to young adults, contribute to the peak incidence of spinal cord trauma between ages 16 and 30. Alcohol consumption is implicated in 25% of spinal cord trauma cases.

Among individuals over 65, the incidence of spinal cord trauma escalates owing to heightened fall risks associated with age. Moreover, medical conditions such as osteoporosis (brittle bones) elevate the likelihood of spinal cord injury even from minor trauma.

Symptoms

Symptoms of spinal cord trauma hinge greatly on the injury's location and severity. The site of the spinal cord injury dictates the initial manifestation of symptoms in the body, affecting all body parts regulated by the spinal cord below the injury site.

Based on severity, spinal cord trauma is categorized as:

• Complete: where the entire spinal cord at a specific location sustains injury, resulting in the loss of all sensations such as temperature, pressure, touch, pain, and body position. Muscles regulated by the spinal cord at and below the injury site experience paralysis.
• Incomplete: where only a segment of the spinal cord at a specific location is damaged. Symptoms may encompass paralysis, sensory loss, or a combination thereof, with numerous variations based on the injury's location.

Furthermore, paralysis stemming from spinal cord injury is classified as:

• Tetraplegia: denoting paralysis of all four limbs, inclusive of the torso, abdomen, and internal organs. Typically, tetraplegia results from spinal cord injuries in the neck region.
• Paraplegia: indicating paralysis of both legs, with accompanying effects on other bodily regions contingent upon the injury location. In paraplegia, spinal cord injury can extend from the upper back to the waist, potentially inducing respiratory difficulties, sexual and urinary dysfunction, contingent upon the injury's precise location.

In severe cases, spinal cord trauma can induce low blood pressure and diminished heart rate, culminating in neurogenic shock due to the body's inability to elevate blood pressure and heart rate.

Diagnosis

Diagnosing spinal cord trauma entails direct examination and imaging. Direct examination aims to pinpoint the nerve injury's location, encompassing assessments of vital signs like blood pressure, pulse rate, respiration, and temperature, alongside neurological physical examinations evaluating sensation, body position perception, and motor function.

Imaging modalities such as X-rays and CT scans facilitate the identification of bone abnormalities like fractures, while magnetic resonance imaging (MRI) detects spinal cord damage, often conducted post-stabilization.

Additionally, laboratory tests like arterial blood gas analysis (ABG), lactate testing, complete blood count, and urine analysis aid in assessing tissue oxygenation, metabolism, blood loss, and potential urinary system injuries, respectively.

Management

Management of spinal cord trauma commences before reaching the nearest emergency department. In case of suspected back injury in someone else, precautionary measures include:

• Ensuring the surroundings are safe and refraining from moving the individual.
• Contacting the nearest emergency health facility.
• Avoid movement of the person, as it may exacerbate the injury.
• Placing a thick towel on both sides of the neck to limit excessive movement.
• If feasible, address visible bleeding and offering reassurance without altering the victim's head or neck position.

Upon reaching the emergency department, initial management entails airway clearance, neck immobilization, and stabilization of breathing and circulation. Intubation or insertion of a breathing tube may be necessary if the individual experiences breathing difficulties. Intravenous (IV) placement aims to stabilize blood pressure, while feeding tube or nasogastric tube (NGT) insertion facilitates feeding, considering potential swallowing or breathing difficulties. Catheter placement aids in urination. 

Medications may be administered to elevate blood pressure, alleviate pain, and prevent vomiting. Additionally, repositioning the patient every few hours mitigates the risk of pressure ulcers on the back (decubitus ulcers).

Surgical intervention may involve spine stabilization, pain and deformity mitigation, and alleviation of nerve compression, blood clots, or foreign objects. Subsequently, the patient undergoes rehabilitation aimed at restoring limb mobility and facilitating daily activities like bathing, eating, and defecating, often involving psychological support due to the challenging nature of recovery from such conditions.

Complications

Complications stemming from spinal cord trauma arise due to the patient's immobility. These can include urinary tract infections, pressure ulcers, vascular occlusion, and chronic pain. Furthermore, prolonged immobility can precipitate lung infections such as pneumonia, increasing the risk of bacteria entering the bloodstream and causing sepsis. If left unaddressed, these conditions can lead to fatalities.

Additionally, complications affecting the affected body parts encompass difficulties in urination and defecation, sexual dysfunction, muscle atrophy, and osteoporosis. These common complications may result in permanent disability and profound dependence.

Prevention

Preventing spinal cord trauma entails cautious driving practices and consistent seat belt use. Measures to prevent falls include installing handrails on stairs, placing non-slip mats in bathrooms, and securing stairs and windows to event children from climbing. It's essential to abstain from driving while under the influence of alcohol. When engaging in water activities like diving, ensure a minimum depth of 3.7 meters. For extreme sports, utilize appropriate protective gear and adhere to safety protocols.

When to see a doctor?

Immediate medical attention is warranted if you or someone around you sustains neck or back injuries. Any fall or injury involving these regions should be treated as potential spinal cord trauma until ruled out because:

• Spinal cord injuries may not manifest immediately.
• Symptoms like numbness and paralysis can manifest either immediately or gradually.
• The timeframe between injury and treatment significantly influences recovery and complication rates. Prompt intervention improves recovery prospects and diminishes complications.

Looking for more information about other diseases Click here!