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Spinal cord trauma
Alternative namesSpinal cord compression or injury; Compression of spinal cord
DefinitionSpinal cord trauma is damage to the spinal cord that results from direct injury to the cord itself, or from indirect injury from damage to the bones, soft tissues, and blood vessels surrounding the spinal cord.
Causes, incidence, and risk factors
Spinal cord trauma can be caused by any number of injuries to the spine that can result from motor vehicle accidents, falls, sports injuries (particularly diving into shallow water), industrial accidents, gunshot wounds, assault, and others. A seemingly minor injury can cause spinal cord trauma if the spine is weakened (such as from rheumatoid arthritis or osteoporosis ).
Only about 5% of spinal cord injuries occur in children. The fatality rate is higher with pediatric spine injuries.
Risk factors include participating in risky physical activities, not wearing protective gear during work or play, or diving into shallow water.
Older people with weakened spines (from osteoporosis) may be more likely to have a spinal cord injury. Patients who have other medical problems that make them prone to falling from weakness or clumsiness (from stroke, for example) may also be more susceptible.
Symptoms vary somewhat depending on the location of the injury. Spinal cord injury results in varying degress of weakness and sensory loss at and below the injury. The pattern depends on whether the entire cord is injured (complete) or only partially (incomplete).
The spinal cord doesn't go below the 1st lumbar vertebra, so injuries at and below this level do not cause spinal cord injury. However, they may cause "cauda equina syndrome" -- injury to the nerve roots in this area.
When spinal cord injuries occur near the neck, varying degrees of symptoms can affect both the arms and the legs:
THORACIC (CHEST-LEVEL) INJURIES
When spinal injuries occur at chest level, varying degrees of symptoms can affect the legs:
Injuries to the cervical or high thoracic cord may also result in:
Signs and testsSymptoms may develop immediately after injury or may occur gradually because of fluid accumulation around the spinal cord or swelling within the spinal cord itself. Spinal cord injury is a medical emergency requiring immediate attention to minimize the long-term effects.
A neurologic examination indicates the location of the injury, if it is not immediately evident. The reflexes may be abnormal or may be absent in affected areas of the body. There may be some recovery of reflexes after swelling has subsided. Muscle spasticity is common as a late effect of spinal cord injury.
A spinal cord trauma is a medical emergency requiring immediate treatment to reduce the long-term effects. The time between the injury and treatment is a critical factor affecting the eventual outcome.
Spasticity can be reduced by many oral medications, medications that are injected into the spinal canal, or injections of botulinum toxins into the muscles. It is important to treat pain with analgesics, muscle relaxants, or physical therapy modalities.
Support GroupsFor organizations that provide support and additional information, see spinal injury resources .
Expectations (prognosis)Paralysis and loss of sensation of part of the body are common. This includes total paralysis and/or numbness and varying degrees of movement or sensation loss. Death is possible, particularly if there is paralysis of the breathing muscles.
The level of injury affects the outcome. Injuries near the top of the spine result in more extensive disability (numbness and paralysis, breathing difficulty) than injuries low in the spine.
Recovery of some movement or sensation within one week usually indicates eventual recovery of most function, although this may take six months or more. Losses that remain after six months are more likely to be permanent.
Calling your health care provider
Call your health care provider if injury to the back or neck occurs. Call the local emergency number (such as 911) if there is any loss of movement or sensation: this is a medical emergency!
Management of spinal cord injury begins at the site of an accident with paramedics trained in immobilizing the injured spine to prevent further damage to the nervous system. Someone suspected of having a spinal cord injury should NOT be moved without immobilization unless there is an immediate threat.
Safety practices during work and recreation can prevent many spinal cord injuries. Use proper protective equipment if an injury is possible.
Football and sledding injuries often involve sharp blows or abnormal twisting and bending of the back or neck and can result in spinal cord trauma. Use caution when sledding and inspect the area for obstacles. Use appropriate techniques and equipment when playing football or other contact sports.
Falls while climbing at work or during recreation can result in spinal cord injuries. Defensive driving and wearing seat belts greatly reduces the risk of serious injury if there is an automobile accident.
Update Date: 11/17/2002Joseph V. Campellone, M.D., Division of Neurology, Cooper Hospital/University Medical Center, Camden, NJ. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT