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SPORTS MEDICINE :
PHYSICAL THERAPY :
MEDICAL: INJURIES: SPINAL CORD:
Inpatient Rehabilitation, Spine Disorders and Injuries
Inpatient Rehabilitation, Spine Disorders and Injuries
Health Encyclopedia
Penn Medicine
University of Pennsylvania
<http://www.pennmedicine.org/encyclopedia/
em_DisplayArticle.aspx?gcid=001066&ptid=1>
A shorter URL for the above link:
<http://tinyurl.com/yzcqtm8>
Definition:
Spinal cord trauma is damage to the spinal cord. It may result from direct
injury to the cord itself or indirectly from damage to surrounding bones,
tissues, or blood vessels.
Alternative Names:
Spinal cord injury; Compression of spinal cord
Causes, incidence, and risk factors:
Spinal cord trauma can be caused by any number of injuries to the spine.
They can result from motor vehicle accidents, falls, sports injuries
(particularly diving into shallow water), industrial accidents, gunshot
wounds, assault, and other causes.
A minor injury can cause spinal cord trauma if the spine is weakened (such
as from rheumatoid arthritis or osteoporosis) or if the spinal canal
protecting the spinal cord has become too narrow (spinal stenosis) due to
the normal aging process.
Direct injury, such as cuts, can occur to the spinal cord, particularly if
the bones or the disks have been damaged. Fragments of bone (for example,
from broken vertebrae, which are the spine bones) or fragments of metal
(such as from a traffic accident) can cut or damage the spinal cord.
<snip>
Other topics covered in this article:
Symptoms
Signs and tests
Treatment
Support Groups
Expectations (prognosis)
Complications
Calling your health care provider
Prevention
References
Spinal cord trauma
Medline Plus
<http://www.nlm.nih.gov/medlineplus/ency/article/001066.htm>
Spinal cord trauma is damage to the spinal cord. It may result from direct
injury to the cord itself or indirectly from damage to surrounding bones,
tissues, or blood vessels.
Causes
Spinal cord trauma can be caused by any number of injuries to the spine.
They can result from motor vehicle accidents, falls, sports injuries
(particularly diving into shallow water), industrial accidents, gunshot
wounds, assault, and other causes.
A minor injury can cause spinal cord trauma if the spine is weakened (such
as from rheumatoid arthritis or osteoporosis) or if the spinal canal
protecting the spinal cord has become too narrow (spinal stenosis) due to
the normal aging process.
Direct injury, such as cuts, can occur to the spinal cord, particularly if
the bones or the disks have been damaged. Fragments of bone (for example,
from broken vertebrae, which are the spine bones) or fragments of metal
(such as from a traffic accident) can cut or damage the spinal cord.
Direct damage can also occur if the spinal cord is pulled, pressed
sideways, or compressed. This may occur if the head, neck, or back are
twisted abnormally during an accident or injury.
Bleeding, fluid accumulation, and swelling can occur inside the spinal
cord or outside the spinal cord (but within the spinal canal). The
accumulation of blood or fluid can compress the spinal cord and damage it.
Most spinal cord trauma happens to young, healthy individuals. Men ages
15-35 are most commonly affected. The death rate tends to be higher in
young children with spinal 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
Symptoms vary somewhat depending on the location of the injury. Spinal
cord injury causes weakness and sensory loss at and below the point of the
injury. The severity of symptoms depends on whether the entire cord is
severely injured (complete) or only partially injured (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.
CERVICAL (NEAR THE NECK) INJURIES
When spinal cord injuries occur near the neck, symptoms can affect both
the arms and the legs:
Breathing difficulties (from paralysis of the breathing muscles)
Loss of normal bowel and bladder control (may include constipation,
incontinence, bladder spasms)
Numbness
Sensory changes
Spasticity (increased muscle tone)
Pain
Weakness, paralysis
THORACIC (CHEST-LEVEL) INJURIES
When spinal injuries occur at chest level, symptoms can affect the legs:
Breathing difficulties (from paralysis of the breathing muscles)
Loss of normal bowel and bladder control (may include constipation,
incontinence, bladder spasms)
Numbness
Sensory changes
Spasticity (increased muscle tone)
Pain
Weakness, paralysis
Injuries to the cervical or high-thoracic spinal cord may also result in
blood pressure problems, abnormal sweating, and trouble maintaining normal
body temperature.
LUMBAR SACRAL (LOWER-BACK) INJURIES
When spinal injuries occur at the lower-back level, varying dgrees of
symptoms can affect the legs:
Loss of normal bowel and bladder control (may include constipation,
incontinence, bladder spasms)
Numbness
Pain
Sensory changes
Spasticity (increased muscle tone)
Weakness and paralysis
Exams and Tests
Spinal cord injury is a medical emergency requiring immediate attention.
The health care provider will perform a physical exam, including a
neurological exam. This will help identify the exact location of the
injury, if it is not already known. Some of the person's reflexes may be
abnormal or absent. Once swelling goes down, some reflexes may slowly
recover.
The following tests may be ordered:
A CT scan or MRI of the spine may show the location and extent of the
damage and reveal problems such as blood clots (hematomas).
Myelogram (an x-ray of the spine after injection of dye) may be necessary
in rare cases.
Somatosensory evoked potential (SSEP) testing or magnetic stimulation may
show if nerve signals can pass through the spinal cord.
Spine x-rays may show fracture or damage to the bones of the spine.
Treatment
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.
Corticosteroids, such as dexamethasone or methylprednisolone, are used to
reduce swelling that may damage the spinal cord. If spinal cord
compression is caused by a mass (such as a hematoma or bony fragment) that
can be removed or brought down before there is total destruction of the
nerves of the spine, paralysis may in some cases be reduced or relieved.
Ideally, corticosteroids should begin as soon as possible after the
injury.
Surgery may be necessary. This may include surgery to remove fluid or
tissue that presses on the spinal cord (decompression laminectomy).
Surgery may be needed to remove bone fragments, disk fragments, or foreign
objects or to stabilize fractured vertebrae (by fusion of the bones or
insertion of hardware).
Bedrest may be needed to allow the bones of the spine, which bears most of
the weight of the body, to heal.
Anatomic realignment is important. Spinal traction may reduce dislocation
and/or may be used to immobilize the spine. The skull may be immobilized
with tongs (metal braces placed in the skull and attached to traction
weights or to a harness on the body).
Treatment will address muscle spasms, care of the skin, and bowel and
bladder dysfunction.
Extensive physical therapy, occupational therapy, and other rehabilitation
interventions are often required after the acute injury has healed.
Rehabilitation assists the person in coping with disability that results
from spinal cord trauma.
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 Groups
For organizations that provide support and additional information, see
spinal injury resources.
Outlook (Prognosis)
Paralysis and loss of sensation of part of the body are common. This
includes total paralysis or numbness and varying degrees of movement or
sensation loss. Death is possible, particularly if there is paralysis of
the breathing muscles.
How well a person does depends on the level of injury. Injuries near the
top of the spine result in more extensive disability than do injuries low
in the spine.
Recovery of some movement or sensation within 1 week usually means the
person has a good chance of recovering more function, although this may
take 6 months or more. Losses that remain after 6 months are more likely
to be permanent.
Routine bowel care frequently takes one hour or more on a daily basis.
A majority of people with spinal cord injury must perform bladder
catheterization from time to time.
Modifications of the person's living environment are usually required.
Most people with spinal cord injury are wheelchair- or bed-bound, or have
impaired mobility requiring a variety of assistive devices.
Possible Complications
The following are possible complications of a spinal cord injury:
Blood pressure changes - can be extreme (autonomic hyperreflexia)
Complications of immobility:
Deep vein thrombosis
Pulmonary infections
Skin breakdown
Contractures
Increased risk of injury to numb areas of the body
Increased risk of kidney damage
Increased risk of urinary tract infections
Loss of bladder control
Loss of bowel control
Loss of sensation
Loss of sexual functioning (male impotence)
Muscle spasticity
Pain
Paralysis of breathing muscles
Paralysis (paraplegia, quadriplegia)
Shock
People living at home with spinal cord injury should do the following to
prevent complications:
Daily pulmonary care, for those who need it.
Follow all instructions regarding bladder care to avoid infections and
damage to the kidneys.
Follow all instructions regarding routine wound care to avoid pressure
sores.
Keep immunizations up to date.
Maintain routine health visits with their doctor.
When to Contact a Medical Professional
Call your health care provider if injury to the back or neck occurs. Call
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.
Prevention
Safety practices during work and recreation can prevent many spinal cord
injuries. Use proper protective equipment if an injury is possible.
Diving into shallow water is a major cause of spinal cord trauma. Check
the depth of water before diving, and look for rocks or other possible
obstructions.
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.
Alternative Names
Spinal cord injury; Compression of spinal cord
References
Evans RW, Wilberger JE, Bhatia S. Traumatic disorders. In: Goetz, CG, ed.
Textbook of Clinical Neurology. 3rd ed. Philadelphia, PA: Saunders
Elsevier; 2007: chap 51.
Ling GSF. Traumatic brain injury and spinal cord injury. In: Goldman L,
Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, PA: Saunders
Elsevier; 2007: chap 422.
Update Date: 6/19/2008
Updated by: Daniel B. Hoch, MD, PhD, Assistant Professor of Neurology,
Harvard Medical School, Department of Nuerology, Massachusetts General
Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director,
A.D.A.M., Inc.
Spinal Cord Trauma
New York Times
Health Guide
<http://health.nytimes.com/health/guides/
disease/spinal-cord-trauma/overview.html>
A shorter URL for the above link:
<http://tinyurl.com/yao7wph>
Merck Manual
Section
Injuries; Poisoning
Subject
Spinal Trauma
Topics
Introduction
<http://www.merck.com/mmpe/sec21/ch311/ch311a.html>
Introduction
Trauma to the spine may produce injuries involving the spinal cord,
vertebrae, or both. Occasionally, the spinal nerves are affected (see
Peripheral Nervous System and Motor Unit Disorders: Symptoms and Signs).
The anatomy of the spinal column is reviewed in another chapter (see
Peripheral Nervous System and Motor Unit Disorders: Toxic Causes of
Neuropathies).
Etiology and Pathophysiology
Cord injury: During a typical year, there are about 11,000 spinal cord
injuries in the US. Nearly 48% occur in motor vehicle collisions, and 23%
result from falls. The remainder is attributed to violence (14%), sports
(9%), and work-related accidents. About 80% of patients are male.
Spinal cord injuries occur when blunt physical force damages the
vertebrae, ligaments, or disks of the spinal column, causing bruising,
crushing, or tearing of spinal cord tissue, and when the spinal cord is
penetrated (eg, by a gunshot or a knife wound). Such injuries can also
produce vascular injury with resultant ischemia or hematoma (typically
extradural), leading to further damage. All forms of injury can cause
spinal cord edema, further decreasing blood flow and oxygenation. Damage
may be mediated by excessive release of neurotransmitters from damaged
cells, an inflammatory immune response with release of cytokines,
accumulation of free radicals, and apoptosis.
Vertebral injury: Fractures may involve the vertebral body, lamina, and
pedicles as well as the spinous, articular, articular, and transverse
processes. Dislocations typically involve the facets. Subluxation involves
ligament rupture without bony injury. In the neck, fractures of the
posterior elements and dislocations can damage the vertebral arteries,
causing a stroke-like syndrome.
Unstable vertebral injuries are those in which bony and ligamentous
integrity is disrupted sufficiently that free movement can occur,
potentially compressing the spinal cord or its vascular supply and
resulting in marked worsening of neurologic function or pain. Such
vertebral movement may occur even with a shift in patient position (eg,
for ambulance transport, during initial evaluation). Stable fractures are
able to resist such movement.
Specific injuries typically vary with mechanism of trauma. Flexion
injuries can produce wedge fractures of the vertebral body or spinous
process fractures. Greater flexion force may cause bilateral cervical
cervical facet dislocation, or if the force occurs at the level of C1 or
C2, odontoid fracture, atlantooccipital or atlantoaxial subluxation, or
both fracture and subluxation. Rotational injury can cause unilateral
facet dislocation. Extension injury most often causes posterior neural
arch fracture. Compression injuries can cause burst fractures of vertebral
bodies.
Article Table of Contents:
Introduction
Etiology and Pathophysiology
Cord injury
Vertebral injury
Cauda equina injury
Symptoms and Signs
Complete cord injury
Partial cord injury
Cauda equina lesions
Complications
Diagnosis
Prognosis and Treatment
Immediate care
Long-term care
Spinal Cord Injury in Children
Title Spinal cord trauma: regeneration, neural repair and functional
recovery
Volume 137 of Progress in brain research
Author Lisa McKerracher
Editors Lisa McKerracher, Guy Doucet, Serge Rossignol
Publisher Elsevier, 2002
ISBN 0444801049, 9780444801043
Length 470 pages
Subjects Spinal cord
Title Neurobiology of spinal cord injury
Contemporary neuroscience
Authors Robert G. Kalb, Stephen M. Strittmatter
Editors Robert G. Kalb, Stephen M. Strittmatter
Edition illustrated
Publisher Humana Press, 2000
ISBN 0896036723, 9780896036727
Length 284 pages
Subjects Medical / Diseases
Medical / Emergency Medicine
Medical / Neurology
Medical / Neuroscience
Medical / Surgery / Neurosurgery
Neurobiology
Science / Life Sciences / Biology / General
Spinal Cord Injuries
Spinal Cord Injuries - physiopathology
Spinal Cord Injuries - therapy
Spinal Cord Injuries/ physiopathology
Spinal cord
Spinal cord - Wounds and injuries - Pathophysiology
Spinal cord/ Wounds and injuries/ Pathophysiology
Title Spinal cord diseases: diagnosis and treatment
Volume 47 of Neurological disease and therapy
Authors Gordon L. Engler, Jonathan Cole, William Louis Merton
Editors Gordon L. Engler, Jonathan Cole, William Louis Merton
Edition illustrated
Publisher Informa Health Care, 1998
ISBN 0824794893, 9780824794897
Length 672 pages
Subjects Medical / Allied Health Services / Emergency Medical Services
Medical / Diagnosis
Medical / Diseases
Medical / Emergency Medicine
Medical / Internal Medicine
Medical / Neurology
Medical / Orthopedics
Spinal Cord Diseases - diagnosis
Spinal Cord Diseases - therapy
Spinal Cord Diseases/ diagnosis
Spinal cord
Spinal cord - Diseases
Spinal cord - Wounds and injuries
Spinal cord/ Diseases
Spinal cord/ Wounds and injuries
Title Spinal trauma: an imaging approach
Authors Victor N. Cassar-Pullicino, Herwig Imhof
Edition illustrated
Publisher Thieme, 2006
ISBN 1588903486, 9781588903488
Length 240 pages
Subjects Medical / Diagnostic Imaging
Medical / Diseases
Medical / Emergency Medicine
Medical / General
Medical / Orthopedics
Medical / Radiology & Nuclear Medicine
Medical / Surgery / General
Medical / Surgery / Neurosurgery
Science / Radiology
Spinal Cord Injuries
Spinal Injuries
Spinal Injuries - diagnosis
Spine
Spine - Diseases - Diagnosis
Spine - Wounds and injuries
Spine - Wounds and injuries - Imaging
Spine/ Diseases/ Diagnosis
Spine/ Wounds and injuries
Spine/ Wounds and injuries/ Imaging
Title Skeletal trauma: basic science, management, and reconstruction,
Volume 1
Skeletal trauma: basic science, management, and reconstruction, Bruce D.
Browner
Skeletal Trauma in Children
Authors Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, Peter G.
Trafton
Editor Bruce D. Browner
Edition 3, illustrated
Publisher Gulf Professional Publishing, 2003
ISBN 0721691757, 9780721691756
Length 2626 pages
Subjects Bone and Bones
Dislocations
Electronic books
Fractures
Ligaments
Medical / Anatomy
Medical / Emergency Medicine
Medical / Orthopedics
Medical / Physiology
Medical / Rheumatology
Medical / Surgery / General
Musculoskeletal system
Science / Life Sciences / Anatomy & Physiology
Title Management of spinal cord injuries: a guide for physiotherapists
Author Lisa Harvey
Edition illustrated
Publisher Elsevier Health Sciences, 2008
ISBN 0443068585, 9780443068584
Length 297 pages
Subjects Medical / Allied Health Services / Physical Therapy
Medical / Clinical Medicine
Medical / Emergency Medicine
Medical / Physical Medicine & Rehabilitation
Physical therapists
Spinal Cord Injuries/ physiopathology
Spinal cord
Spinal cord/ Wounds and injuries/ Physical therapy
Title The spinal cord injured patient
Authors Bok Y. Lee, Lee E. Ostrander
Editors Bok Y. Lee, Lee E. Ostrander
Edition 2, illustrated
Publisher Demos Medical Publishing, 2002
ISBN 188879951X, 9781888799514
Length 432 pages
Subjects Medical / Emergency Medicine
Medical / Neurology
Medical / Nursing / Nurse & Patient
Medical / Pathology
Medical / Physical Medicine & Rehabilitation
Medical / Surgery / General
Spinal cord
Spinal cord/ Wounds and injuries/ Patients/ Rehabilitation
Spinal cord/ Wounds and injuries/ Treatment
Title Spinal Cord Injury and the Family: A New Guide
The Harvard University Press family health guides
Authors Michelle J. Alpert, Saul Wisnia, Cindy Purcell
Edition illustrated
Publisher Harvard University Press, 2008
ISBN 0674027140, 9780674027145
Length 338 pages
Subjects Health & Fitness / Diets
Health & Fitness / General
Health & Fitness / Healthy Living
Health & Fitness / Physical Impairments
Medical / Allied Health Services / Emergency Medical Services
Medical / Emergency Medicine
Social Science / Handicapped
Spinal cord
Spinal cord - Wounds and injuries
Spinal cord - Wounds and injuries - Patients - Family relationships
Spinal cord/ Wounds and injuries/ Patients/ Family relationships
Spinal cord/ Wounds and injuries/ Popular works
Title Spinal Cord Injury: A Guide for Patients and Families
AAN Press quality of life guide
American Academy of Neurology
Authors Michael E. Selzer, Bruce H. Dobkin
Editor Lisa M. Shulman
Edition illustrated
Publisher Demos Medical Publishing, 2008
ISBN 1932603387, 9781932603385
Length 200 pages
Subjects Health & Fitness / Diets
Health & Fitness / General
Health & Fitness / Physical Impairments
Medical / Allied Health Services / Emergency Medical Services
Medical / Emergency Medicine
Medical / General
Medical / Neurology
Spinal cord
Spinal cord/ Wounds and injuries/ Popular works
Title Neural stem cells for brain and spinal cord repair
Contemporary neuroscience
Authors Tanja Zigova, Evan Y. Snyder, Paul R. Sanberg
Editors Tanja Zigova, Evan Y. Snyder, Paul R. Sanberg
Edition illustrated
Publisher Humana Press, 2003
ISBN 1588290034, 9781588290038
Length 434 pages
Subjects Brain
Cell Differentiation - physiology
Cell transplantation
Cellular therapy
Central Nervous System Diseases - therapy
Central nervous system
Central nervous system - Diseases - Treatment
Central nervous system/ Diseases/ Treatment
Medical / Genetics
Medical / Neurology
Medical / Neuroscience
Medical / Surgery / Neurosurgery
Nerve Regeneration
Neural stem cells
Neural stem cells - Transplantation
Neural stem cells/ Transplantation
Neurons
Science / Life Sciences / Biology / Molecular Biology
Science / Life Sciences / Cytology
Science / Life Sciences / Genetics & Genomics
Stem Cells - physiology
Stem Cells - transplantation
Stem cells
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