spinal cord injuries

Definition

Spinal cord injuries (SCIs) refer to damage to the spinal cord resulting from trauma, disease, or degeneration. This can lead to temporary or permanent changes in motor, sensory, and autonomic function below the level of the injury, potentially causing paralysis, loss of sensation, and other complications.

Aetiology

Spinal cord injuries can result from various causes, including:

Trauma: Motor vehicle accidents, falls, sports injuries, and violence (e.g., gunshot or stab wounds).
Non-traumatic causes: Infections, tumours, degenerative diseases, and congenital conditions such as spina bifida.

Pathophysiology

The pathophysiology of spinal cord injuries involves primary and secondary mechanisms of injury. The primary injury occurs at the time of trauma and involves direct damage to the spinal cord. Secondary injury processes, including inflammation, oedema, and ischaemia, can lead to further neuronal damage and functional loss over time.

Risk Factors

Age: Young adults and the elderly are at higher risk.
Gender: Males are more commonly affected than females.
High-risk activities: Participation in contact sports, motorcycling, and high-risk occupations.
Pre-existing spinal conditions: Conditions such as osteoporosis and spinal stenosis.

Signs and Symptoms

Loss of movement and sensation below the level of injury.
Loss of bowel and bladder control.
Difficulty breathing (if the injury is high in the spinal cord).
Muscle weakness or spasticity.
Chronic pain or abnormal sensations.

Investigations

Clinical history and physical examination, including a thorough neurological assessment.
Magnetic Resonance Imaging (MRI) of the spine: The gold standard for diagnosing spinal cord injuries.
Computed Tomography (CT) scan if MRI is contraindicated or unavailable.
X-rays: To assess for fractures or dislocations.
Blood tests: To check for underlying conditions or complications.

Management

Primary Care Management

Initial assessment and stabilisation of the patient, ensuring airway, breathing, and circulation (ABCs).
Immobilisation of the spine to prevent further injury.
Immediate referral to a specialist (neurologist or neurosurgeon) if spinal cord injury is suspected.
Pain management and supportive care while awaiting specialist assessment.

Specialist Management

Surgical intervention: Decompression surgery to relieve pressure on the spinal cord and stabilise the spine.
Medications: Corticosteroids to reduce inflammation and swelling, and other medications to manage complications.
Rehabilitation: Intensive physiotherapy and occupational therapy to maximise functional recovery and independence.
Respiratory support: Mechanical ventilation if respiratory muscles are affected.
Long-term follow-up: Regular monitoring and management of any complications or recurrence.

Example Management for Spinal Cord Injuries

A patient presenting with symptoms of spinal cord injury, such as loss of movement and sensation below the level of injury, should be urgently referred to a specialist. An MRI should be performed to confirm the diagnosis and identify the cause. Surgical intervention may be necessary to decompress the spinal cord and stabilise the spine. Corticosteroids may be administered to reduce inflammation. The patient should receive multidisciplinary care, including physiotherapy to aid recovery and regular follow-up to monitor for any complications or recurrence.

References

NICE. (2024). Spinal Injury: Assessment and Initial Management. Retrieved from NICE
NHS. (2023). Spinal Cord Injury. Retrieved from NHS
American Association of Neurological Surgeons. (2016). Spinal Cord Injury. Retrieved from AANS
Fehlings, M. G., et al. (2017). A Clinical Practice Guideline for the Management of Acute Spinal Cord Injury. The Lancet.
Hickey, K. J., et al. (2011). Early Decompression and Neurological Outcome After Traumatic Cervical Spinal Cord Injury. Spine.