Effects of Spinal Cord Injury

The spinal cord may become severed or injured due to accidents, acts of violence or physical diseases such as polio, according to Dr. Edward Benzel of the Cleveland Clinic Spine Institute. Depending upon the extent and location of the spinal cord damage, a range of motor, sensory or autonomic nervous system functions (involuntary functions such as breathing) may be affected.
Loss of Motor Function
Spinal cord injury can cause partial or complete paralysis, or loss of motor function. Loss of movement may occur as a result of bruising, compression, lacerations or complete severing of the spinal cord. Partial paralysis (called paresis) can occur in all four limbs (quadraparesis), or slight paralysis may develop only in the lower extremities (paraparesis). In some cases, complete paralysis of the lower extremities and lower trunk may occur while the upper limbs remain unaffected (paraplegia). According to Dr. Edward Benzel, chairman of the Cleveland Clinic Spine Institute, loss of motor function typically occurs below the level of impact to the spinal cord, and paralysis may be temporary or permanent depending upon the severity of the injury. For example, if the cervical spine in the neck region is affected, loss of motor function is often seen in the hands, arms and neck. If the spinal cord in the lower back region is injured, loss of function may occur in the hips and legs.
Loss of Sensation
Spinal cord injuries may be associated with damage to the sensory nerve fibers. Nerve damage can cause temporary or permanent loss of sensation in one or more areas of the body, leading to loss of sensations such as touch, pressure and temperature.
Respiratory Problems
According to a review published in a 2007 issue of the Journal of Spinal Cord Medicine, spinal cord injuries--particularly those in the cervical or neck region--may lead to paralysis or paresis of the muscles that are responsible for involuntary respiration. Those who aren't able to breathe sufficiently on their own may require long-term mechanical ventilator support to survive; however, mechanical ventilation increases the risk of complications such as pneumonia, infection and death. The review’s authors note that respiratory insufficiency is the top cause of morbidity and mortality after a spinal cord injury.
Autonomic Dysreflexia

Autonomic Dysreflexia, or hyperreflexia, is a life-threatening over-activity of the autonomic nervous system (responsible for controlling involuntary actions of muscles and organs in the body) that occurs uniquely in patients with spinal cord injury. According to the University of Washington Department of Rehabilitation Medicine, people with a severed spinal cord at or above the T-6 vertebrae are at greater risk of developing the condition. When pain or pressure (or a full bladder or bowel) below the level of spinal cord injury occur, blood vessels constrict and blood pressure rises. Nerves in the sympathetic nervous system relay a message to the brain that blood pressure is getting too high, and the brain in turn sends a signal down the spinal cord to relax blood vessels and lower blood pressure. However, spinal cord injuries may prevent this message from reaching the part of the body below the severed cord. Consequently, blood pressure acutely rises and stroke, seizures or death may occur.

What Are the Symptoms of a C2 Spinal Injury?

The spinal cord is divided into four segments: cervical, thoracic, lumbar and sacral. Together, they make up a vital part of the body's central processing nervous system; injury to the spinal cord can be grave and sometimes fatal. The cervical part of the spinal cord lies in the neck. Injuries occurring at the second cervical vertebrae, known as C2, manifest through a particular constellation of symptoms and signs.

Respiratory Dysfunction

As stated by the University of Alabama at Birmingham Spinal Cord Injury Information Network, an injury in the upper cervical region of the spinal cord—vertebrae C1 through C3—will cause complete paralysis of breathing muscles. This occurs because all the nerve signals sent by the brain originate at a higher level. An injury at C2 will interrupt the nervous system's signals to the muscles responsible for breathing. The muscles paralyzed by such an injury include the diaphragm, the chest and abdominal muscles, and the neck muscles. If the injury is complete and the spinal cord is completely transected at this level, the patient will lose the ability to breathe spontaneously and will need a ventilator.

Muscle Paralysis

The Merck Manuals Online Medical Library notes that injury of the spinal cord at C2 will result in complete or partial paralysis of all four limbs and trunk muscles. The muscles comprising the anal and bladder sphincters are also paralyzed causing the patient to lose voluntary control over urination and defecation. If the spinal cord is severely injured, the patient could remain paralyzed for life. If the injury is partial, however, the patient may regain some movement, particularly of the trunk muscles.

Sensory Loss

The nerves responsible for delivering sensation also pass through the spinal cord. Each spinal cord segment gives sensory supply to an area of the skin called a dermatome. All sensations are relayed to the brain via the spinal cord in order to provide feeling.

According to the American Spinal Injury Association, C2 provides sensory supply to the area over the back of the head and the top part of the neck. Injury at the C2 level will cause the patient to be totally deprived of sensations below that level because of the interruption of the pain pathway and the nerve signals going to the brain.

What Are the Treatments for Lumbar Tethered Spinal Cord?

Tethered spinal cord syndrome can be alleviated by surgery to the lumbar spine. This is generally performed in children because the maturing spinal column grows and stretches the spinal cord, and sometimes the spinal roots become irritated, resulting in painful sensations. Sometimes adults also require detethering when they exhibit similar signs and symptoms.
Surgical Detethering
According to the New York Presbyterian Hospital, early surgery is usually recommended for children showing signs of a tethered spinal cord, and this is the primary method used to repair this condition. Treatment will prevent deterioration of nerve function as the child's spine grows. The procedure necessitates exposing the lumbar vertebrae in the lower back where the spinal cord is tethered, or pinned. The surgeon will detether the spinal cord by excising any protrusions or removing adhesion points. This is very delicate surgery and the dangers of spinal cord or spinal nerve root injury are omnipresent. The nervous system is therefore monitored during surgery to minimize the chances of damage. However, even with these advanced techniques, the risk of complication of an atonic bladder has not proven to be diminished. Also, the complications of sexual and bowel dysfunctions may result. These conditions may be permanent or transient. If a child matures and reaches adult height without showing signs of tethered spinal cord syndrome, then treatment may not be necessary. However, there is no guarantee the patient will remain unaffected. With movement of the spine, the tethered spinal cord gradually begins to wear down and the patient may experience symptoms in adulthood; surgery may be indicated at that point.
Sometimes making a large incision on the back for open surgery to untether the spinal cord is not an option. Under these circumstances, the surgeon may opt to cut specific spinal nerve roots. This can ease the painful symptoms of tethered spinal cord syndrome. This procedure can be performed endoscopically. According to a 2009 paper in the journal "Child's Nervous System," such endoscopic untethering can be safe and effective. It has the advantages of reduced surgical trauma, postoperative pain and blood loss, as well as a smaller surgical incision and a shorter hospital stay. It is not known, however, if using endoscopic untethering techniques yields superior efficacy results.

Sometimes the spinal cord can retether after surgery, and this can happen months or years later. According to a 2006 article in the "Journal of Neurosurgery," in such circumstances another surgery may be required to untether the spinal cord once again. The incidence of retethering in children is significantly higher than in adults.

Spinal Cord Injury In Paraplegia

Spinal cord injuries are becoming more and more common. In fact, the Christopher and Dana Reeve Foundation estimates that there are more than one million people living with some type of spinal cord injury in 2010. A spinal cord injury that causes a loss of function in the legs is called paraplegia.
What Causes Paraplegia
Most spinal cord injuries are either the result of a motor vehicle accident or a work-related injury; however, other common causes include sports accidents, falls and violent crimes. The physical trauma of such accidents can compress or even sever the spinal cord, causing temporary or permanent damage. When the spinal cord damage affects the function of the lower limbs, it is termed paraplegia.
Effects of Paraplegia
In people with paraplegia, movement and sensation below the level of spinal cord injury is impaired to some degree. According to the Mayo Clinic, someone who is paraplegic will not only have symptoms in both of his legs, but also in his trunk and some of the organs in the pelvis. For some people, paraplegia disrupts bowel and bladder function. It may also impair sexual function. According to the National Spinal Cord Injury Association (NSCIA), paraplegia can affect the breathing muscles, and the ability to regulate temperature and blood pressure, depending on what part of the spinal cord is damaged.

The NSCIA reports that while there is no known cure for spinal cord injury, many people with paraplegia recover function gradually, and may continue to gain function for a year or more following their injury. Treatment following a spinal cord injury with paraplegia involves stabilizing the spine, often through surgery, as well as physical and occupational therapy.

What Is a Spinal Cord Injury?

Although the hard bones of the spinal column protect the soft tissues of the spinal cord, vertebrae can still be broken or dislocated in a variety of ways and cause traumatic injury to the spinal cord. Injuries can occur at any level of the spinal cord. The segment of the cord that is injured, and the severity of the injury, will determine which body functions are compromised or lost. Because the spinal cord acts as the main information pathway between the brain and the rest of the body, a spinal cord injury can have significant physiological consequences.

Catastrophic falls, being thrown from a horse or through a windshield, or any kind of physical trauma that crushes and compresses the vertebrae in the neck can cause irreversible damage at the cervical level of the spinal cord and below. Paralysis of most of the body including the arms and legs, called quadriplegia, is the likely result. Automobile accidents are often responsible for spinal cord damage in the middle back (the thoracic or lumbar area), which can cause paralysis of the lower trunk and lower extremities, called paraplegia.
Other kinds of injuries that directly penetrate the spinal cord, such as gunshot or knife wounds, can either completely or partially sever the spinal cord and create life-long disabilities.
Most injuries to the spinal cord don't completely sever it. Instead, an injury is more likely to cause fractures and compression of the vertebrae, which then crush and destroy the axons, extensions of nerve cells that carry signals up and down the spinal cord between the brain and the rest of the body. An injury to the spinal cord can damage a few, many, or almost all of these axons. Some injuries will allow almost complete recovery. Others will result in complete paralysis.
Until World War II, a serious spinal cord injury usually meant certain death, or at best a lifetime confined to a wheelchair and an ongoing struggle to survive secondary complications such as breathing problems or blood clots. But today, improved emergency care for people with spinal cord injuries and aggressive treatment and rehabilitation can minimize damage to the nervous system and even restore limited abilities.
Advances in research are giving doctors and patients hope that all spinal cord injuries will eventually be repairable. With new surgical techniques and exciting developments in spinal nerve regeneration, the future for spinal cord injury survivors looks brighter every day.
This information has been written to explain what happens to the spinal cord when it is injured, the current treatments for spinal cord injury patients, and the most promising avenues of research currently under investigation.
Facts and Figures About Spinal Cord Injury
There are an estimated 10,000 to 12,000 spinal cord injuries every year in the United States.
About 200,000 Americans are currently living with spinal cord injuries.
The average cost of managing the care of spinal a cord injury patient is between $15,000 and $30,000 per year.
Forty-six percent of all spinal cord injuries happen during car accidents. Sixteen percent, are the result of injuries relating to violent encounters. The rest are due to sporting accidents, falls, and work-related accidents.
Fifty to seventy percent of spinal cord injury victims are between 15 and 35 years old.

Eighty percent of spinal cord injury patients are men

Treatment for C-6 Spinal Cord Injuries

Treatment for C-6 Injuries
C-6 Spinal Cord injuries can be classified as either complete or incomplete injuries. Complete injuries result in the total loss of movement and sensation below the point of injury, while incomplete injuries indicate that some function below the level of injury is retained.
The correct intervention and support following the injury will increase the likelihood of the best possible long-term prognosis. In most cases, the acute stage of injury is followed by extensive rehabilitation, which is designed to help the survivor adapt both physically and mentally to his or her new condition. While their lives will certainly be different than they were before the injury, with the correct intervention and support, survivors with C-6 injuries can go on to lead very fulfilling lives. In the meantime, scientists continue to study treatments for spinal cord injury, designed to both reduce the effect of the injury and promote the growth of functional nerve fibers.

How should spinal cord injury be treated ?

Spinal cord treatment is divided into two phases—the acute phase and the rehabilitation phase. The acute phase starts immediately following the accident, and comprises the care that is received at the scene of the accident, the care that is administered upon admission to the hospital, and all subsequent care prior to the survivor entering the rehabilitation phase.
During the time immediately following the injury, the goal of the medical team is to stabilize the patient to ensure that no further damage to the spinal cord is sustained. Doctors are particularly concerned with reducing or minimizing swelling, as this can cause even more extensive damage to the spinal cord. Other treatment during this phase includes a combination of medication, surgery, bed rest, traction, and immobilization.
Immediately upon arriving at the hospital, the medical team will usually give the survivor a strong course of a steroid called methylprednisone (MP), which is designed to reduce swelling. The key is for this drug to be administered within eight hours of the injury. This will minimize the chances of further damage being done to the spinal cord as a result of swelling. In cases where bone fragments or foreign objects are pressing on the spine and causing additional swelling, surgery to remove these objects will be done.
Bed rest is a very important part of the acute care phase, because it allows the bones of the spine, which bear the majority of the body’s weight, to heal. Spinal traction may also be used to immobilize the spine and prevent dislocation. Sometimes the skull is immobilized with special equipment, allowing the spine to realign during the healing phase.

During the acute phase, the medical team may also indicate that the patient is experiencing something called “spinal shock.” Spinal shock is a condition that causes the survivor’s reflexes not to work, as a result of the trauma the spine has sustained. During the time the survivor is experiencing spinal shock, doctors may be hesitant to discuss long-term prognosis. That’s because it’s very difficult to accurately separate the loss of function that has resulted from the injury from the loss of function that’s occurring as a result of spinal shock. In most cases some function beyond what is seen during the spinal shock stage will return to the survivor.