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.
When all is said and done, the goal during the acute phase is to stabilize
the patient and minimize the amount of damage done to the spinal cord. Once the
patient has stabilized, he or she will enter into the rehabilitative phase of
care.
How do we know the hospital is equipped and knowledgeable to deal with a
spinal cord injury?
Family members won’t have time to be choosy about where their loved one is
taken, but they can rest assured that they’ll be taken to a hospital that has
the experience and ability to handle the acute phase of spinal cord injury.
The main goal of the emergency response team—the group that arrives upon the
scene of the accident—is to get the injured person to the nearest Brain and
Spinal Cord Injury Program (BSCIP) designated facility. BSCIP-designated
hospitals must meet certain standards and criteria set forth by the Department
of Health, and must also be approved by the Joint Commission on Accreditation of
Healthcare Organizations (JCAHO). Any hospital that has been designated with the
BSCIP label has the experience, personnel, and equipment necessary to see that
the patient receives the best care possible. BSCIP-designated facilities are
located throughout the country, in a pattern that ensures that every person who
sustains a spinal cord injury is able to reach one in a reasonable amount of
time.
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