Can a T5 Spinal Cord injury be repaired?

Spinal cord injury is very complex and the ability to "fix" the problem depends on many things including how badly the nerves have been injured, the age of the patient, the mechanism of injury, etc.

A spinal cord injury — damage to any part of the spinal cord or nerves at the end of the spinal canal — often causes permanent changes in strength, sensation and other body functions below the site of the injury.

If you've recently experienced a spinal cord injury, it might seem like every aspect of your life will be affected.


Many scientists are optimistic that advances in research will someday make the repair of spinal cord injuries possible. Research studies are ongoing around the world. In the meantime, treatments and rehabilitation allow many people with a spinal cord injury to lead productive, independent lives.

People with a severed spinal cord face a number of complications linked to their inability to move. Deep vein thrombosis can occur from the lack of normal blood flow to parts of the body. Blood pools in the veins and can cause clots, pressure sores, joint problems, and urinary trouble. Men who are paralyzed below the waist are usually unable to perform sexually, but a woman may still be able to become pregnant and deliver a healthy child under close medical supervision.

Cells in the spinal cord do not regenerate like the cells in the skin, blood, muscle, and some other organs do. When a spinal cord is totally severed, the damage is usually permanent. Patients require long-term rehabilitation to learn how to deal with the condition and gain as much function as possible. Clinical trials began in 2010 using embryonic stem cells to treat patients with a severed spinal cord after years of studies on animals.

Stem Cell Therapy For Spinal Cord Injury

Spinal cord injuries can result in partial or full paralysis, depending on how extensive the damage is and the injury's location. When the nerves in the spinal cord are damaged, conventional medicine does not have a way of repairing them. Stem cell therapy for spinal cord injury is a controversial option that has the potential to heal nerve damage.

The spinal cord contains the nerves by which the brain communicates with the rest of the body. Just as an appliance cannot work if someone cuts its power cord, the brain will not be able to communicate through damaged nerves in the spine. The part of the spine that contains the damaged nerves will be the point below which the individual could become paralyzed, as nerve impulses will no longer be able to pass through those nerves.

Stem cell therapy for spinal cord injury works by reestablishing the severed nerve connections in the spine with new nerve cells. Doctors do this by injecting stem cells into the damaged area of the spine. These are cells that are what scientists call pluripotent, meaning they are undifferentiated cells that can become any kind of cell in the human body. When these undifferentiated stem cells are placed with cells of a particular type, they transform themselves into that kind of cell. Therefore, when stem cells are injected into an area containing nerve cells, they will turn into new nerve cells. These new nerves can recreate the connection between the part of the spine above the injured area and the part of the spine below the injured area.

This therapy has the possible benefit of helping cure paralysis due to a damaged spine, but the use of stem cells makes it a controversial topic. One source of these stem cells is fertilized human blastocysts, the stem of cells that grows into an embryo, that laboratories create from donated eggs and sperm. These embryonic stem cells are removed from the blastocyst, and scientists allow the individual stem cells to continue dividing into new stem cells. This process eventually creates large stem cell lines for use in research or medicine. Many individuals say that using these stem cells is immoral because they believe that harvesting stem cells from a human blastocyst is the moral equivalent aborting a human fetus.


Research is uncovering new sources of adult stem cells that doctors could use in stem cell therapy for spinal cord injury. These are stem cells that are present inside the adult body, such as in bone marrow, and not harvested from blastocysts. Since these stem cells come from an individual's own body, their use does not attract the kind of controversy that surrounds the use of embryonic stem cells.

What is a severed Spinal Cord Injury?

A spinal cord injury usually begins with a sudden, traumatic blow to the spine that fractures or dislocates vertebrae. The damage begins at the moment of injury when displaced bone fragments, disc material, or ligaments bruise or tear into spinal cord tissue. 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 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.
The spinal cord is divided into segments which control different parts of the body. The upper segments regulate movement and sensation in the upper body, while the lower part sends signals the lower body. A cord that is completely cut in one area causes total paralysis in the part of the body linked to that segment. If the spinal cord is partially severed, some feeling and movement may be possible. Injury to the specific section of the spinal cord that controls breathing can cause death.
Car accidents account for about half of all severed spinal cords. Sporting mishaps, falls, and some diseases can also cause permanent damage to the spinal cord. More than 75% of all victims who suffer from a severed spinal cord are young, male adults. The accidents are often linked to risky behavior, such as diving into shallow water, accidents while not wearing a seat belt, and drinking while driving. Emergency workers who respond to these accidents routinely strap patients to a backboard to prevent further damage whenever a spinal cord injury is suspected.
People with a severed spinal cord face a number of complications linked to their inability to move. Deep vein thrombosis can occur from the lack of normal blood flow to parts of the body. Blood pools in the veins and can cause clots, pressure sores, joint problems, and urinary trouble. Men who are paralyzed below the waist are usually unable to perform sexually, but a woman may still be able to become pregnant and deliver a healthy child under close medical supervision.

Cells in the spinal cord do not regenerate like the cells in the skin, blood, muscle, and some other organs do. When a spinal cord is totally severed, the damage is usually permanent. Patients require long-term rehabilitation to learn how to deal with the condition and gain as much function as possible. Clinical trials began in 2010 using embryonic stem cells to treat patients with a severed spinal cord after years of studies on animals.

Rehabilitation For C5 Spinal Cord Injury

The spinal cord -- the part of the body that relays nerve signals from the brain -- is made of boney disks known as vertebrae that stack on top of each other to form a column. A sudden blow to the vertebrae -- for example, from a sports injury or a large fall -- can dislocate or fracture a part of the spinal cord. However, most injuries are less severe, usually resulting in pieces of vertebrae tearing into cord tissue or pressing down on the nerve tissue that sends signals. After the injury has been treated, a lengthy rehabilitation is needed to restore all possible functions.

C5 Spinal Nerve
The spinal cord includes several main parts. The topmost division, known as the cervical spine nerve, controls many of the muscles in the neck and arms. The C5 spinal nerve occurs on the fifth vertebra down and controls parts of the shoulders and biceps. However, every nerve below an injury site is affected, so a complete spinal cord injury will cause paralysis of the body and legs, in addition to the fingers and wrists. It is likely that you will retain full head and neck movement and good control of your shoulders, but if elbow movement is compromised, then you will be unable to bend or straighten the joint.
Injuries
Rehabilitation will be mostly geared toward coping with and adapting to a change in lifestyle. Yet, depending upon the classification of the injury, muscle strength and mobility in many parts of the body may be regained to a certain degree. Those that are classified as an A injury are complete: nerve signals cannot be conveyed below the injured vertebra. The classification of B denotes that sensory but not motor function is preserved. Some physical therapy may help for injuries ranging from C, in which more than half of the key muscles are not strong enough to move the joint against gravity, to D, in which more than half of the key muscles allow the joint to move against gravity. A classification of E means that motor and sensory functions are normal, and physical therapy can restore much of the lost function.
Rehabilitation

An injury to the C5 vertebra, which supplies nerves to the diaphragm, may cause a momentary stop to breathing, requiring immediate ventilation support. Once the vertebra is treated and breathing functions improve, most patients can be weaned from the machine in the weeks following the injury. However, patients may still have low stamina. The goal of rehabilitation from that point forward is to help the patient learn to use a device such as a walker, leg braces or a wheelchair to move and also use certain communication technologies. Occupational therapy will allow the patient to redevelop motor skills, if possible, and relearn basic functions such as toileting routines and self-grooming. If the injury is complete, then the patient will need help getting in and out of a wheelchair and with domestic care and personal assistance around the house.

Causes of Spinal Cord Injuries

Spinal cord injuries occur in a variety of ways. In adults, damage to the spinal columnis usually also involved and the cord is stretched, bruised, impacted or compacted because of an external force or movement.
Age-related wear and tear on the spinal column, can cause narrowing of the intervertebral canal called stenosis. This results in pressure on the spinal cord and thespinal nerves, causing loss of function.

In children, a spinal cord injury often occurs by an over-stretching of the spinal cord.

What are the common causes of traumatic SCI?

Most traumatic SCI in Australia is caused by:

Motor vehicle accident involving either occupants or pedestrians

Falls

Sporting related accidents

Diving into shallow water

In Australia, traumatic SCI occurs in about 15 adults for each million in the population, every year. This has not changed for many years. It is expected to increase gradually in the years ahead due to our aging population, as many older people fall, which can cause a traumatic SCI.

The following types of injuries can cause spinal cord damage.

Flexion injuries:

Occur when there is a sudden forcible forward movement of the head, similar to a whiplash injury. This results in damage to the vertebrae in the neck (cervical) region of the spinal column. The damaged vertebrae then impact on the spinal cord, causing damage around C5-C6. Spinal ligaments are often also torn. These types of injuries commonly occur in motor vehicle accidents.

Rotation injuries:

Often occur alongside a flexion injury, where there is rotation of the spinal column, often in the cervical, lower thoracic and lumbar regions. This results in an associated injury of the spinal cord. Spinal ligaments are also often torn. Rotation injuries often happen in motor vehicle accidents where the vehicle is hit from the side. They also occur with people wearing lap seat belts, and in motorbike accidents.

Compression injuries:

Occur in diving accidents, where the force is transmitted through the head; or falls from a height, where the force is transmitted through the base of the spine or lower limbs. Impact causes the vertebrae, mostly commonly in the cervical or lower thoracic and lumbar region, to fracture into pieces and protrude into the spinal canal, damaging the spinal cord. The intervertebral discs may also be displaced and protrude into the spinal canal.

Hyperextension injuries:

Happen if you fall and the neck is forcibly extended in a backward direction, stretching the spinal cord. Even if there is minimal damage to the spinal column, the opening up of the discs and stretching of the ligaments damages the spinal cord. This injury is often seen in older people, and those injured in domestic accidents and assaults. Hyperextension of the neck is the most common way children damage their spinal cords. There is often little or no damage to the spinal column, but the force of the trauma causes excessive stretching of the spinal cord.

Penetrating injuries:


Occur when an object such as a knife or bullet penetrates the spinal cord. This type of injury can occur at any level of the spinal column and is often not associated withspinal column damage.

Spinal Cord Injury Causese ans Basic

Spinal cord injury occurs when there is any damage to the spinal cord that blocks communication between the brain and the body. After a spinal cord injury, a person’s sensory, motor and reflex messages are affected and may not be able to get past the damage in the spinal cord. In general, the higher on the spinal cord the injury occurs, the more dysfunction the person will experience. Injuries are referred to as complete or incomplete, based on whether any movement and sensation occurs at or below the level of injury.
The most important – and sometimes frustrating – thing to know is that each person’s recovery from spinal cord injury is different.

Causes of Spinal Cord Injury
Traumatic injuries
Motor vehicle accidents
Football
Falls
Gymnastics
Violence
Diving into shallow water
Spinal cord injuries affect more men than women. The majority of people who sustain a spinal cord injury are young adults between the ages of 16 and 30 because of riskier behaviors.
Non-traumatic injuries/illnesses
Cancer Osteoporosis
Multiple sclerosis
Inflammation of the spinal cord

Arthritis

Levels of Spinal Cord Injury

People with spinal cord injury are often told that they have an injury at a given spinal cord level, that they are “complete” or “incomplete”, that they have a bony fracture at one or more spinal vertebral levels, and that they are classified as A, B, C, D, or E according to the American Spinal Injury Association (ASIA) Classification. What is the meaning of the different spinal cord injury levels, the definition of complete and incomplete injury, and the different classification of spinal cord injury? In this article, I will try to explain the currently accepted definitions of spinal cord injury levels and classification.

Vertebral vs. Cord Segmental Levels
The spinal cord is situated within the spine. The spine consists of a series of vertebral segments. The spinal cord itself has “neurological” segmental levels that are defined by spinal roots that enter and exit the spinal column between vertebral segments. As shown figure 1, the spinal cord segmental levels do not necessarily correspond to the bony segments. The vertebral levels are indicated on the left side while the cord segmental levels are listed for the cervical (red), thoracic (blue), lumbar (green), and sacral (gray) cord.
The spine has 7 cervical (neck), 12 thoracic (chest), 5 lumbar (back), and 5 sacral (tail) vertebra. The spinal cord is shorter than the spinal canal, usually ending just below the L1 vertebral body. The C1 spinal roots exit the spinal column above the C1 vertebral body. There is no C8 vertebral body and so the C8 roots exit between C7 and T1. The T1 roots exit between T1 and T2 and the L5 roots exit between L1 and S1 vertebrae.
The first and second cervical vertebra hold and pivot the head. The C1 vertebrae, upon which the head is perched, is called Atlas after the Greek god who holds the earth. The back of the head is the occiput. The junction between the occiput and atlas is thus the atlanto-occiput junction. The C2 vertebra, upon which Atlas pivots, is called Axis, The junction between C1 and C2 vertebra is the atlanto-axis junction. The cervical cord innervates the diaphragm (C3), the deltoids (C4), biceps (C4-5), wrist extensors (C6), triceps (C7), wrist extensors (C8), and hand muscles (C8-T1).
The twelve thoracic vertebrae have associated ribs. The spinal roots form the intercostal (between the ribs) nerves that run on the bottom side of the ribs and connect to the intercostal muscles and associated dermatomes. About 5% of people have a vestigial 13th rib. The spinal cord ends just below L1. The conus is the tip of the spinal cord. Below the conus, the spinal roots of L2 to S5 form the cauda equina. Injuries to the lower thoracic spinal cords generally damage the lumbar enlargement. Injuries to the lumbosacral spine invariably reults in damage to the lumbosacral enlargement.

In summary, spinal vertebral and spinal cord segmental levels are not necessarily the same. In the upper spinal cord, the first two cervical cord segments roughly match the first two cervical vertebral levels. However, the C3 through C8 segments of the spinal cords are situated between C3 through C7 bony vertebral levels. Likewise, in the thoracic spinal cord, the first two thoracic cord segments roughly match first two thoracic vertebral levels. However, T3 through T12 cord segments are situated between T3 to T8. The lumbar cord segments are situated at the T9 through T11 levels while the sacral segments are situated from T12 to L1. The tip of the spinal cord or conus is situated at L2 vertebral level. Below L2, there is only spinal roots, called the cauda equina.

Prevention of Spinal Cord Injury

Following this advice may reduce your risk of a spinal cord injury:
Drive safely. Car crashes are one of the most common causes of spinal cord injuries. Wear a seat belt every time you drive or ride in a car.
Make sure that your children wear a seat belt or use an age- and weight-appropriate child safety seat. To protect them from air bag injuries, children under age 12 should always ride in the back seat.
Check water depth before diving. To make sure you don't dive into shallow water, don't dive into a pool unless it's 9 feet (about 3 meters) or deeper, don't dive into an aboveground pool and don't dive into any water of which you don't know the depth.

Prevent falls. Use a step stool with a grab bar to reach objects in high places. Add handrails along stairways. Put nonslip mats on tile floors and in the tub or shower. For young children, use safety gates to block stairs and consider installing window guards.
Take precautions when playing sports. Always wear recommended safety gear. Avoid leading with your head in sports. For example, don't slide headfirst in baseball, and don't tackle using the top of your helmet in football. Use a spotter for new moves in gymnastics.

Don't drink and drive. Don't drive while intoxicated or under the influence of drugs. Don't ride with a driver who's been drinking.

Spinal Cord Injury Recovery

When treating a person with a spinal cord injury, repairing the damage created by injury is the ultimate goal. By using a variety of treatments, greater improvements are achieved, and, therefore, treatment should not be limited to one method. Furthermore, increasing activity will increase his/her chances of recovery.

Making Connections
In order to restore movement and sensation, axons must grow from surrounding healthy tissue into the site of injury and then continue on to the brain. Even when researchers are able to stimulate the growth of injured axons, they often find they cannot get the axons to grow beyond the site of injury itself.
To promote this growth, Mark Tuszynski, a neuroscientist at the University of California, San Diego, added nerve cells and growth factors to the injury site and beyond. By leaving behind a trail of bread crumbs to guide axons at points along the spinal cord, for the first time researchers witnessed "axons regenerating into and beyond an injury site," Tuszynski explains.
Improving locomotor function
Improvement of locomotor function is one of the primary goals for people with a spinal cord injury. SCI treatments may focus on specific goals such as to restore walking or locomotion to an optimal level for the individual. The most effective way to restore locomotion is by complete repair, but techniques are not yet developed for regeneration. Treadmill training, over groundtraining, and functional electrical stimulation can all be used to improve walking or locomotor activity. These activities work if neurons of the central pattern generator (CPG) circuits, which generate rhythmic movements of the body, are still functioning. With inactivity, the neurons of CPG degenerate. Therefore, the above activities are important for keeping neurons active until regeneration activities are developed. A 2012 systematic review found insufficient evidence to conclude which locomotor training strategy improves walking function most for people with spinal cord injury. This suggests that it is not the type of training used, but the goals and the routines that have the biggest impact.
While there is a wide range of experimental approaches to treating spinal cord injury, they all share a common goal: improving the lives of people with spinal cord injuries.

"What we know about spinal cord injury has dramatically increased in the last 40 years," says Guest. "The rate of acceleration of improvements in treating spinal cord injuries will continue in the next decades, and the outlook for such patients will only get better."

Pain In Spinal Cord Injury

The spinal cord is the major bundle of nerves carrying nerve impulses to and from the brain to the rest of the body. Rings of bone, called vertebrae, surround the spinal cord. These bones constitute the spinal column or back bones.

Spinal cord injury can be direct trauma to the spinal cord itself or indirect damage to the bones, soft tissues, and blood vessels surrounding the spinal cord.

Spinal cord damage results in a loss of function, such as mobility or feeling. In most people who have spinal cord injury, the spinal cord is intact. Spinal cord injury is not the same as back injury, which may result from pinched nerves or ruptured disks. Even when a person sustains a break in a vertebra or vertebrae, there may not be any spinal cord injury if the spinal cord itself is not affected.

Causes of Spinal Cord Injury

Spinal cord injuries may result from falls, diseases like polio or spina bifida (a disorder involving incomplete development of the brain, spinal cord, and/or their protective coverings), motor vehicle accidents, sports injuries, industrial accidents, and assaults, among other causes. If the spine is weak because of another condition, such as arthritis, minor injuries can cause spinal cord trauma.

Spinal Cord Injury With Bowel Care

You or a caregiver can manage your bowel problems to prevent unplanned bowel movements,constipation, and diarrhea. Although this often seems overwhelming at first, knowing what to do and establishing a pattern makes bowel care easier and reduces your risk of accidents.

A spinal cord injury generally affects the process of eliminating waste from the intestines, causing a:Reflexive bowel. This means you cannot control when a bowel movement occurs.

Flaccid bowel. This means you can't have a bowel movement. If stool remains in the rectum, mucus and fluid will sometimes leak out around the stool and out the anus. This is called fecal incontinence.

Bowel programs

When choosing a way to deal with bowel problems, you and your rehab team will discuss such things as the type of bowel problem you have, your diet, whether you or a caregiver will do the program, and any medicines that may affect your program.

For a reflexive bowel, you may use a stool softener, a suppository to trigger the bowel movement, and/or stimulation with your finger (digital stimulation). There are many stool softeners and suppositories available. You will have to experiment to find what works best for you.

For a flaccid bowel, you may use digital stimulation and manual removal of the stool. At first, you do this program every other day. Later, you may need to do it more often to prevent accidents. You may also have to adjust how much and when you eat.


Eating more fiber can help some people who have spinal cord injuries manage their bowel habits. Good sources of fiber include whole-grain breads and cereals, fruits, and vegetables.

Living With Spinal Cord Injury

Often a spinal cord injury (SCI) is caused by a blow to the spine, resulting in broken or dislocated bones of the spine (vertebrae.) The vertebrae bruise or tear the spinal cord, damaging nerve cells.
When the nerve cells are damaged, messages cannot travel back and forth between the brain and the rest of the body. This causes a complete or partial loss of movement (paralysis) and feeling.
Sometimes the spinal cord is damaged by infection, bleeding into the space around the spinal cord,spinal stenosis, or a birth defect, such as spina bifida.
At the hospital
A person with a potential SCI is taken to an emergency department and then to an intensive care unit. The first priority is stabilizing bloodpressure and lung function, as well as the spine, to prevent further damage. When a spinal cord injury is caused by a serious accident, treatment for other injuries is often needed.
The following tests may be done right away to help find out the extent of the injury. They may also be done routinely throughout and after you leave rehabilitation (rehab).
An ultrasound of the kidneys checks your bladder function. This is done every 1 to 2 years.
A spinal X-ray monitors your spine's condition. Your doctor lets you know how often this is done—usually monthly for the first 3 to 6 months.
Computed tomography scan (CT scan) and magnetic resonance imaging (MRI), which provide detailed pictures of the spine, are done as needed.
A bone density test measures the minerals (such as calcium) in your bones using a special X-ray, a CT scan, or ultrasound.
A few days after the injury, your doctor will ask you questions. Also, he or she will test not only the strength of key muscles but also your response to light touch and pinpricks all over your body.

Recovery From Spinal Cord Injury Treatment

People often ask experts when or if there will ever be a cure for spinal cord injury. Although there are many differing opinions about this, I am confident there will be a cure in my lifetime. In the meantime, anyone with a spinal cord injury should have a long-term plan for their treatment and care.
The number of spinal cord injuries per year has remained fairly stable over the last two decades, with nearly 12,000 occurring each year mostly from sports injuries, car accidents and other forms of traumatic injury. Currently in the United States there are approximately 200,000 people are living with spinal cord injuries or spinal dysfunction. With today’s advanced medical treatments, more spinal cord injury patients survive the trauma compared to just a few decades ago. This positive shift in mortality rate underlines the great importance of initial acute treatment and follow up rehabilitation.
Treatment for spinal cord injuries can be divided into to two stages: acute and rehabilitation. The acute phase takes place immediate following the injury and is conducted at a hospital with an appropriate trauma center. During this time, the patient is immobilized to ensure that the damage to the spinal cord is minimized and any other injuries can be treated. This phase may also include surgery to reinforce the damaged area of the spine to prevent further injury. The acute phase will conclude when the patient is stabilized and ready to begin the next step towards recovery—rehabilitation therapy.
The rehabilitation phase will provide the tools necessary to begin working toward independence. This is a critical time for recovery because many of the gains the patient will make in movement happen during this time. This is why acute rehabilitation, as opposed to rehab done in sub-acute facilities, is so important after such an injury. Improvements made during this period can set the stage for the patient’s recovery afterwards.
While all spinal cord injury patients require rigorous physical and occupational therapy, the injuries and pace of recovery are unique to each person. An individualized plan should be designed to help the patient maximize their recovery. In addition, spinal cord injury patients should receive ongoing education from various disciplines as their injuries and resulting conditions are life-changing and permanent. This education should focus on coping, additional resources and the need for lifelong follow up to deal with changing needs, laying the groundwork for a lifetime of work and improvement.
Once acute rehabilitation concludes, the real work comes next as patients need to continually strive to maintain muscle mass and flexibility through exercise therapy. This can be done at outpatient rehabilitation therapy clinics or at other facilities.

Patients must work on sustaining physical integrity until there is a cure so when the time comes, they will be ready for it.