2015年8月10日星期一

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.

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