Understanding Spinal Cord Injury: Severity and Complexity
Most spinal cord injuries, when severe, can cause sudden onset of weakness in the limbs, depending on the level of spinal cord injury.
Spine. Image courtesy of Pearson Scott Foresman/Wikimedia Commons
The spinal cord is made up of a column of nervous tissue that extends from the base of the skull to the lower back. It is covered by three thin layers made up of protective tissues called dural membranes. These nerves carry impulses from the brain to various muscles in the body. The spinal cord is an extremely delicate structure and constitutes our central nervous system (CNS) along with our brain. Since nerve tissue does not have the ability to regenerate, if the spinal cord is injured, the defects may be permanent.
Although spinal cord damage can occur in many ways, the most common cause of spinal cord injury is trauma in some form to the spine. Non-traumatic injuries are not as common but can occur due to tumors, blood loss or stenosis (the space inside the spine being too small). Most of the time, trauma causes fractures of the vertebral bodies, which in turn cause compression of the spinal cord. Direct injury to the spinal cord in the form of bleeding into the cord or swelling of the cord can also occur due to injury. Sometimes spontaneous fractures of the vertebrae can occur in the elderly, mainly due to osteoporosis, resulting in spinal damage. In rare cases, some tumors can spread to the spine, causing the vertebrae to collapse and injuring the spinal cord.
Most spinal cord injuries, when severe, can cause sudden onset of weakness in the limbs, depending on the level of spinal cord injury. Difficulty passing/controlling urination and difficulty passing stools may occur in some cases. Severe pain in the neck or back region is also associated with spinal cord injury. Simply put, spinal cord injuries can be divided into two broad categories: complete and incomplete. A complete spinal cord injury refers to the absence of all sensation and motor function below the injury. An incomplete spinal cord injury, on the other hand, occurs when you have motor or sensory function and feel under the injured area.
Treatment for spinal cord injuries can be conservative or surgical depending on the type and extent of the injury. The goal of any surgical treatment is to relieve pressure on the spinal cord to stop further damage and to prevent further movement of the vertebrae at this level by fixation of the spine. Restoring the alignment of the vertebral bodies is also important.
These surgeries can now be performed with minimally invasive techniques in a multidisciplinary tertiary care hospital with a Full Time Specialist System (FTSS), ensuring easy availability and access to dedicated specialists. Minimally invasive surgeries place screws into the vertebrae for stabilization through tiny incisions. This avoids a large amount of muscle dissection and blood loss associated with open multi-level bindings. In selected cases, robotic screw fixations can be used when the anatomy is extremely distorted. If there is only an internal cord injury, medical management in the form of steroids and motion avoidance is recommended.
Our spines act as the fundamental support for our entire body balancing the neck, chest, lower back and pelvis, to keep the head, trunk and legs in correct alignment. By instilling healthy spinal habits into our lives through regular exercise, stretching, and maintaining a balanced weight, we can minimize the risk of injury. Therefore, the best way to treat spinal cord injuries is to prevent them.
The author is consultant, neurosurgery. Views are personal.
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