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Saturday, January 2, 2016

Treatment for spinal cord injury

Asalamualaikum and today i want to share a knowledge regarding what is a spinal injuries and what is the plan and goal for manage it.

l  The vertebral column is made up of 26 bones that provide axial support to the trunk. The vertebral column provides protection to the spinal cord, which runs through its central cavity. Between each vertebra is an intervertebral disk, which acts as a shock absorber

Anatomy of spine
l  The spinal cord ends in the lumbar area and continues through the vertebral canal as spinal nerves. Because of its resemblance to a horse's tail, the collection of these nerves at the end of the spinal cord is called the cauda equina. These nerves send and receive messages to and from the lower limbs and pelvic organs.

Vertebra and spinal nerves
l  The spinal cord and its peripheral nerves are protected by the vertebral column, a stack of bones which surround and provide support. Between the vertebrae is a fluid-filled disk

Spinal Injuries
Alternative names
Spinal cord compression

Spinal cord trauma is damage to the spinal cord that results from direct injury to the cord itself, or from indirect injury from damage to the bones, soft tissues, and blood vessels surrounding the spinal cord

Causes, incidence, and risk factors
l  motor vehicle accidents
l  falls
l  sports injuries (particularly diving into shallow water)
l   industrial accidents
l  gunshot wounds
l  assault
l  Diseases (Cancer, infections, arthritis and inflammation of the spinal cord )
l  A seemingly minor injury can cause spinal cord trauma if the spine is weakened (such as from rheumatoid arthritis or osteoporosis) or if the spinal canal protecting the spinal cord has become too narrow (spinal stenosis) due to the normal aging process .
l  Direct injury, such as cuts, can occur to the spinal cord, particularly if the bones or the discs have been damaged. Fragments of bone (from fractured vertebrae, for example) or fragments of metal (such as from a traffic accident) can cut or damage the spinal cord
l  Bleeding, fluid accumulation, and swelling can occur inside the spinal cord or outside the spinal cord (but within the spinal canal). The accumulation of blood or fluid can compress the spinal cord and damage it
l  Older people with weakened spines (from osteoporosis) may be more likely to have a spinal cord injury.
l  Patients who have other medical problems that make them prone to falling from weakness or clumsiness (from stroke, for example) may also be more susceptible

Signs & Symptoms
l  Pain or an intense stinging sensation caused by damage to the nerve fibers in the spinal cord
l  Loss of movement
l  Loss of sensation, including the ability to feel heat, cold and touch
l  Loss of bowel or bladder control
l  Exaggerated reflex activities or spasms
l  Changes in sexual function, sexual sensitivity and fertility
l  Difficulty breathing, coughing or clearing secretions from the lungs

Emergency signs and symptoms
of spinal cord injury after a head injury or accident
l  Fading in and out of consciousness
l  Extreme back pain or pressure in the neck, head or back
l  Weakness, incoordination or paralysis in any part of the body
l  Numbness, tingling or loss of sensation in the hands, fingers, feet or toes
l  Loss of bladder or bowel control
l  Difficulty with balance and walking
l  Impaired breathing after injury
l  An oddly positioned or twisted neck or back

l  paralysis (paraplegia, quadriplegia)
l  loss of sensation
l  loss of bladder control
l  increased risk of urinary tract infections
l  increased risk of chronic bilateral obstructive nephropathy
l  loss of bowel control
l  loss of sexual functioning (male impotence)
l  paralysis of breathing muscles
l  increased risk of injury to numb areas of the body
l  pain
l  complications of immobility:
l  deep vein thrombosis
l  pulmonary infections
l  skin breakdown
l  contractures
l  shock
l  extreme blood pressure fluctuations
l  spasticity (late complication)


Thoracic and lumbar spine injuries
Examination & Investigation
l  Examine the back for tenderness, kyphos and a gap in the interspinous and supraspinous ligaments.
Neurological signs  
l  Signs of cord compression are not usually present in a stable fracture. Nerve roots however, may be damaged by both bone and disc especially in the lumbar region.
l  This does not show any appreciable forward displacement of one vertebra on the next. Compression of the vertebral body, a burst fracture or a chip fracture are usually the only abnormalities. In the lumbar region the transverse processes may be fractured.

Emergency assessment

Level of injuries

Stable spinal fractures Thoracic lumbar and sacrum


l  Medications. Methylprednisolone (Medrol) is a treatment option for acute spinal cord injury. This corticosteroid seems to cause some recovery in people with a spinal cord injury if given within eight hours of injury. Methylprednisolone works by reducing damage to nerve cells and decreasing inflammation near the site of injury.
l  Immobilization. You may need traction to stabilize your spine and bring the spine into proper alignment during healing. Sometimes, traction is accomplished by placing metal braces, attached to weights or a body harness, into your skull to hold it in place. In some cases, a rigid neck collar also may work.
l  Surgery. Occasionally, emergency surgery is necessary to remove fragments of bones, foreign objects, herniated disks or fractured vertebrae that appear to be compressing the spine. Surgery may also be needed to stabilize the spine to prevent future pain or deformity. However, some surgeons believe it's safer to wait for several days before attempting any surgery

Type Of spinal injuries and  Dr management

Treatment Stable injuries of the thoracic and lumbar

l  Bed rest — The patient should be nursed on a mattress with fracture boards for a few days.
l  Back extension exercises — These should be started immediately, plus radiant heat locally.
l  Back support — This is usually required when the patient is mobilised out of bed.
a. Taylor brace — Supports both the thoracic and lumbar spine.
b. Lumbo-sacral brace — Supports the lumbar spine. This should be used for 3 months, or longer when the patient is mobile. The patient can be up and walking in the support but must not lift weights.

Type of  spinal brace

Unstable spinal fractures
Immediate management
l  Transport flat on back if possible, on a stretcher; otherwise face down with spine extended.
Initial treatment
l  The patient should be nursed on a soft mattress supported by fracture boards. Two-hourly turning and back exercises are essential. Most patients should be treated conservatively without operation .

l  In the thoracic region patients usually have a complete transection of the cord with complete paraplegia due to the relatively ‘tight fit’ of the thoracic cord. These patients are often best treated by 2-hourly turning and lifting on a soft mattress on fracture boards to prevent bed sores and to facilitate care of bladder and bowel, and prevention of joint contractures. Occasionally internal stabilisation of the spine will enable earlier mobilisation, and ease the problem of nursing.
Thoraco-lumbar region
l  Occasionally, there is an indication for stabilisation of the fracture with spinal Harrington rods or CD instrumentation for incomplete lesions in the thoraco–lumbar region. Operative stabilisation may make for ease of nursing and earlier mobilisation.
Cauda equina lesions
l   These should be explored as an emergency if pressure by an intervertebral disc or bone is suspected. MRI or myelography may be valuable. Perineal numbness and paralysis of the anus and bladder make this an emergency, and decompression should be carried out without delay.
Progressive lesions
l  All progressive lesions should be urgently explored. There may be a place for systemic cortisone administration.
l   Lumbar — In the lumbar region early stabilisation will enable early mobilisation, but operation is usually not indicated unless these is pressure on the cauda equina by bone or disc.

Further management — unstable spinal

l  The patient should be mobilised in 8 – 12 weeks with the help of calipers, crutches and a wheelchair.
l  This is essential and should be commenced immediately after admission to hospital.
l  • Bed sores — The use of a hydrostatic flotation bed for patients with paraplegia may prevent the occurrence of bed sores and often allow bed sores to heal. Water bed treatment is indicated in hospitals where lack of nursing staff prevents 2-hourly turning of the patient.
l  Most patients with good power in the arms can walk with the aid of crutches and above-knee calipers. A high or midthoracic lesion may necessitate a tripod gait with both legs swung forward simultaneously as the body is supported by calipers plus 2 crutches placed firmly on the ground.
l  Both crutches are then moved forward, with the legs this time acting as the fixed pivotal unit. It is essential that every effort be made to encourage the patient to walk.
Flexion contractures
l   These are common in the hip, knee and ankle and should be prevented or treated by physiotherapy where possible. Failing this, subcutaneous fasciotomy to correct the contractures is preferable to open operation.

Rehabilitation And Aims
l  a rehabilitation team will work with pt to improve pt remaining muscle strength and to give pt the greatest possible mobility and independence .
l  Rehabilitation team may include a physical therapist, occupational therapist, rehabilitation nurse, rehabilitation psychologist, social worker, dietitian recreation therapist and a doctor who specializes in physical medicine (physiatrist) or spinal cord injury.

l  During the initial stages of rehabilitation, The team therapists usually emphasize regaining leg and arm strength, redeveloping fine-motor skills and learning adaptive techniques to accomplish day-to-day tasks
l  A program typically includes exercise by physiotherapist  and occupational therapist will help to train in ADL as a wheelchair user or equipment that can make it easier to fasten buttons or dial a telephone.
l  Therapy often begins in the hospital and continues for several weeks in a rehabilitation facility. As therapy continues, you and your family members will receive counseling and assistance on a wide range of topics, from dealing with urinary tract infections and skin care to modifying your home and car to accommodate your disability
l  Therapists will encourage you to resume your favorite hobbies, participate in athletic activities and return to the workplace, if possible.
l  They'll even help determine what type of assistive equipment you'll need for these vocational and recreational activities and teach you how to use it
l  Extensive physical therapy, occupational therapy, and other rehabilitation interventions are often required after the acute injury has healed. Rehabilitation assists the person in coping with disability that results from spinal cord trauma.

Further Treatment

I would say the info i share to you is more a basic and  i will help to give us some of the clear picture regarding of this condition and how to deal with this situation .

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