SCI results in a decreased or absence of movement, sensation, and body organ function below the level of the injury. The most common sites of injury are the cervical and thoracic areas. SCI is a common cause of permanent disability and death in children and adults.
Between two vertebras there is fibro-cartilagenous structure known as disc. Inter-vertebral disc is composed of outer tough fibrous structure called annulus fibrosus, which encloses jelly like structure called nucleus pulposus. Tear of annulus forces nucleus out side, this Spinal Cord Surgery which has come out presses on the neural structures lying behind disc and causes backache, leg pain(sciatica).
Many surgeries are done under local anesthesia, hence surgeries can be done even in patients with high risk of anesthesia.
There is less blood loss.
Patient can be mobilized very early and he can be back to work faster.
It prevents complications associated with prolonged bed rest.
Anatomy Of The Spine
The human spine is a complex structure that provides both mobility (so you can bend and twist) and stability (so you can remain upright all day). The normal spine has an “S” –like curve when looked at from the side. This curvature allows for even distribution of weight. The ”S” curve helps a healthy spine withstand stress. Ultimately, this interdependence among all sections of the spine, plus the competing demands of mobility and stability make the spine vulnerable to injury and deterioration due to ageing.
The spine consists of 33 vertebrae, including the following : -
- 7 cervical (neck)
- 12 thoracic (upper back)
- 5 lumbar (lower back)
- 5 sacral (sacrum - located within the pelvis)
- 4 coccygeal (coccyx - located within the pelvis)
What Are The Types Of SCI?
SCI can be divided into two main types of injury : -
Complete Injury : -
Complete injury means that there is no function below the level of the injury ? either sensation and movement ? and both sides of the body are equally affected. Complete injuries can occur at any level of the spinal cord.
Incomplete Injury : -
Incomplete injury means that there is some function below the level of the injury ? movement in one limb more than the other, feeling in parts of the body, or more function on one side of the body than the other. Incomplete injuries can occur at any level of the spinal cord.
Statistics : -
SCI occurs mainly in young adults, ages 16 to 30. Eighty-two percent of SCI patients are male. There are about 8,000 new cases of SCI per year in the US. Current estimates indicate between 250,000 and 400,000 people in the US are living with a spinal cord injury or spinal dysfunction.
Causes Of SCI
The most common causes of spinal cord injuries in the United States are:
• Motor vehicle accidents - Auto and motorcycle accidents are the leading cause of spinal cord injuries, accounting for more than 40 percent of new spinal cord injuries each year.
• Acts of violence - As many as 15 percent of spinal cord injuries result from violent encounters, often involving gunshot and knife wounds, according to the National Institute of Neurological Disorders and Stroke.
• Falls - Spinal cord injury after age 65 is most often caused by a fall. Overall, falls cause about one-quarter of spinal cord injuries.
• Sports and recreation injuries - Athletic activities, such as impact sports and diving in shallow water, cause about 8 percent of spinal cord injuries.
• Alcohol - Alcohol use is a factor in about 1 out of every 4 spinal cord injuries.
• Diseases - Cancer, arthritis, osteoporosis and inflammation of the spinal cord also can cause spinal cord injuries.
Your ability to control your limbs after spinal cord injury depends on two factors: the neurological level of the injury and the completeness of injury. The lowest normally functioning segment of your spinal cord is referred to as the neurological level of your injury.
The completeness of the injury is classified as either:
Complete - If all sensory (feeling) and motor function (ability to control movement) is lost below the neurological level, your injury is called complete.
Incomplete - If you have some motor or sensory function below the affected area, your injury is called incomplete.
Additionally, paralysis from a spinal cord injury may be referred to as:
Tetraplegia or quadriplegia - This means your arms, trunk, legs and pelvic organs are all affected by your spinal cord injury.
Paraplegia - This paralysis affects all or part of the trunk, legs and pelvic organs.
Your health care team will perform a series of tests to determine the neurological level and completeness of your injury.
Tests And Diagnosis
In the emergency room, a doctor may be able to rule out a spinal cord injury by careful inspection, testing for sensory function and movement, and asking some questions about the accident. But if the injured person complains of neck pain, isn't fully awake, or has obvious signs of weakness or neurological injury, emergency diagnostic tests may be needed.
These Tests May Include:
• X-rays - Medical personnel typically order these tests on all people who are suspected of having a spinal cord injury after trauma. X-rays can reveal vertebral (spinal column) problems, tumors, fractures or degenerative changes in the spine.
• Computerized tomography (CT) scan - A CT scan may provide a better look at abnormalities seen on an X-ray. This scan uses computers to form a series of cross-sectional images that can define bone, disk and other problems.
• Magnetic resonance imaging (MRI) - MRI uses a strong magnetic field and radio waves to produce computer-generated images. This test is extremely helpful for looking at the spinal cord and identifying herniated disks, blood clots or other masses that may be compressing the spinal cord.
• Myelography - Myelography allows your doctor to visualize your spinal nerves more clearly. After a special dye is injected into your spinal canal, X-rays or CT scans of your vertebrae can suggest a herniated disk or other lesions. This test is used when MRI isn't possible or when it may yield important additional information that isn't provided by other tests.
If your doctor suspects a spinal cord injury, he or she may prescribe traction to immobilize your spine.
Observation and medical management in the intensive care unit (ICU).
Medications, such as corticosteroids (to help decrease the swelling in the spinal cord).
Mechanical ventilator, a breathing machine (to help the patient breathe).
Foley catheter a tube that is placed into the bladder that helps to drain the urine into a collection bag.
Feeding tube (placed through the nostril to the stomach, or directly through the abdomen into the stomach, to provide extra nutrition and calories).
The Spinal Cord Injury Rehabilitation Team
The spinal cord injury rehabilitation team revolves around the patient and family and helps set short-and long-term treatment goals for recovery. Many skilled professionals are part of the spinal cord injury rehabilitation team
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