Spinal injury

Spinal injury can occur to the bones (vertebrae) that make up the spine, or to the spinal cord, which is the bundle of nerves running down the neck and spine that carries electrical signals between the brain and body. Spinal cord injury can disrupt these signals and is therefore extremely serious, because it can result in loss of movement (paralysis) below the point of injury. Damage to the vertebrae often occurs at the same time as damage to the spinal cord, but the spinal cord can also be damaged without any damage to the vertebrae.

Causes

There are many possible causes of spinal injury. Some common causes include:

• Motor vehicle accidents;
• Any trauma to the head, neck, face, chest or back;
• Falls;
• Stab or bullet wounds;
• Infection, inflammation and tumours, and;
• Electric shock.

Signs and symptoms

Signs and symptoms of spinal injury can include:

• Difficulty walking;
• Loss of movement in the arms or legs;
• Loss of control of the bladder or bowel;
• A stiff neck or neck pain;
• A numb or tingling feeling in the arms or legs, and;
• Weakness.

Methods for diagnosis

To diagnose spinal injury, a doctor will perform a physical examination, during which they will perform a range of tests to check a person's ability to move and feel sensation. This involves the doctor touching various parts of the person's body to check they can still feel, as well as checking their muscle strength and reflexes.

After physical examination, X-rays, CT or MRI scans are done to check if there is any spinal injury and related damage, such as fractures.

 

Types of treatment

First aid

Immediate first aid for a spinal injury is required. If someone has experienced a spinal injury, call 000. A person with a spinal injury should not be moved unless it is absolutely necessary (such as if they are in a car that is on fire). Their head and neck are to be held in place until medical assistance arrives. Under no circumstances should their head or neck be straightened, or allowed to bend or twist.

If someone is unconscious as a result of their injury, it is also important to check their breathing and, if necessary, to perform cardiopulmonary resuscitation (CPR). If CPR has to be performed, then it is again important not to tilt the person's head back.

Surgery and medication

Steroid medications can help to slightly improve a person's condition if taken within eight hours of injury. Depending on the extent of the injury, surgery may also be required to remove bone fragments, foreign objects or herniated discs, as well as to stabilise the spine.

Rehabilitation

After the initial period of treatment, rehabilitation is generally recommended to aid a person's recovery. It requires the assistance of physiotherapists to help strengthen muscles, and occupational therapists to help the person learn new skills. Psychologists will also form part of the management team, as the difficulties experienced from having a spinal injury can be a cause of psychological distress.

Researchers are currently developing robotic exoskeletons and other technological solutions that will hopefully one day help people with total paralysis to walk again, but the technology is in the early stages of development and is not yet in wide use.

 

Potential complications

The main complication of spinal cord injury is loss of movement, which results from damage to the nerves that form the spinal cord. When people lose the use of their legs, this is termed paraplegia. When they lose the use of their body and all four limbs, it is termed quadriplegia or tetraplegia.

If the nerves are completely severed, then total paralysis occurs. If they are only partly severed, then some movement may remain.

Spinal injury can also lead to loss of bladder or bowel control. This can be very difficult to deal with; however, with appropriate treatment many people can live with these issues.

Prognosis

The vast majority of people with a spinal cord injury have a minor enough injury that they can remain fully independent. If the damage is moderate, there is a chance they will walk again. However, if the spinal cord injury is severe, chances of a full recovery are poor. If paralysis is still present three days after injury, there is likely to be some ongoing physical disability.

Very rarely, if the spinal injury is very high up in the neck, it can cause paralysis of the breathing muscles, leading to cessation of breathing. If first aid is not immediately given, death is a possibility.

Prevention

There are a number of different ways to reduce the risk of spinal injury in different situations, including:

• Wearing a seatbelt when in a car;
• Not drinking and driving;
• Not diving into shallow pools or other bodies of water where the depth of the water cannot be seen, and;
• Avoiding high-impact contact sports, or if they are played, by only tackling someone safely and not head-first.