Spinal Cord Injuries

INTRODUCTION:-

A Spinal Cord Injury (SCI) is defined as damage or trauma to the spinal cord that in turn results in a loss or impaired function resulting in reduced mobility or sensation.

The spinal cord does not have to be completely severed for there to be a loss of function. In fact, the spinal cord remains intact in most cases of spinal cord injury.

Types of spinal injuries:

The spinal injuries are generally of four types:

  1. Cord maceration, in which the morphology of the cord is severely distorted.
  2. Cord lacerations (gun shot or knife wounds)
  3. Contusion injury, which leads to a central hematomyelia that may evolve to syringomyelia
  4. Solid cord injury, in which there is no central focus of necrosis as in contusion injury

In the latter two the spinal cord surface is not breached and the connective tissue component is minimal. However, in the former two types of injuries, the surface of the cord is lacerated and a prominent connective tissue response is invoked.

Of these four injury types, the contusion injury is a progressive injury that enlarges over time.

Within these four injury types, degree of completeness must be considered, as incomplete lesions will benefit more dramatically than complete lesions in terms of degree of recovery that can be obtained.

Thus, spinal lesions are also divided as follows:

  1. Complete injury
  2. Incomplete injury

Complete injury: Here, the person is completely paralyzed below their lesion.

Incomplete injury: Here, only part of the spinal cord is damaged. A person with an incomplete injury may have sensation below their lesion but no movement, or visa versa. Although, no two incomplete spinal cord injuries are the same, a person with an incomplete spinal cord injury has been shown to have a better chance of recovery than that of a complete injury.

Pathology of spinal injury:

After the injury, there are three phases of responses occurring:

  • Acute
  • Secondary
  • Chronic

A variety of parallel pathophysiological processes begins. This phase encompasses the moment of injury and extends for the first few days. Upon initial impact or injury, there is immediate mechanical damage to neural and other soft tissue, including endothelial cells of the vasculature. Thus necrosis, or cell death, results from these mechanical and ischemic insults, is instantaneous.

After the insult, over the next few minutes, the injured nerve cells respond with an injury-induced barrage of action potentials. Accompanying this are significant electrolytic shifts, principally involving the monovalent and divalent cations Na+, K+, and Ca2+, that contribute to a failure in normal neural function and spinal shock, which lasts for about 24 hours and represents a generalized failure of circuitry in the spinal neural network.

Hemorrhage occurs, with localized edema, loss of microcirculation by thrombosis, vasospasm and mechanical damage, and loss of vasculature auto regulation, all of which further exacerbate the neural injury. Furthermore, compression of the spinal cord occurs as a result of vertebral displacement followed by edema and later by fibrotic responses, contributing further to the neural injury.

The secondary and chronic injury processes, because these occur within minutes to weeks after injury, are strategically better for therapeutic targets.

The grading scale for the evaluation of the functional recovery:

The most common used grading system for evaluation of functional recovery of a spinal cord injury is the Frankel scale. This scale contains five grades (A-E), based on motor and sensory deficits.

A: complete paralysis

B: sensory function only below the injury level

C: incomplete motor function below injury level

D: fair to good motor function below injury level

E: normal function

Symptoms of spinal cord injuries:

The symptoms of SCI depend on two factors: where the damage occurs and how serious it is. For instance, Damage to nerves below the C3 level of nerves may cause loss of feeling and paralysis of the arms as well as the legs and upper body. The C3 nerves are located in the middle of the neck. This kind of injury may also damage a person’s chest muscles, making breathing difficult, but not impossible.

However, the following are the other symptoms that a spinal injury can cause:

  • Blood clots: Immobility for a long period of time can cause the formation of Blood clots in veins. This clot may break loose and cause damage to the heart or lungs.
  • Calcium deposits: Spinal cord injury may cause the growth of bone-like material in muscles and tendons, which may produce swelling, redness, heat, and stiffness in a muscle.
  • Failure of autonomic responses: The autonomic responses are the bodily responses that occur automatically, without the need for a person to think about it. Spinal cord injuries can damage these systems.
  • Loss of bladder and bowel control: Spinal cord injury can cause damage to the nerves that control the bladder and bowel muscles. A person may urinate or defecate without wanting to, or may not be able to urinate or defecate when he or she needs to.
  • Muscle stiffness: Spinal cord damage may make it impossible to move muscles normally, which after a while tend to become tight and shortened. This process is called a contracture. Eventually, the muscles become frozen in an abnormal and awkward position. When this happens, the muscle is said to be spastic.

Diagnosis:

Investigations such as blood tests, electromyography (EMG), magnetic resonance imaging (MRI), and sometimes genetic testing are useful to rule out other disorders that may mimic MND.

Treatment:

At the Time of Injury Immediate medical treatment focuses on stabilizing the spine and aggressive treatment with corticosteroid drugs to limit damage and improve the chance of recovery. Patient may need surgery to stabilize the spine, perhaps by fusing together vertebrae or inserting metal pins; to remove bone chips, bullets or other objects; or to drain fluid to relieve pressure. Patient may also need traction and bed rest to immobilize your back while it heals.

Other treatments focus on preventing secondary problems, such as catheterization if bladder control is lost, antibiotics for urinary tract infections, skin care and frequent changes in position to avoid bedsores, and physical therapy to strengthen muscles.

Longer Term:

Once the initial injury heals, functional improvements may continue for at least six months. Disability that remains after that point is likely to be permanent. Long-term treatment involves an intense program of rehabilitation therapy. Although SCI often results in permanent disability, rehabilitation can maximize the level of function and help injured people adapt and lead independent, productive lives. Continuing treatment might include nutrition management, psychological counseling, physical and occupational therapy, various mechanical and electrical aids, and careful monitoring by physicians.

Physioline’s Prevention of spinal injuries:

To help prevent spinal cord injuries:

  • Always follow safe driving practices
  • Walk away from situations that become violent
  • Take precautions to prevent falls around your home
  • In sports, always wear proper safety equipment that fits and is in good working order. Follow the rules of the activity.
  • Never dive into any body of water where diving is prohibited or where you cannot see the bottom to make sure the water is deep enough and free from obstacles.

DETAILED TREATMENT :- Kindly contact Physioline for the detailed assessment and treatment program which is individualised according to every patient.

Paralysis Patients get Combination Therapy 

Physioline, a specialized physiotherapy and rehabilitation center of international repute in Manish Nagar, Andheri west, Mumbai introduced world’s best treatment protocol for the paralytic patients called Combination therapy. As the name suggests it is a combination of an array of therapies for the paralytic patients. Physioline in India is the first to bring such a intensive and result oriented treatment protocol of global standards right at your door step pioneered by Dr Sanjay Bakhshi, the founder and chief physiotherapist and rehabilitation consultant.

Combination therapy consists of the usage of specialized and sophisticated electronic equipment from Germany namely ‘Mentamove’ in adjunction with all the best approaches and techniques used world wide for the treatment of paralysis, all which are FDA approved German & US Equipment.

Combination therapy works on the principal of ‘Neuro-Plasticity’ i.e. the ability of the brain to reorganize its neuronal networks so that it functions by experience thus helping to relearn and adapt to new conditions. This  therapy can be used in the treatment of most of the causative factors of paralysis, to mention a few paralyses due to stroke,Facial Paralysis post-op for brain tumors, cranio cerebral trauma, spinal cord injuries, multiple sclerosis cerebral palsy etc. This form of therapy promises recovery at a faster pace with success rates scaling as high as 99% and with absolutely no side effects as well as a fair reduction in the cost of illness and medications.

With this innovative concept, the success ratio soars as high upto 99.99% in neurological conditions and 100% pain relief in orthopedic conditions. This has rewarded them with satisfied patients over the years.

The overall goal of treatment or management at Physioline is to cater to the health needs of patients and strive hard to enhance their capacity to function and remain as independent as possible. The endeavor to be the best in the field has prompted Dr Sanjay Bakhshi to constantly look for new ways to improve the results for the patients. With each new patient he and his team try to gain greater knowledge for guiding the successful recovery of future patients with similar impairments and diseases.

E-mail: physioline@gmail.com

Website:  www.physioline.in

Contact: 26302176 / 26340779 / 65266092