Fractures and dislocations of the spine are serious injuries because they may be associated with damage to the spinal cord or cauda equina.
The thoracolumbar segment is the commonest site of injury , the lower cervical being the next common.
About 20% of all spinal injuries result in a neurological deficit in the form of paraplegia in the thoracolumbar spine injuries,or quadriplegia in the cervical spine injuries.
Unfortunately, there’s no way to reverse damage to the spinal cord. But, researchers are continually working on new treatments, including prostheses and medications that may promote nerve cell regeneration or improve the function of the nerves that remain after a spinal cord injury.
In the meantime, spinal cord injury treatment focuses on preventing further injury and empowering people with a spinal cord injury to return to an active and productive life.
Urgent medical attention is critical to minimize the effects of any head or neck trauma. So treatment for a spinal cord injury often begins at the scene of the accident.
Emergency personnel typically immobilize the spine as gently and quickly as possible using a rigid neck collar and a rigid carrying board, which they’ll use to transport you to the hospital.
Early (acute) stages of treatment
In the emergency room, doctors focus on:
Maintaining your ability to breathe
Immobilizing your neck to prevent further spinal cord damage
Avoiding possible complications, such as stool or urine retention, respiratory or cardiovascular difficulty, and formation of deep vein blood clots in the extremities
You may be sedated so that you don’t move and sustain more damage while undergoing diagnostic tests for spinal cord injury.
If you do have a spinal cord injury, you’ll usually be admitted to the intensive care unit for treatment. You may even be transferred to a regional spine injury center that has a team of neurosurgeons, orthopedic surgeons, spinal cord medicine specialists, psychologists, nurses, therapists and social workers with expertise in spinal cord injury.
Medications. Methylprednisolone (Medrol) is a treatment option for an acute spinal cord injury. If methylprednisolone is given within eight hours of injury, some people experience mild improvement. It appears to work by reducing damage to nerve cells and decreasing inflammation near the site of injury. However, it’s not a cure for a spinal cord injury.
Immobilization. You may need traction to stabilize your spine, to bring the spine into proper alignment or both. Sometimes, traction is accomplished by securing metal braces, attached to weights or a body harness, to your skull to keep your head from moving. In some cases, a rigid neck collar may work. A special bed also may help immobilize your body.
Surgery. Often, 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.
Experimental treatments. Scientists are trying to figure out ways to stop cell death, control inflammation and promote nerve regeneration. Ask your doctor about the availability of such treatments.
After the initial injury or disease stabilizes, doctors turn their attention to preventing secondary problems that may arise, such as deconditioning, muscle contractures, pressure ulcers, bowel and bladder issues, respiratory infections, and blood clots.
The length of your hospitalization depends on your condition and the medical issues you’re facing. Once you’re well enough to participate in therapies and treatment, you may transfer to a rehabilitation facility.
Rehabilitation. Rehabilitation team members will begin to work with you while you’re in the early stages of recovery. Your 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 injuries.
During the initial stages of rehabilitation, therapists usually emphasize maintenance and strengthening of existing muscle function, redeveloping fine motor skills and learning adaptive techniques to accomplish day-to-day tasks. You’ll be educated on the effects of a spinal cord injury and how to prevent complications, and you’ll be given advice on rebuilding your life and increasing your quality of life. You’ll be taught many new skills. and you’ll use equipment and technology that can help you live on your own as much as possible. You’ll be encouraged to resume your favorite hobbies, participate in social and fitness activities, and return to school or the workplace.
Medications. Medications may be used to manage some of the effects of spinal cord injury. These include medications to control pain and muscle spasticity, as well as medications that can improve bladder control, bowel control and sexual functioning.
New technologies. Inventive medical devices can help people with a spinal cord injury become more independent and more mobile. Some devices may also restore function. These include:
Modern wheelchairs. Improved, lighter weight wheelchairs are making people with a spinal cord injury more mobile and more comfortable. For some, an electric wheelchair may be needed. Some wheelchairs can even climb stairs, travel over rough terrain and elevate a seated passenger to eye level to reach high places without help.
Computer adaptations. For someone who has limited hand function, computers can be very powerful tools, but they’re difficult to operate. Computer adaptations range from simple to complex, such as key guards or voice recognition.
Electronic aids to daily living. Essentially any device that uses electricity can be controlled with an electronic aid to daily living (EADL). Devices can be turned on or off by switch or voice-controlled and computer-based remotes.
Electrical stimulation devices. These sophisticated devices use electrical stimulation to produce actions. They’re often called functional electrical stimulation (FES) systems, and they use electrical stimulators to control arm and leg muscles to allow people with a spinal cord injury to stand, walk, reach and grip.
Robotic gait training. This emerging technology is used for retraining walking ability after spinal cord injury.
Prognosis and recovery
Your doctor may not be able to give you a prognosis right away. Recovery, if it occurs, typically starts a week to six months after an injury. However, some people experience small improvements for up to one year or longer.