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Spinal Cord Injury

A spinal cord injury is regarded by many as one of the most devastating injuries. There are different types of spinal cord injuries depending on the region of the spinal cord and spinal level involved. The injury may be complete or incomplete. Anterior cord syndrome is the most common, and most severe, as it affects the front portion of the spinal cord which controls motor function and the majority of sensation. Central cord syndrome typically occurs as a result of a cervical hyperextension injury in an elderly person causing damage to the middle portion of the spinal cord. This usually causes a patient to have increased weakness and numbness in the hands and arms compared to the legs. Brown-Séquard syndrome results from an injury to one side of the spinal cord, causing same-side weakness and opposite-side numbness. This syndrome has the best prognosis and chance for recovery. Patients who have sustained a complete injury rarely, if ever, recover significant strength or sensation below the level of injury. Paraplegia is defined as profound or complete loss of motor function of the legs. Quadriplegia is defined as profound or complete loss of motor function of the arms and legs. Tetraplegia is defined as profound or complete loss of motor function of the head, neck, arms and legs and requires the patient be on a ventilator to breathe.

How is it diagnosed?

The diagnosis of a spinal cord injury is fairly straightforward in most patients. However, it is important to quickly and accurately assess the patient and the cause of the spinal cord injury, reduce a spine dislocation and/or surgically decompress and stabilize the fractured vertebrae if present.

What are the treatment options?

The treatment of a spinal cord injury can be divided into four categories: pre-hospital care, emergency room care, operative and hospital care and rehabilitation. Pre-hospital care focuses on extrication of the patient from an accident in a safe manner, taking adequate spine precautions to stabilize the neck in a collar and spine on a backboard to avoid additional spine and spinal cord injury. Emergency room care of a patient with a spinal cord injury dictates that a patient receive methylprednisolone intravenously as prescribed by the NASCIS guidelines. A patient should be appropriately and efficiently evaluated, so as to diagnose the underlying cause of the spinal cord injury and neurologic deficit. Urgent treatment, whether it be a closed reduction of a cervical dislocation or surgical decompression if indicated, is warranted as soon as the patient is medically stable to undergo such a procedure. Aggressive mobilization and rehabilitation should be started immediately in the post-operative period with twice daily physical therapy either in the in-patient or out-patient setting. Patients with tetraplegia or severe quadriplegia generally require life-long assistance with activities of daily living and routine self-care.

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