Fact-Checked: Why Trust Rittgers Rittgers & Nakajima Spinal cord injuries (SCI), often caused by physical trauma from motor vehicle accidents, falls, acts of violence, and medical negligence, are medical emergencies that require a rapid response to prevent further damage. The first steps taken after the injury occurs can be incredibly important to preventing further injury. Before a SCI patient is moved at all, it is critical that they’re head and neck are stabilized to prevent movement. Then, using a rigid backboard to maintain spinal alignment, the patient is transported to the hospital.
Immediate Response and Stabilization: The First Critical Steps
When a patient arrives in the Emergency Room with a suspected spinal cord injury, medical teams immediately start shifting their focus to assessing the severity of the injury and getting a clear picture of what is going on. This involves both a comprehensive neurological examination as well as advanced imaging. The neurological exam involves checking reflexes, muscle strength, and the ability to feel sensations throughout the body. Advanced imaging, including Magnetic Resonance Imaging (MRI), Computed Tomography (CT), and X-rays are taken to get an internal view of the potential SCI.
The Diagnostic Process: Neurological Exams and ER Imaging
MRIs, CTs, and X-rays are each valuable diagnostic tools that allow the medical team to visualize different parts of the body. While any combination of these tools can be used to help diagnose SCI, MRIs are able to show problems that other imaging cannot, making it the more definitive choice for determining whether or not someone has a SCI. MRIs are good for showing soft tissue internal structures, the difference between normal and abnormal tissue, and does not require radiation. CTs on the other hand give a better view of bony structures, lung and chest issues, and detecting cancers.
Although MRIs often come at a higher price and take much longer than CT scans, they are superior at detecting abnormalities of the spinal cord, bulging discs, small disc herniation’s, pinched nerves, and other soft tissue problems associated with SCI. Unfortunately, due to the magnetic nature of an MRI, patients with metallic implants may not be able to undergo this kind of imaging.
In addition to imaging and examinations, medical teams also begin early treatment of the SCI including managing hemodynamic stability (maintaining stable blood pressure and heart rate), pharmacological treatment, respiratory support and airway management, preventing secondary spinal cord damage, and assessing the need for spinal stabilization surgery.
Understanding Symptoms: How Injury Location Affects the Body
Symptoms of SCI can vary widely and the location of the injury on the spinal cord will determine what part of the body is affected and how badly the symptoms are. Injuries to the first and second vertebrae, found in the neck, often affect the respiratory muscles and ability to breath while a lower injury to the lumbar vertebrae may affect the patient’s nerve and muscle control of the bladder, bowel, legs, and sexual function. In general, symptoms of SCI include chronic back pain, lower extremity weakness, pain, and numbness, loss of movement, trouble breathing, and potentially complete paralysis of the limbs.
Examples of SCI include spinal cord compression, ischemia, and infarction. Spinal cord compression can occur anywhere on the spinal cord and is caused by pressure being placed on the spinal cord leading to impaired neurological function. Symptoms of spinal cord compression include chronic neck pain and stiffness, loss of fine motor skills, paralysis, reduced range of motion, and loss of bowel function. While physicians tend to recommend oral medication along with physical therapy, surgical intervention may be necessary to treat spinal cord compression.
Spinal cord ischemia is caused by a blockage of the blood flow to the spinal cord, depriving it of oxygen. With spinal cord ischemia, early diagnosis and treatment are critical to improving the chances of recovery and minimizing long term damage. Symptoms of spinal cord ischemia include severe back pain, weakness, numbness, and difficulty controlling the limbs. Due to spinal cord ischemia’s inconsistency in symptoms, there are no fixed guidelines for treatment, meaning treatment plans tend to be especially tailored to the patient’s unique circumstances. Similar to ischemia, spinal cord infarction is a stroke either within the spinal cord or the arteries that supply it. Recovery from infarction depends on how quickly treatment is received and how severe the damage was. While physical and occupational therapy, surgery, and symptom specific treatments give most individuals a good chance of recovery, paralysis caused by infarction may be permanent.