The spine: What you need to know about spinal cord injuries

Gracefully slender and utterly fragile, the spinal cord is one of the most sensitive parts of the body, to the extent that minor damage can lead to paralysis. Medical experts warn that damage to any part of the spinal cord can lead to permanent changes in sensation, one’s strength and other bodily functions. Dr Emmanuel Bukara, a consultant orthopaedic surgeon at King Faisal Hospital, explains that a spinal cord injury is basically trauma to the spinal cord. He says that the damage can be complete or partial and that when it’s complete, the whole body can be affected. When it’s partial, that is if it happens to one of the regions of the spine either at the lumbar or thoracic among others, then particular parts of the body can be affected. Understanding the spinal structure The spinal cord is more like a communication between the brain and the rest of the body and anatomically is surrounded by vertebrae bodies which are the bones that make up the spine. Symptoms and signs of spinal cord injury range from weakness of limbs or loss of function of the limbs. / Net photo. The spinal cord is the cylindrical bundle of nerve fibres that connects nearly all parts of the body to the brain, with which it forms the central nervous system. As for the spine, it is a series of vertebrae extending from the skull to the back, enclosing the spinal cord. Dr Bukara explains that the spine is made up of different regions that is; the cervical, thoracic, lumbar and sacrum. Causes of spinal injuries Dr Eric Mutabazi, a senior physiotherapist at King Faisal Hospital, says spinal cord injury is trauma to the spinal cord resulting in change, either temporary or permanent in its normal motor, sensory or autonomic function. He says the possible causes of these injuries can either be traumatic or non-traumatic. Mutabazi mentions stab injuries, motor vehicle accidents, falling from heights and sports injuries as some of the traumatic causes. Dr Wilbur Bushara, a general practitioner, says that spinal injuries occur when there is an abrupt forceful movement of the head and that this can result in damage to the vertebrae in the neck. The damaged vertebrae can then affect the spinal cord, causing damage. He indicates that non-traumatic injuries can occur due to certain factors like infections, tumours on the spine, and inflammation among other factors. Dr Bukara emphasises Bushara’s view, saying that some injuries can happen secondary to infection, which can also cause inflammation, like in circumstances where a person suffered from tuberculosis. “Bacterial infections, tumours on the spine, can lead to inflammation of the spine leading to its damage,” he says. Symptoms to look out for Symptoms and signs range from weakness of limbs or loss of function of the limbs, according to Dr Bukara. “Loss of sensation and incontinence of urine and stool are some of the other symptoms. And at times, there is cauda equina where you lose sensation around the pilenium (area around sexual organs),” he adds. While examining such conditions, Dr Bukara says sensation for different dermatomes (different units or subsections of the body) are sought as a way of assessment and that this helps assess where the injury is. “We also do a para rectal examination (exam around the rectum) and also look at the bulbocavernosus reflex to see if there is spinal shock or not. When the reflex is absent, it means that the patient is in spinal shock,” Dr Bukara adds. Treatment Dr Mutabazi advises that before starting any treatment an x-ray, CT scan or an MRI examination should be done to diagnose the spinal cord injury. This helps to understand the level of the injury and the precautions to be used on a particular case. He says such cases can be handled either by conservative or surgical management. “Basically we treat the cause, for example, if they are fractures leading to the spinal injury they need to be stabilised; with this, you may have surgery like posterior fixation. If it’s an infection, you need to do debridement plus fixation and if it’s a tumour then it needs to be resected,” Bukara says. According to research done by MedicineNet.com, the first step in treatment of a suspected spinal cord injury is to verify if the patient is breathing and the heart is beating. A spinal cord injury in the upper neck can cause a loss of control of normal breathing. This may require the placement of a breathing tube and use of a ventilator. The next step in treatment of a spinal cord injury is immobilisation. This often occurs at the time of injury prior to being transported to the hospital. Emergency medical technicians may place the patient in a cervical collar or on a backboard to help prevent the spine from moving. If the patient has a spinal cord injury, further movement of the spine could lead to further damage. After a spinal cord injury is diagnosed, the patient might be started on a high dose of steroids. This could help decrease the amount of damage to the spinal cord by reducing inflammation and swelling. There are risks associated with using steroids for spinal cord injury. The patient’s doctor can help decide if steroids are appropriate, the research shows. The patient then may be placed in traction or a halo device around the head to try to stabilise the spine and prevent further damage. Many cases of spinal cord injury are treated with surgery. editorial@newtimes.co.rw

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The spine: What you need to know about spinal cord injuries