Understanding spinal cord Injuries: Severity and complexity



The spinal cord consists of a column of nerve tissue that runs from the base of the skull till the lower back. It is covered by three thin layers made of protective tissues called dural membranes. These nerves carry impulses from the brain to various muscles of the body. The spinal cord is an extremely delicate structure and makes up our Central Nervous System (CNS) along with our brain. As nervous tissues do not have the capacity to regenerate, if the spinal cord gets injured, the defects may be permanent.

Though damage to the spinal cord can happen in multiple ways, the most common cause of spinal cord injuries is trauma in any form to the spine. Non traumatic injuries are not as prevalent but can occur due to tumors, blood loss or stenosis (space inside the backbone being too small). Most of the times trauma causes fractures of the vertebral bodies, which in turn cause compression over the spinal cord. Direct injury to the spinal cord in the form of bleeding into the cord or swelling of the cord can also occur due to injury. Sometimes spontaneous fractures of the vertebrae can occur in elderly people, mostly due to osteoporosis, leading to spinal injury. In rare cases some tumors may spread to the spine causing a collapse of the vertebrae and injuring the spinal cord.

Most of the spinal cord injuries when severe, can lead to a sudden onset of weakness in the limbs, depending on the level of cord injury. Difficulty in passing/controlling urination and difficulty in passing stools may occur in some cases. Severe pain in the neck or back region is also associated with spinal cord injury. Simply put, spinal cord injuries can be divided into two broad categories: Complete and Incomplete. Complete spinal cord injury refers to the absence of all feeling and all motor functions below the injury. Incomplete spinal cord injury on the other hand, is when you have some motor or sensory function and feeling below the injured area.

The treatment of spinal cord injuries may be conservative or surgical depending on the type and extent of injury. The aim in any surgical treatment, is to relieve pressure over the spinal cord to stop further damage and to avoid further movement of the vertebrae at that level by fixation of the spine. Restoring the alignment of the vertebral bodies is also equally important.

These surgeries can now be done with minimally invasive techniques at a multidisciplinary tertiary care hospital with a Full Time Specialist System (FTSS), ensuring easy availability and access to dedicated specialists. Minimally invasive surgeries enable the placement of screws in the vertebrae for stabilization through tiny stab incisions. This avoids large amount of muscle dissection and blood loss associated with multilevel open fixations. In certain selected cases, Robotic screw fixations may be used when the anatomy is extremely distorted. If there is only internal injury to the cord, then medical management in the form of steroids and avoiding movement is recommended.

Our spines act as the foundational support for our entire body by balancing the neck, chest, lower back and pelvis, to keep the head, trunk and legs in correct alignment. By inculcating healthy spinal habits into our lives through regular exercising, stretching and maintaining a balanced weight, we can minimize the risk of injury. Hence, the best way to treat spinal cord injuries is to prevent them.

The author is consultant, neurosurgery, Kokilaben Dhirubhai Ambani Hospital, Navi Mumbai. Views are personal.

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