WHAT IS SPINAL CORD INJURY?

Damage to the small network of nerves and cells that transmits and receives messages from the brain to the rest of the body known as a spinal cord injury (SCI). The lower back is where the spinal cord travels from the lower region of the brain.

SCI can result through damage to the vertebrae and surrounding tissue as well as direct injury to the spinal cord itself. Changes in sensation, movement, strength, and bodily functions below the injury site may be transitory or permanent because of this damage.

Symptoms

The location and severity of the injury along the spinal cord determine how disabled a person will be. A higher spinal cord injury might result in tetraplegia or quadriplegia, which paralyzes the majority of the body and all limbs. Paraplegia, or paralysis affecting the lower body, can result from a spinal cord injury.

One or practically all of the nerve fibers that pass the injured area of the spinal cord can be damaged. For injuries with little to no nerve cell loss, a nearly full recovery is feasible.

A spinal cord injury may result in one or more of the following symptoms:

· Hands and feet that are numb, tingly, or have lost or changed their sense of touch

· As swelling and hemorrhage affect the spinal cord, paralysis may occur instantly or gradually.

· discomfort or pressure in the back, neck, or head

· decline in movement

· the inability or weakness to move anybody portion

· unnatural head or spine postures

· a lack of bowel and bladder control

· difficulties walking

· Having trouble breathing

· Modifications to sexual function

There are two categories for spinal cord injuries: complete and incomplete.

1. An incomplete injury is one in which some signals can still be sent to or from the brain by the spinal cord. People who have partial injuries still have some sensory ability, and they may have some control over the action of the muscles below the lesion site.

2. A complete injury is one in which the sensory and motor functions below the lesion site are lost because there is no nerve connectivity below the injury site.

Primary damage happens straight from the injury and is immediate. Secondary injury is the outcome of cellular activity changes, cell death, and swelling that can put pressure on your spinal cord and vertebrae.

SPINAL COLUMN ANATOMY

The spinal cord is a delicate, coiled column of blood vessels, tightly bunched nerve cells (neurons and glia), and nerve fibers that carry electrical information. Between the brain and the rest of the body, it transmits and receives information. Additionally, millions of nerve cells located in the spinal cord itself regulate intricate movement patterns like rhythmic breathing and walking.

Through a canal in the middle of the spine's bones, the spinal cord travels from the brain to the lower back. Similar to the brain, the spinal cord is shield by three layers of tissue and is in-cased in cerebrospinal fluid (CSF), which serves as a shock absorber.

Just beyond the spinal cord, different kinds of nerve cells transmit information to the brain. There are 31 pairs of nerves, each with thousands of axons, branch out into four zones and connect the spinal cord to muscles and other parts of the body:

· The spinal cord in the neck gives rise to the cervical spinal nerves (C1 to C8), which control impulses going to the diaphragm, the back of the head, the neck and shoulders, the arms, and the hands.

· The upper mid-back is where the thoracic spinal nerves (T1 to T12), which control impulses to the chest, some back, and numerous organ systems, including portions of the belly, emerge from the spinal cord.

· The low back's lumbar spinal nerves (L1 to L5) protrude from the spinal cord and provide signals to the buttocks, some of the external genital organs, and some regions of the leg.

· The sacral spinal nerves (S1 to S5) protrude from the spinal cord in the low back and provide signals to the feet, the majority of the external genital organs, the region around the anus, and the thighs and lower portions of the legs.

WHO IS MORE LIKELY TO GET A SPINAL CORD INJURY?

The most frequent causes of SCI in the US are car accidents and severe falls. The remainder are brought on by violent crimes (most often assaults and gunshot wounds), sports injuries, medical or surgical procedures, workplace accidents, illnesses and ailments that might injure the spinal cord, and other less frequent causes. Age (either between the ages of 16 and 30 or after the age of 65 for severe falls), alcohol usage, specific diseases, or failing to wear the appropriate gear, such as a seat belt or protective sports equipment, are all risk factors.

WHAT ARE THE OTHER MUSCLES AND SOFT TISSUES IN THE NECK?

Other structures around or involving your cervical spine include the following:

Muscles supporting your cervical spine

The major muscles that attach to your cervical spine include:

Sternocleidomastoid- This muscle travels from behind your ear to the front of your neck, one on each side of your head. It fastens to your collarbone and sternum, which is your breastbone. This muscle enables you to tilt your chin up and move your head side to side.

Trapezius- From the base of your skull, through your cervical and thoracic spine, and out to your shoulder blade, this set of triangle muscles extends. You can tilt your head up, shift your neck back, turn your head to the right or left, or elevate your shoulder blade with their assistance.

Levator scapulae- The top of your shoulder blade (scapula) and the first four cervical vertebrae are where this muscle is attach. It aids in lifting your shoulder blade, side bent head movement, and head rotation.

Erector spinae- This muscle group is made up of various muscles. These muscles aid in posture, neck rotation, and backward neck extension in the region of your cervical spine.

Deep cervical flexors- Along the front of your cervical spine, these muscles run. They enable forward neck flexion and support the stability of your cervical spine.

These four muscle groups connect sub occipital muscles- The top of your cervical spine and the base of your head. You can extend and turn your head with their assistance.

HOW IS A SPINAL CORD INJURY DIAGNOSED AND TREATED?

Diagnosing a spinal cord injury

The emergency department doctor will examine you for proper breathing, responsiveness, weakness, and movement or feeling at or below your level of damage. Emergency medical examinations for spinal cord damage consist of:

1) The body's tissues, organs, bones, and nerves are all captured in finely detailed three-dimensional images using magnetic resonance imaging (MRI). It can reveal damage to the ligaments that support the cervical spine, brain and spinal trauma from trauma, herniated discs (cartilage placed between the vertebrae), vascular (blood vessel) anomalies, hemorrhage, inflammation that might compress the spine and spinal cord, and bleeding.

2) Organs, bones, and tissues may all be seen in quick, crisp two-dimensional images thanks to computer tomography (CT). Bone fractures, hemorrhage, and spinal stenosis (narrowing of the spinal canal) can all be found using a CT scan.

3) Most bodily parts, including joints and major organ systems, may be seen in two dimensions on an X-ray. Vertebral misalignment or fracture might be observed within a few minutes.

TREATING SPINAL CORD INJURY

If a spinal cord injury is suspected at the accident scene, emergency professionals will carefully position you on a backboard and put a tight collar around your neck to protect your spinal cord. Sedatives may be used on them to calm down and stop moving. If you have breathing difficulties and your body is not getting enough oxygen from the lungs, a breathing tube may be implanted.

The trauma center's immediate care options include:

· Using a hard brace or mechanical force to realign your spine is usually done as quickly as possible to stabilize it and stop further injury.

· Surgery to remove any bones, disc herniation has, fractured vertebrae, or other objects affecting your spinal column. In the days following an injury, spinal decompression surgery to release pressure within the spinal column may also be required. According to the findings of a neurosurgical study, early surgery is occasionally linked to a better functional outcome.

SUMMARY

A spinal cord injury that affects all the nerves below the level of injury can have significant implications for a person’s motor and sensory functions. This type of injury is usually classified as a complete injury, where there is a complete loss of sensation and movement below the level of injury. The severity of the impact can vary depending on the location and extent of the injury.

Since research on spinal cord injuries is ongoing, there is ongoing hope for emerging treatments and therapies that can potentially improve outcomes and functionality for individuals with this type of injury.

References

https://www.hcplive.com/view/diagnosis-and-management-cervical-spine-injuries-athletes

https://www.ninds.nih.gov/health-information/disorders/spinal-cord-injury

https://www.spine-health.com/conditions/spine-anatomy/cervical-spinal-nerves