Spinal Cord Injury: Treatments and Rehabilitation
Hope Through Research
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The Waiting Game Spinal Cord Injury:
C4 Is a Crucial Level
Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD
 There are seven cervical
vertebrae, twelve thoracic and five lumbar. Each level gained or lost is a
victory in rehabilitation, but C4 is the big one.
Nerves run from the brain through the spinal cord to the body. They connect
to the muscles and tissues of the body, allowing them to function. Some
functions are within our control, like moving an arm, making a facial expression
or walking. Others are part of our unconscious system, things we take for
granted, like breathing or swallowing saliva.
The fourth cervical vertebra is the level where nerves run to the diaphragm,
the main muscle that allows us to breathe. It separates the chest from the
abdomen, and when it contracts, air is sucked into the lungs like a bellows. No
contraction, no sucking, no breathing. People who survive spinal cord injuries
above this level need ventilators or machines to breathe.
In front of a national audience on September 9, 2007, Kevin Everett, a pro football
player, broke his neck at the level of C4. The bones surrounding his spinal cord
had been damaged, and the ligaments holding everything stable were torn. The
spinal canal - the space where the cord is supposed to have room to sit - was
narrowed, and the cord stopped working. While he lay paralyzed on the field, the
trainers, doctors and paramedics at his side began doing the work that is
practiced time and again.
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A Short History of the Treatment of Spinal Cord Injury
Accounts of spinal cord injuries and their treatment date back to ancient
times, even though there was little chance of recovery from such a devastating
injury. The earliest is found in an Egyptian papyrus roll manuscript written in
approximately 1700 B.C. that describes two spinal cord injuries involving
fracture or dislocation of the neck vertebrae accompanied by paralysis.* The
description of each was "an ailment not to be treated."
Centuries later in Greece, treatment for spinal cord injuries had changed
little. According to the Greek physician Hippocrates (460-377 B.C.) there were
no treatment options for spinal cord injuries that resulted in paralysis;
unfortunately, those patients were destined to die. But Hippocrates did use
rudimentary forms of traction to treat spinal fractures without paralysis. The
Hippocratic Ladder was a device that required the patient to be bound, tied to
the rungs upside-down, and shaken vigorously to reduce spinal curvature. Another
invention, the Hippocratic Board, allowed the doctor to apply traction to the
immobilized patient's back using either his hands and feet or a wheel and axle
arrangement.
Hindu, Arab, and Chinese physicians also developed basic forms of traction to
correct spinal deformities. These same principles of traction are still applied
today.
In about 200 A.D., the Roman physician Galen introduced the concept of the
central nervous system when he proposed that the spinal cord was an extension of
the brain that carried sensation to the limbs and back. By the seventh century
A.D., Paulus of Aegina was recommending surgery for spinal column fracture to
remove the bone fragments that he was convinced caused paralysis.
In his influential anatomy textbook published in 1543, the Renaissance
physician and teacher Vesalius described and illustrated the spinal cord in all
its parts. The illustrations in his books, based on direct observation and
dissection of the spine, gave physicians a way to understand the basic structure
of the spine and spinal cord and what could happen when it was injured. The
words we use today to identify segments of the spine - cervical, thoracic,
lumbar, sacral, and coccygeal - come directly from Vesalius.
With the widespread use of antiseptics and sterilization in surgical
procedures in the late nineteenth century, spinal surgery could finally be done
with a much lower risk of infection. The use of X-rays, beginning in the 1920s,
gave surgeons a way to precisely locate the injury and also made diagnosis and
prediction of outcome more accurate. By the middle of the twentieth century, a
standard method of treating spinal cord injuries was established - reposition
the spine, fix it in place, and rehabilitate disabilities with exercise. In the
1990s, the discovery that the steroid drug methylprednisolone could reduce
damage to nerve cells if given early enough after injury gave doctors an
additional treatment option.
Next: What Is a Spinal Cord Injury? »
- methylprednisolone, Medrol, Depo-Medrol - Explains the medication thmethylprednisolone (Medrol) a drug used to achieve prompt suppression of inflammation. Article includes descriptions, uses, drug interactions, and side effects.
- CT Scan (Computerized Axial Tomography) - CT Scan (Computerized Axial Tomography, CAT scan) is a procedure that assists in diagnosing tumors, fractures, bony structures, and infections in the organs and tissues of the body.
- Fracture - Read about fracture of bone(s). The most common fractures are stress fractures, rib fractures, skull fractures, and fractures in children. Causes vary and treatment is dependant upon the type of fracture.
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Spinal Cord Injury: Treatments and Rehabilitation
Spinal Cord Injury »
What is the spinal cord?
The spinal cord is a collection of nerves that travels from the bottom of the
brain down your back. There are 31 pairs of nerves that leave the spinal cord
and go to your arms, legs, chest and abdomen. These nerves allow your brain to
give commands to your muscles and cause movements of your arms and legs. The
nerves that control your arms exit from the upper portion of the spinal cord,
while the nerves to your legs exit from the lower portion of the spinal cord.
The nerves also control the function of your organs including your heart, lungs,
bowels, and bladder. For example, signals from the spinal cord control how fast
your heart beats and your rate of breathing.
Other nerves travel from your arms and legs back to the spinal cord. These
nerves bring back information from your body to your brain including the senses
of touch, pain, temperature, and position. The spinal cord runs through the
spinal canal. This canal i...
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