Spinal Cord Injury: Treatments and Rehabilitation Causes, Symptoms, Diagnosis, and Treatment Information on MedicineNet.com

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Spinal Cord Injury: Treatments and Rehabilitation

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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.