Spinal Cord Injury: Treatments and Rehabilitation (cont.)
What Are the Immediate Treatments for Spinal Cord Injury?
The outcome of any injury to the spinal cord depends upon the number of axons
that survive: the higher the number of normally functioning axons, the less the
amount of disability. Consequently, the most important consideration when moving
people to a hospital or trauma center is preventing further injury to the spine
and spinal cord.
Spinal cord injury isn't always obvious. Any injury that involves the head
(especially with trauma to the front of the face), pelvic fractures, penetrating
injuries in the area of the spine, or injuries that result from falling from
heights should be suspect for spinal cord damage.
Until imaging of the spine is done at an emergency or trauma center, people
who might have spinal cord injury should be cared for as if any significant
movement of the spine could cause further damage. They are usually transported
in a recumbent (lying down) position, with a rigid collar and backboard
immobilizing the spine.
Respiratory complications are often an indication of the severity of spinal
cord injury. About one third of those with injury to the neck area will need
help with breathing and require respiratory support via intubation, which
involves inserting a tube connected to an oxygen tank through the nose or throat
and into the airway.
Methylprednisolone, a steroid drug, became standard treatment for acute
spinal cord injury in 1990 when a large-scale clinical trial supported by the
National Institute of Neurological Disorders and Stroke showed significantly
better recovery in patients who were given the drug within the first 8 hours
after their injury. Methylprednisolone appears to reduce the damage to nerve
cells and decreases inflammation near the injury site by suppressing activities
of immune cells.
Realignment of the spine using a rigid brace or axial traction is usually
done as soon as possible to stabilize the spine and prevent additional damage.
On about the third day after the injury, doctors give patients a complete
neurological examination to diagnose the severity of the injury and predict the
likely extent of recovery. The ASIA Impairment Scale is the standard diagnostic
tool used by doctors. X-rays, MRIs, or more advanced imaging techniques are also
used to visualize the entire length of the spine.
ASIA (American Spinal Injury Association) Impairment Scale*
| Classification |
Description |
| A |
Complete: no motor or sensory function is preserved below the level of
injury, including the sacral segments S4-S5 |
| B |
Incomplete: sensory, but not motor, function is preserved below the
neurologic level and some sensation in the sacral segments S4-S5 |
| C |
Incomplete: motor function is preserved below the neurologic level,
however, more than half of key muscles below the neurologic level have a muscle
grade less than 3 (i.e., not strong enough to move against gravity) |
| D |
Incomplete: motor function is preserved below the neurologic level, and at
least half of key muscles below the neurologic level have a muscle grade of 3 or
more (i.e., joints can be moved against gravity) |
| E |
Normal: motor and sensory functions are normal |
* Used with permission of the American Spinal Injury Association.
Spinal cord injuries are classified as either complete or incomplete,
depending on how much cord width is injured. An incomplete injury means that the
ability of the spinal cord to convey messages to or from the brain is not
completely lost. People with incomplete injuries retain some motor or sensory
function below the injury.
A complete injury is indicated by a total lack of sensory and motor function
below the level of injury.
Next: How Does a Spinal Cord Injury Affect the Rest of the Body? »
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