REPOST: Spinal cord injury: Levels, symptoms & treatment

LiveScience.com's Tanya Lewis writes about the injuries that may affect the spinal cord and the treatments used to address them.

The spinal cord is a bundle of nerves that extends from the brain and runs down the middle of the back. It sends signals to and from the brain and the rest of the body. It is a soft tissue surrounded and protected by the vertebrae in the spine.

Shown here is the nervous system, containing the brain, spinal cord and peripheral nerves.
Image source: LiveScience.com

A spinal cord injury is caused by damage to any part of the spine, including to the vertebrae, ligaments or disks, or the spinal cord itself. Spinal cord injuries can cause permanent loss of function below the level of the injury, including paralysis.

The incidence of spinal cord injury among survivors is about 40 cases per million in the United States, or about 12,000 new cases per year, according to the National Spinal Cord Injury Statistical Center (NSCISC). Estimates of the number of people in the United States living with spinal cord injuries range from 238,000 to 332,000.


Causes

A sudden blow to the spine that fractures, dislocates, crushes or compresses the vertebrae can cause traumatic spinal cord injuries. A gunshot or knife wound can also cut the spinal cord. During the weeks following the injury, bleeding, swelling, inflammation and fluid buildup in or near the spinal cord often cause further damage.

Diseases such as arthritis, cancer, inflammation, infections or degeneration of spinal disks can cause nontraumatic spinal cord injuries.

NSCISC lists the following causes of spinal cord injury since 2010:

• Motor vehicle accidents (36.6 percent)
• Falls (28.5 percent)
• Violence (14.3 percent)
• Sports (9.2 percent)
• Other/Unknown (11.4 percent)

Spinal cord injury levels

Spinal cord injuries vary in their location and severity. The "level" of injury refers to the lowest part of the spinal cord with normal function. Higher-level injuries affect the arms, hands, trunk, legs and pelvic organs, whereas lower-level injuries affect only the legs, pelvic organs and trunk. These can result in paralysis of all four limbs (tetraplegia or quadriplegia) or paralysis of the lower limbs (paraplegia).

The severity of the injury is classified as either complete, in which nearly all movement and sensation below the level of the injury is lost, or incomplete, in which some residual movement and sensation remains.

Image source: LiveScience.com

Symptoms

Symptoms of spinal cord injury include:

• loss of movement
• loss of sensation (sense of touch, heat or cold)
• loss of bowel or bladder control
• exaggerated reflexes or spasms
• changes in sexual function or sensitivity
• pain or stinging due to nerve damage
• difficulty breathing, coughing, or clearing the throat

Emergency symptoms of an injury include:

• severe pain or pressure in the neck, head or back
• weakness, lack of coordination or paralysis of part of the body
• numbness, tingling or loss of feeling in the hands and feet
• loss of bladder or bowel control
• difficulty walking or balancing
• difficulty breathing after the injury
• a twisted neck or back

People with these symptoms should seek immediate medical attention.

Treatment

Treatment options are limited, but prosthetic technologies and therapeutic drugs that may help nerve cells regenerate or improve how well remaining nerves function are being developed.

Immediately after an accident, emergency responders immobilize the spine using a stiff neck collar and carrying board in order to transport the patient. Emergency treatment involves maintaining breathing ability, preventing shock, keeping the neck immobilized, and preventing complications such as blood clots.

Once a patient is diagnosed with a spinal cord injury, they may receive medications, such as Methylprednisolone (Medrol), which can cause mild improvement in some patients, if taken within eight hours of injury. Doctors may use traction (often by attaching metal braces and weights to the skull to prevent it moving) to stabilize the spine and/or realign it. Surgery may be needed to remove fragments of bone, herniated disks, fractured vertebrae or foreign objects, or to stabilize the spine to minimize pain or future deformity.

A variety of experimental treatments may also be available.

Rehabilitation

A team of therapists and specialists work with patients during their early stages of recovery. Physical therapists focus on having the patient maintain and strengthen existing muscle function, while occupational therapists, rehab psychologists and others help the patient learn basic tasks and new skills.

Modern technology can provide some independence to individuals living with spinal cord injury. Assistive equipment includes wheelchairs, computer adaptations, electronic aids, robotic gait training and electrical stimulation.

Researchers are currently developing neural prostheses, known as brain-computer interfaces. These systems use electrodes on the scalp or implanted in the brain, which record electrical signals from neurons and translate them into control of a computer or prosthetic limb. The technology is still in its early stages, however, and not available for general use.
  
Get more updates on physical medicine and related disciplines from this Mary Kneiser blog. 

REPOST: What Kids Should Know About Spinal Injuries in Sports

Laura Landro discusses efforts to raise awareness of a little-understood but dangerous risk to young athletes: injuries to the cervical spine which can lead to paralysis or even death. More from this Wall Street Journal article.

There is a new push to alert high school athletes about neck injuries.
(Image source: wsj.com)

It could be a hard tackle in football, a cross-check in ice hockey or a fall off the top of a cheerleading pyramid.

A new push is under way to raise awareness of a little-understood but dangerous risk to young athletes: injuries to the cervical spine, the highly vulnerable area between the first and seventh vertebrae that protects the spinal cord connecting the brain to the body. Players and teammates may not instantly recognize the severity of the damage, and the wrong move can damage or sever the spinal cord, resulting in paralysis or even death.

In addition to programs to educate coaches, parents and students, a number of groups are pressing for more certified athletic trainers who are qualified to quickly recognize and respond to spinal and other injuries.

Though less common than concussions, cervical-spine injuries most often occur when players in contact sports lower their head or tuck their chin into their chest and collide with another player, the ground or objects such as goal posts. While players often recover from injuries such as fractures of one or more vertebrae, commonly referred to as a broken neck, cervical spine injuries can also be quickly fatal.

De'Antre Turman, a 16-year-old Atlanta-area high school football player, died in August after being injured during a scrimmage, suffering a fracture to his third vertebra on the field, Fulton County Medical Examiner investigator Mark Guilbeau said in a telephone interview.

San Diego-based Athletes Saving Athletes co-founder Tommy Mallon, kneeling, conducts a demonstration with volunteer Danny Kolts during a 2012 seminar.
(Image source: wsj.com)

The Centers for Disease Control and Prevention estimate as many as 20,000 spinal-cord injuries occur annually in the U.S., with sports accounting for about 12%, and new cases most often occurring in 15-to-35-year-olds.

Robert Cantu, chief of neurosurgery at Emerson Hospital in Concord, Mass., and medical director of the National Center for Catastrophic Sports Injury Research at the University of North Carolina at Chapel Hill, says new rules put in place in 1976 to discourage headfirst contact in football—known as "spearing"—aren't consistently followed.

The number of reported cervical-spine injuries that lead to permanent or temporary neurological damage, such as partial or complete paralysis, remains small but appears to be on the rise. The center's Annual Survey of Catastrophic Football Injuries in high school and college last year found that in four of the previous 10 years, the number of such injuries that led to some paralysis was in the double digits—14 in 2008, for example—after dropping into the single digits throughout the 1990s. Many severe spinal-cord injuries in sports also go unreported, Dr. Cantu says.

Coaches who were surveyed told the researchers that they teach players to tackle with the head up, but many players still lower their heads before making contact and many ball carriers are injured with their heads down.

"There is a sense of invulnerability in young athletes who think it's not going to happen to them," says Ron Courson, director of sports medicine at the University of Georgia. In addition to training players on proper blocking and tackling techniques, his team practices injury response scenarios on the field with trainers, physicians and emergency responders before football season begins.

At Penn-Trafford High School in Harrison City, Pa., there are three athletic trainers on staff for the 1,600 athletes in grades 9 to 12, says Larry Cooper, head athletic trainer. Parents can attend classes for coaches about injury risks and a sports emergency action plan is available on the school's website.

While college athletic programs nearly always have athletic trainers on staff, the National Athletic Trainers' Association says only two-thirds of U.S. secondary schools with athletic programs have access to full- or part-time athletic trainers, who are typically licensed by the state and work under the direction of physicians. That's up from 40% to 45% in 2005, but leaves a third of schools without one, the nonprofit association says. The group is conducting a state-by-state ranking of public schools and a similar study on private schools to determine why schools don't have trainers. (Expense is one factor.) The group also is analyzing the medical care available at games when an athletic trainer isn't present.

Athletes Saving Athletes graduate Tucker Boucher, left, with fellow San Diego-area student-athletes. ASA focuses on sports safety education and injury prevention.
(Image source: wsj.com)

"Parents who would never leave their kids off at a public swimming pool without a lifeguard think nothing about dropping them off at football or soccer without an athletic trainer. But they need to ask who is taking care of their kids when they are participating in these sports," says Jim Thornton, president of the athletic trainer association and director of sports medicine and athletic training at Clarion University in Clarion, Pa.

The association issued recommendations for management of cervical-spine injuries in athletes in 2009 which include special care in removing a helmet, face mask and shoulder pads and immobilization techniques on the field. Erik Swartz, an athletic trainer and associate professor at the University of New Hampshire who co-wrote the recommendations, says one of the highest risks in a spine injury is moving an athlete.

Tommy Mallon, now 22, collided with another player during a lacrosse game in 2009 at Santa Fe Christian high school in Solana Beach, Calif. A teammate ran to his side but fortunately didn't attempt to help him up until athletic trainer Riki Kirchhoff got to the scene. She kept Mr. Mallon on the ground until emergency medical responders arrived.

At the hospital, he was diagnosed with a fracture in his spine at the C1 vertebra and a damaged artery restricting blood flow to the brain. After months of grueling rehabilitation, including traction in a massive "halo" device to immobilize his head and neck and physical therapy, he was able to start classes at the University of San Diego in the spring of 2010. Though he won't be able to play contact sports again, he sustained no permanent neurological damage.

Mr. Mallon and his mother, Beth Mallon, a photographer who was at the game when his injury occurred, formed a nonprofit group, Advocates for Injured Athletes, to help other families navigate the challenges of injuries and lobby for certified athletic trainers at every high school.

Last year the Mallons also launched Athletes Saving Athletes, a program which offers classes taught by athletic trainers to help student-athletes understand signs and symptoms of different types of sports injuries and conditions. About 1,500 athletes in the San Diego area have participated and Ms. Mallon aims to expand the program. "We can educate athletes to recognize basic symptoms, and if they suspect a neck injury, don't move them. Don't touch them. Just stay with them until help arrives," she says.

Tucker Boucher, 16-year-old junior at Cathedral Catholic High School in San Diego, says after going through the program, he talked to his lacrosse team about risks and how to recognize symptoms of injury. His mother, Annie Boucher, who also attended a session, says the training "empowers these kids with knowledge of certain situations that can save somebody's life."

Dr. Mary Kneiser works with athletes as they regain their strength and form after suffering an injury. Learn more how physiatrists help injured athletes get back on their feet on this Facebook page.