The spine is composed of bones called vertebrae connected by soft tissues, joints, and cushions (discs) between the vertebrae. Spinal cord injury occurs within this protected bony structure.
This chain of vertebrae enables our trunk to stand upright, bend, and rotate sideways. Additionally, the ring-shaped bone structure at the back of each vertebra both protects the spinal cord from external factors and allows the spinal cord to pass through this gap.
The spinal cord is made of nervous tissue that connects the brain with the arms, trunk, and legs, transmitting commands from the brain to these regions and bringing sensory information back to the brain. Furthermore, it ensures the proper functioning of all the body’s sensory functions. It is also responsible for controlling bowel, sexual functions (erection, ejaculation, vaginal lubrication), and bladder functions.
What is Spinal Cord Injury?
Spinal cord injury is a serious condition affecting both patients and their families. Spinal injuries can vary in severity from mild soft tissue damage to spinal fractures and spinal cord injuries. They are among the most important causes of paralysis.
Of spinal fractures caused by trauma, 5-10% occur in the cervical vertebrae, and 70% occur in the thoracic and lumbar vertebrae. The most frequently injured area is the T12-L1 region (the last thoracic and first lumbar vertebra), which is the most mobile part of the spine.
What Are the Causes of Spinal Cord Injury?
When a bone is subjected to more load than it can bear, it fractures. Spinal fractures often occur as compression fractures in the front part of the vertebrae. If the force is more severe, the middle and back parts of the vertebra may also break. In these cases, broken fragments can shift into the spinal canal and damage the spine. These types of fractures are called “burst fractures.” Burst fractures have a high risk of spinal cord injury and paralysis, though not every burst fracture results in paralysis. Vertebral fractures are the most common cause of spinal cord injury.
Sometimes excessive load on the spine causes injuries to surrounding soft tissues and can lead to dislocation of the spinal joint. In this case, the connection between two vertebrae is disrupted. This condition is called spinal dislocation. Dislocations may occur alone, but usually, both fracture and dislocation occur together, known as fracture-dislocation spinal injuries. Both fracture-dislocations and isolated dislocations carry a high risk of spinal cord injury.
Worldwide and in our country, the most common cause of spinal cord injury is traffic accidents. Following this are falls from heights, firearm injuries, sports injuries, especially diving into shallow pools or seawater.
Osteoporosis and spinal tumors are the most common non-traumatic causes of spinal injuries. 85% of spinal injuries occur in the 18-50 age group and are four times more frequent in males.
What Are the Symptoms After Spinal Cord Injury?
In spinal cord injury, either bone tissue, neural tissue, or both are damaged. Symptoms of spinal injuries may include vertebral fractures, back and neck pain, numbness and tingling, muscle spasms, and loss of movement in the arms and legs.
If fractures occur and the spinal cord is damaged, there will be a complete loss of sensation and movement below the injury level, called a complete injury. If the spinal cord damage is partial or mild, movement and sensory loss will be less severe, called an incomplete injury.
Clinically, two main conditions arise after spinal cord injury:
- Tetraplegia (Quadriplegia): Refers to loss of function in all four limbs. It results from injury to the cervical spinal cord segments. Partial loss of motor and sensory function in the arms, trunk, legs, and pelvic organs is called tetraparesis; complete loss is tetraplegia. It can be complete or partial.
- Paraplegia: Refers to loss of function in the lower limbs. It results from lesions in the thoracic, lumbar, and less commonly sacral segments. Sensory disorders occur in the trunk, legs, and pelvic organs. Paraplegia can also be complete or incomplete.
What Should Be Considered in Spinal Cord Injury?
Initial intervention in spinal and spinal cord injuries is critical. The patient should not be moved excessively and should remain lying down until medical personnel arrive. In the first detailed examination, alongside general systemic checks (lungs, heart, circulation, neurological systems), anatomical areas related to the trauma should also be carefully examined.
Spinal injuries due to trauma should be handled sensitively as the spine protects crucial nervous system extensions like the spinal cord. Mistakes made within the first hour after evaluation can lead to irreversible consequences for the patient’s future life. Delayed intervention can result in irreversible loss and complications.
What Treatment Methods Are Used in Spinal Cord Injury?
If a spinal fracture is detected without spinal cord injury, immobilization with a brace or cast can be tried. The goal is to stabilize the fracture to allow healing, prevent pressure on the spinal cord, and avoid kyphosis.
In spinal cord injuries, the level and completeness (complete or incomplete) of the injury are the most important factors. Whether there is partial or complete loss of movement and sensation below the injury level is also crucial. If spinal cord damage exists:
- Since nerves controlling the bladder and bowel exit the spinal cord, spinal cord injuries may cause problems with urination and defecation. Therefore, adequate bladder emptying is necessary, and urine backflow to the kidneys must be prevented.
- Pressure ulcers should be prevented while the patient is bedridden. Techniques such as using an air mattress and repositioning the patient every 24 hours can be applied.
- Disuse can cause muscle and bone mass loss.
- Joint stiffness and limited mobility may develop.
- Medication may be given for severe neuropathic pain and muscle spasms (spasticity).
- In incomplete cases, partial or full recovery of movement may be observed over months or years; unfortunately, there is no recovery in complete injuries.
- Blood thinners are administered within the first 3 months to prevent deep vein thrombosis in the legs.
Rehabilitation and physical therapy are life-saving treatments for these patients. The aim of rehabilitation is to prevent complications and help the patient become as independent as possible. The main goal is to regain strength in muscles with strength loss. For this purpose:
- Range of motion exercises
- Stretching exercises
- Muscle strengthening exercises
- Neurofacilitation techniques
can be applied. Additionally,
- Robotic rehabilitation
- Hydrotherapy, aquatherapy
- Functional neuromuscular electrical stimulation and biofeedback techniques
should be used. To prevent muscle wasting, bed exercises should be applied, and the patient should be brought to a vertical position as soon as possible. If conditions permit, walking with assistive devices and external supports should be attempted as early as possible.