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Spinal cord trauma   

Overview | Symptoms | Treatment | Prevention

Alternative names:

Spinal cord compression; Spinal cord injury; Compression of spinal cord

Treatment

A spinal cord trauma is a medical emergency requiring immediate treatment to reduce the long-term effects. The time between the injury and treatment is a critical factor affecting the eventual prognosis (probable outcome).

Corticosteroids such as dexamethasone or methylprednisolone are used to reduce swelling that may compress the spinal cord. If spinal cord compression can be relieved before there is total destruction of the nerves of the spine, paralysis may in some cases be reduced or relieved. Ideally, corticosteroids should begin within 8 hours after the injury.

Surgery may be recommended. This may include surgery to remove fluid or tissue that presses on the spinal cord (decompression laminectomy). Surgery may be needed to remove bone fragments, disc fragments or foreign objects or to stabilize fractured (broken) vertebrae (by fusion of the bones or insertion of hardware).

Bedrest may be needed to allow the bones of the spine, which bears most of the weight of the body, to heal.

Anatomic realignment is important. Spinal traction may reduce dislocation and/or may be used to immobilize the spine. This may include immobilization of the skull by use of tongs (metal braces placed in the skull and attached to traction weights or to a harness on the body).

Neurologic losses are treated, including treatment of muscle spasms, care of the skin, and treatment of bowel and bladder dysfunction.

Extensive physical therapy, occupational therapy, and other rehabilitation interventions are often required after the acute injury has healed. Rehabilitation assists the person in coping with disability that results from spinal cord trauma.

Prognosis

Paralysis and loss of sensation of part of the body are common outcomes. This includes total paralysis and/or numbness and varying degrees of movement or sensation loss. Death is possible, particularly if there is paralysis of the breathing muscles.

The level of injury affects the outcome. Injuries near the top of the spine result in more extensive disability (numbness and paralysis, breathing difficulty) than injuries low in the spine.

Recovery of movement or sensation within 1 week usually indicates eventual recovery of most function, although this may take 6 months or more. Losses that remain after 6 months are more likely to be permanent.

Complications

• paralysis (paraplegia, quadriplegia)
• loss of sensation
• loss of bladder control
• increased risk of urinary tract infections
• increased risk of chronic bilateral obstructive nephropathy
• loss of bowel control
• loss of sexual functioning (male impotence)
• increased risk of injury to numb areas of the body
• paralysis of breathing muscles
• deep vein thrombosis
• shock
• hypovolemic shock from blood loss during the accident

Call Your Health Care Provider If:

Call your health care provider if injury to the back or neck occurs. Call the local emergency number (such as 911) if there is any loss of movement or sensation, this is a medical emergency! Management and treatment of spinal cord injury begins in the field at the site of an accident with paramedics trained in immobilization of the injured spine to prevent further damage to the nervous system.

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