Abstract
This paper will examine the etiology and pathophysiology of injuries and trauma that affect the central nervous system, specifically the spinal cord and the standard and emerging treatment modalities. Included within this paper will be examples of people who have suffered spinal cord injuries that have a high morbidity rate and will not be able to recover to their pre-injury status and examples of people who received innovative treatments that allowed them mobility where the prognosis prior to the treatment was grim.
There are approximately 11,000 spinal cord injuries annually in the US with a majority of the mechanism being motor vehicle collisions and the remainder resulting from falls, violence, sports and work-related incidents. The combination of the severity of injury and the fact that the nervous system cannot regenerate the recovery from such insults are extremely poor.
Spine/Spinal Cord Injury Pathology
Injuries to the spinal cord are the result of mechanisms such as blunt force or penetrating trauma. These mechanisms usually produce injuries to the surrounding vasculature and blood oxygen deficiency which further complicates the injury. Any insult to the spinal cord that produces complete spinal cord transection will absolutely disrupt all of the nerve tracts. In turn all functions below the area of injury are permanently lost and are more accurately determined 24 hours post-injury. Any spinal cord injury occurring at the cervical level will result in quadriplegia and loss of all functions below the injury site and any injury occurring at the thoracic or lumbar level will result in paraplegia and loss of lower trunk only.
Injuries or traumas that cause any partial or incomplete spinal cord transection will result in limited disruption of nerve tracts and some cord-mediated functions remain intact. In contrast to a complete transection of the cord, there is a potential for recovery and some functions may only be lost temporarily.
Vertebral and cauda equina injuries are those injuries involving the spinal column and the spinal cord caused by several factors such as trauma to the spinal column involving the spinal cord as well.
The symptoms for the spinal cord injury would depend on the location of the injury and the severity of the injury. The location of a spinal cord injury would determine the parts of the body that would be affected. Say for example the higher the injury in the spinal cord would also cause more paralysis. The severity of the injury is also another factor that would determine the signs and symptoms that could be classified as partial or complete which depends on the width of the spinal cord that has been damaged. Partial spinal cord injury also termed as incomplete injury is when the spinal cord did not totally loose the function of their spinal cord. The spinal cord still has the function to covey message to and from the brain and so some sensation and possibly some motor functions are retained located below the area affected. A complete spinal cord injury in the other hand is also defined as a total or near-loss of the sensation and the motor function below the location of the injury. This term is used to describe the severity of the spinal cord injury. Despite whether it is a complete spinal cord injury or a partial cord injury the following signs and symptoms are present: a stinging sensation which is intense or pain is present because of the damaged nerve fibers in the person’s spinal cord, another symptom would also be paralysis, sensation loss such as the ability to feel cold, heat and touch, the loss of control for bowel and bladder movement experiences exaggeration on reflexes and spasms, changes in the function of fertility and sexual function and the person may experience breathing difficulties and difficulties in coughing and clearing secretion from the lungs. But there are also other symptoms that are danger signs with people who suffered spinal cord injury after a head injury or an accident and these would include consciousness fading in and out, extreme back pain, head, neck, or back pressure, weakness, paralysis in some part of the body, numbness or loss of sensation in the hands, fingers, feet or toes, difficulty to balance and to walk and difficulty of breathing (Ettinger, 2007).
The Brown-Sequard syndrome which is a rare neurological syndrome which is caused by tumor in the spinal cord, trauma, ischemia or infection is characterized by a spinal cord lesion that causes weakness or paralysis on one side of the body or what we call as hemiparaplegia, loss of sensation or hemianesthesia on the other side.
Anterior cord syndrome is characterized by a spinal cord injury or compression in the anterior part that would cause paralysis from the site of the injury going downwards and decreased sensation and pain from the injury site going downwards (Spinal Iord Injuries).
Central cord syndrome is one form of a spinal cord injury that is incomplete which causes impairment in the arms and legs at a lesser extent. There is still a communication between the brain and the parts of the body located below the injury. The signs and symptoms associated with this spinal cord injury include paralysis or loss of the fine motor movements of the arms and the hands and a relatively less effect in the leg movements. A sensory loss below the injury site may also occur and a bladder control loss as well (Central Cord Syndrome).
Cauda Equina Syndrome or a spinal cord disease caused by significant changes in the spinal column especially the narrowing of the spinal canal that compresses the nerve roots located below the spinal cord level. And the symptoms of the cauda equina syndrome would include pain in a leg or both legs that travels from the buttocks going down to the back of the thighs going down to the legs, the person would also feel numbness in the groin or in the area of contact if the person sits on a saddle, there would also be a disturbance in the bladder and bowel movement, weakness and loss of sensations in the lower extremities, and reduced or the absence of the reflexes in the lower extremity (Cauda Equina Syndrome).
After a person would have this spinal cord injury there would be a number complication that would accompany the injury. These would include the following complications: the respiratory complication that would affect the respiratory center that mechanical ventilation may be necessary for sustaining the life of a person if injury occurs above the cervical 4. If the injury would involve below C4 the client may still be able to use the diaphragm to initiate the breathing process that may later cause hypoventilation that puts the patient at risk for respiratory acidosis and possibly pneumonia. Another complication would be the cardiovascular complication If the spinal cord transect above T5 level this may cause an interruption in the functions of the sympathetic nervous system that may cause bradycardia and possibly hypotension. An interruption in the sympathetic nervous system may also cause vasodilation that may possibly cause shock. Spinal shock may also occur that may last from the first 7-10 days but may extend for up to two years with an average of two years. Another complication is that we which involve the Urinary and the gastrointestinal system which would include urine retention due to bladder hyperirritability. Gastric distention may also occur if injury is located above the T5 because of the injury’s effect to the sympathetic nervous system. Stress ulcers can also be another complication (Spinal Cord Injuries). Another complication of spinal cord injury is the Hyperthermia wherein the body’s temperature may increase depending on the environment’s temperature but because of the altered function of the autonomic nervous system that is caused by the injury fluctuations in the temperature of the body occurs.
The diagnosis for the spinal cord injury would include the following tests: complete neurological examination, ABG, CBC, blood chemistry urinalysis, x-rays of the anterior, posterior and lateral spine, CT scan, MRI and EMG may be needed to know the extent of the damage (Spinal Cord Injuries).
Treatment for Spine/Spinal Cord Trauma
Treatment for spinal cord injury like the symptoms varies with the degree and the extent of the damage. There had been studies done and studies going on to find a very promising treatment of spinal cord injuries. Spinal cord injuries may be treatable if it is just a minor injury that would not affect the motor and sensation ability much but with the severe type of injuries like what Christopher Reeve suffered, treatment may not be possible. The following are some examples if the treatment modalities for spinal cord injuries: taking a pill for paraplegia is one but this study had a limited human testing in two Canadian medical centers. The drug 4 aminopyridine (4AP) is injected to the human being which would help restoring the nerve impulse traffic to and from the brain through the injured spinal cord. The result of testing in human beings is quite remarkable because with the first person, who underwent the trial, after 5 years from his injury began to breathe more normally half an hour after the drug administration and an ongoing study is done with the use of oral administration of this drug (Borgens).
Christopher Reeve’s spinal cord injury was caused by a trauma when Mr. Reeve’s horse stopped suddenly throwing him to the ground head first which shattered his C1 and C2 that caused damage to his spinal cord. The MRI result showed that at C2 level was severely injured that left a cyst filled with central fluid with a narrow donut shaped rim surrounding it which was a result of the spinal cord dying off due to the injury which then prevented the function of the spinal cord interrupting messages to and from the brain. His injury was classified as Grade A on the American Spinal Injury Association scale. He was paralyzed from neck down and he was dependent on assisted ventilation with a little hope of recovery (Hoiland, 2002).
Kevin Everett’s spinal cord injury on the other hand was something different. On September 9, 2007, he had a neck injury while attempting to tackle Domenik Hixon. After a lengthy surgery, according to his agent Brian Overstreet, the hope for Evereet to walk or even to move was sparse. On September 10 at a press conference it was Dr. John Marzo who informed the public that Everett’s injury was a fracture and a dislocation of a cervical spine that led to a spinal cord injury. It was said that the injury was caused by the dislocation of the 3rd and 4th cervical vertebrae (2007 Neck Injury). Just minutes after the injury when Everett was brought to the hospital, Dr. Andrew Cappuccino, MD applied a moderate hypothermia to Everett’s injury at his neck and back that cradled the spinal cord from self destruction through brushing and swelling. After surgery, Everett received another cooling treatment and by that time he already regained some mobility on his legs and ankles (Paul, 2007).
Conclusion
Spinal cord injuries are not at all hopeless cases. There are ways which would help in the person injured to recover. Studies have been going on to help find ways in the treatment for spinal cord injuries to give hope to people who have the injury like Mr. Reeves and Mr. Everett. Although, initial prognosis would say that the hope for regaining mobility was grim, there are times when prognosis may be wrong. With the use of the high end technology and the willingness of the person to survive and regain some if not all of his function, there can be a way.
References
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Hetch, et.al. (2004). Christopher Reeve and Spinal Cord Injury. Web.
Hoiland, E. (2002). Promising Progress for Christopher Reeve’s Spinal Injury. Web.
Paul, E. (2007). On-field Hypothermia Saves Everett Dr Barth Green and his team promote on-field spine support. Web.