The spinal cord is a collection of nerves that travels from the bottom of the brain down your back. 31 pairs of nerves leave the spinal cord and go to your arms, legs, chest and abdomen. These nerves allow your brain to give commands to your muscles and cause movements of your arms and legs.
Spinal Cord Injury
The spinal cord is very sensitive to injury. Unlike other parts of your body, the spinal cord does not have the ability to repair itself if it is damaged. A spinal cord injury occurs when there is damage to the spinal cord either from trauma, loss of its normal blood supply, or compression from tumor or infection.
Types of Injuries
- Complete: If almost all feeling (sensory) and all ability to control movement (motor function) are lost below the spinal cord injury.
- Incomplete: If you have some motor or sensory function below the affected area.
CERVICAL (NECK) INJURIES
When spinal cord injuries occur in the neck area, symptoms can affect the arms, legs, and middle of the body. The symptoms may occur on one or both sides of the body. Symptoms can also include breathing difficulties from paralysis of the breathing muscles if the injury is high up in the neck.
- Cervical Herniated Disc: This type of cervical spine injury happens when the soft spinal discs bulge or rupture out of the spinal canal and put pressure on nearby nerve roots or the spinal cord. The culprit is usually some sudden force.
- Cervical Disc Degeneration: Over time, wear and tear on the cervical spine can injure it and cause the discs in the cervical spine to degenerate. The degeneration process can be exacerbated by a fall or twisting injury to the neck.
THORACIC (CHEST LEVEL) INJURIES
When spinal injuries occur at chest level, symptoms can affect the legs. Injuries to the cervical or high thoracic spinal cord may also result in blood pressure problems, abnormal sweating, and trouble maintaining normal body temperature.
- Thoracic intervertebral joint sprain: The intervertebral joint is the joint that joins the levels of the spine together. Injury to this joint is usually due to a forced movement forward or backward of the thoracic spine. Pain can be felt locally about 2 cm to the side of the spine and may radiate around the chest wall to the front of the chest. Pain is increased with forwarding or backward movement of the spine.
- Thoracic muscle rupture: This injury is common in many sports such as throwing sports, football, basketball and boxing. It is also commonly done when lifting heavy objects.
- Costovertebral joint disorders: The costovertebral joint is a joint in the back that joins the rib and the spine. Common problems arise from spraining the joint during forced chest movement or from inflammation due to arthritis.
- Rib brushing/fracture: This injury is very common in contact sports such as football and rugby. It most commonly occurs as a result of a blow to the ribs.
- Scheuermann’s disease (Osteochondrosis): This is the most common cause of pain in the thoracic spine in adolescents, especially boys. It is a hereditary back disease in which the back becomes rounded due to the bodies of the vertebrae becoming wedged shaped.
- Scoliosis (Curvature of the spine): This is a curvature of the spine in a sideways direction which causes the spine to be S-shaped. Symptoms with scoliosis are not always present. Symptoms include complications due to muscle weakness and joint “looseness” on the convex side and muscle tightness and spasm with joint tightness on the concave side.
When spinal injuries occur at the lower back level, symptoms can affect one or both legs, as well as the muscles that control the bowels and bladder.
- Non-specific Low Back Pain (NSLBP): Low back pain can be caused by structures being too tight (hypomobility) or too loose (hypermobility). The pain producing structures in the lumbar spine include the vertebra, the facet joints (links two vertebrae together in your spinal column), intervertebral disc, ligaments, nerves and their protective coverings, muscles and their attachments.
- Intervertebral Disc Degeneration / Sciatica: The intervertebral discs are composed of a soft, inner nucleus pulposus surrounded by a tough fibrous outer ring, the annulus fibrosus. With trauma and aging, the annulus fibrosus can weaken and thin (disc degeneration or herniation), particularly with the repetitive combination of bending forwards while rotating the trunk i.e. lifting.
- Lumbar Stress Fractures: LBP may also be caused by spondylolysis, or a stress fracture of the pars interarticular, a region of the vertebra. It is often seen in sports involving repeated back extension and rotation, such as gymnastics, cricket fast bowling or tennis. While it was thought to be congenital, it is probably an acquired overuse injury. The fracture usually occurs on the opposite side to the one performing the task i.e. a left sided fracture takes place in the right handed tennis player.
- Spinal Canal Stenosis: Another commonly encountered cause of LBP is spinal canal stenosis. It is a condition that is rare in young and middle-aged athlete’s but may occasionally be seen in older athletes. The condition is caused by arthritic degeneration of the spine, resulting in the vertebra, facet joints, and ligaments which surround the spinal nerves of the spinal cord to become enlarged. In this manner, these structures may compress one or several spinal nerves, causing LBP, leg pain, and leg numbness while walking.
Signs and Symptoms
- Loss of movement
- Loss of sensation, including the ability to feel heat, cold and touch
- Loss of bowel or bladder control
- Exaggerated reflex activities or spasms
- Changes in sexual function, sexual sensitivity, and fertility
- Pain or an intense stinging sensation caused by damage to the nerve fibers in your spinal cord
- Difficulty breathing, coughing or clearing secretions from your lungs
- Extreme back pain or pressure in your neck, head or back
- Weakness, incoordination or paralysis in any part of your body
- Numbness, tingling or loss of sensation in your hands, fingers, feet or toes
- Loss of bladder or bowel control
- Difficulty with balance and walking
- Impaired breathing after injury
- An oddly positioned or twisted neck or back
- Spinal Decompression Surgery
Spinal decompression surgery is a general term that refers to various procedures intended to relieve symptoms caused by pressure, or compression, on the spinal cord and nerve roots. Bulging or collapsed disks, thickened joints, loosened ligaments and bony growths can narrow the spinal canal and the spinal nerve openings (foramen), causing irritation.
Diskectomy is a surgery to remove all or part of a cushion that helps protect your spinal column. These cushions, called disks, separate your spinal bones (vertebrae).
- Minimally invasive spine surgery
Minimally invasive spine surgery uses very small surgical incisions (often less than one inch) and specially designed surgical tools to treat spinal disorders. Because minimally invasive surgery is performed through small tubes, there is little disruption of normal structures. It reduces postoperative pain, speeds recovery, and leads to shortened hospital stays. Many minimally invasive spine procedures can be performed on an outpatient basis.
Foraminotomy is a surgery that widens the opening in your back where nerve roots leave your spinal canal. You may have a narrowing of the nerve opening (foraminal stenosis).
- Spinal Fusion
Spinal fusion is a surgery to join two bones (vertebrae) in the spine. Fusion permanently joins two bones together, so there is no longer movement between them. Spinal fusion is usually done along with other surgical procedures of the spine.
Vertebroplasty is performed by a radiologist, without surgery, and involves inserting a glue-like material into the center of the collapsed spinal vertebra to stabilize and strengthen the crushed bone. The material is inserted through the anesthetized skin with a needle and syringe, entering the midportion of the vertebra under the guidance of specialized X-ray equipment. Once inserted, the material hardens to form a cast-like structure within the broken bone. Relief of pain comes quickly from this casting effect, and the newly hardened vertebra is then protected from further collapse.
The rehabilitation process following a spinal cord injury typically begins in the acute care setting. Physical therapists, occupational therapists, social workers, psychologists and other health care professionals usually work as a team under the coordination of a physiatrist to decide on goals with the patient and develop a plan of discharge that is appropriate for the patient’s condition