spinal cord injury (SCI)

Etiology

• traumatic event
  • contusion
  • compression
  • lacerations
  • central cord syndrome

Pathology

• damage to cells within the spinal cord
• severing nerve tracts

Clinical manifestations

• paralysis
• loss of sensation & reflex function below the point of injury
  • autonomic activity (breathing)
  • bowel & bladder control
• delayed manifestations
  • pain or sensitivity to stimuli
  • muscle spasms
  • sexual dysfunction
• sensory loss best determined by ascending pinprick exam, including the trunk
• distal spinal cord lesions may cause lower motor neuron signs
  • muscle weakness, decreased muscle tone, areflexia

Radiology

• CT of neck if neurologic evaluation is compromised
• CT angiography if vertebral artery injury is suspected
• MRI of entire spinal cord if spinal cord compression is suspected

Complications

• urinary tract infections
• pneumonia
• pressure ulcers

• disease interaction(s) of spinal cord injury with urinary incontinence

Management

• immediate relief of cord compression
• high-dose methylprednisolone of benefit if administered within 8 hours of injury
  • duration of therapy
    • 24 hours if administered within 3 hours
    • 48 hours if administered 3-8 hours after injury
• stabilization of the vertebral column to prevent further injury if:
  • altered cognition
  • neck pain
  • focal neurologic deficit
  • distracting injury
• prognosis
  • depends on:
    • the severity of the injury
    • the segment of spinal cord at which the injury occurs
    • nerve fibers are injured
  • most people regain some functions between a week & 6 months after injury
  • the likelihood of spontaneous recovery diminishes after 6 months
• neurorehabilitation strategies can minimize long-term disability

Notes

• Reanimation technology using a microchip implanted in the brain
  • can identify an electrical activity pattern when the subject thinks about moving the hand
  • this pattern is transmitted through a cable to a computer, which translates the signal so that a sleeve worn on the forearm can stimulate the muscles to move the hand
• a specific population of neurons in the spinal cord appears to be responsible for electrical stimulation-enhanced recovery 6
  • lumbar cord neurons are not killed by spinal cord injuries but instead are disconnected from the brain & thus rendered functionless
  • epidural electrical stimulation of the lumbar spinal cord during neurorehabilitation improves walking ability
  • one specific type of neuron with a distinctive gene-expression pattern has been identified

More general terms

• spinal cord disease
• CNS trauma

More specific terms

• anterior cord syndrome
• Brown-Sequard syndrome
• central cord syndrome (central cervical cord syndrome)
• posterior cord syndrome
• spinal cord compression; compressive myelopathy
• spinal cord concussion

Additional terms

• spinal cord (spinal marrow)