09/25/2013
Spinal Cord Injury
What is a spinal cord injury?
A spinal cord injury is damage to the thick bundle of nerves that runs from the brain to the lower back. This bundle of nerves, called the spinal cord, is enclosed in the hollow center of the spine. The spinal cord carries messages to and from the brain and the nerves in the rest of the body. When the spinal cord is crushed, stretched, or torn, the nerves are damaged. If the spinal cord is just bruised or swollen, the nerves may be able to heal. However, if the nerves are crushed, cut, or torn, they are usually not able to heal. This means that the nerves will no longer be able to deliver signals from the brain to the part of the body that they control.
The symptoms of spinal cord injury depend on how much and what part of the spinal cord is damaged. Nerves in the lower part of the spinal cord control functions and feelings lower in your body, such as your legs. If the spinal cord is damaged in the middle or lower back you may be paralyzed and lose feeling the lower body and legs. Nerves in the upper end of the spinal cord control the lower part of the body as well as movement, feeling, and body functions higher in your body. For example, an injury in the neck may paralyze arms, legs, bladder, bowels, and even the muscles that control breathing.
What can I expect in the hospital?
A spinal cord injury is a medical emergency which requires admission to the hospital. All spinal cord injuries require careful observation, especially in the first 24 hours.
Several things may be done while you are in the hospital to monitor, test, and treat your condition. They include:
Monitoring
You will be checked often by the hospital staff.
Your strength, range of motion, and ability to feel pain will be checked regularly.
Your heart rate, blood pressure, and temperature will be checked regularly.
A heart (cardiac) monitor may be used to keep track of your heartbeat.
Your blood oxygen level may be monitored by a sensor that is attached to your finger or earlobe.
Your fluid intake may be monitored closely by keeping track of everything you eat and drink and any IV fluids you receive.
You may have a small tube (catheter) placed into your bladder through the urethra (the opening from the bladder to the outside of the body) to drain and measure urine from the bladder.
Testing
Testing may include:
Neurologic examination: Testing to check your strength, sensation, balance, reflexes, and memory. This will include looking at your eyes with a flashlight to see if your pupils are the same size.
X-rays: Pictures of the inside of the back to check for broken bones or other problems
Computed tomography (CT) scan: A series of X-rays taken from different angles and arranged by a computer to show thin cross sections of the spinal cord and the tissues around it.
Magnetic resonance imaging (MRI): A powerful magnetic field and radio waves are used to take pictures from different angles to show thin cross sections of the spinal cord and the tissues around it.
Myelography: A series of X-rays taken after injecting special dye into the fluid around your spinal cord to show the spinal cord, nerves, and blood vessels around the spinal cord.
Treatment
The treatment for spinal cord injury depends on the location of the injury, your symptoms, how well you respond to treatment, your overall health, and any complications you may have.
You will have a small tube (IV catheter) inserted into a vein in your hand or arm. This will allow for medicine to be given directly into your blood and to give you fluids, if needed.
You may receive oxygen through a small tube placed under your nose or through a mask placed over your face. In very severe cases, you may need a tube put into your lungs to help you breathe.
Sometimes traction is used to pull bones back into their proper place.
You may need surgery to relieve pressure on the cord from a bone or disk that is pushing on it. Broken vertebrae around the injury may be fused together to support your spine and to protect your spinal cord from further injury.
Your provider may prescribe medicine to:
Decrease swelling around the spinal cord
Treat pain
You may need therapy to help you adjust to some of the functions you may have lost due to the injury. Most rehabilitation programs include:
Physical therapy to help you regain or maintain muscle strength and teach you ways to move safely.
Occupational therapy to help you relearn ways to do the tasks that you previously did.
Speech therapy to help you if you have problems with swallowing, speaking, or understanding words.
Therapy may include skin, bladder, and bowel care, and training. You may need help with daily activities.
What can I do to help?
You will need to tell your healthcare team if you have new or worsening of any of these symptoms.
Trouble breathing
Trouble with muscle movements, such as swallowing, moving arms and legs
Loss of bladder control
Loss of bowel control
Numbness
Tingling
Depression
Redness, bumps, blisters, or sores on your skin
Signs of infection around your surgical wound if you had surgery. These include:
The area around your wound is more red or painful.
The wound area is very warm to touch.
You have blood, pus, or other fluid coming from your wound area.
You have chills or muscle aches.
Ask questions about any medicine or treatment or information that you do not understand.
How long will I be in the hospital?
How long you stay in the hospital depends on how severely your spinal cord is injured and the location of the injury. The average amount of time to stay in the hospital after a spinal cord injury is 8 to 14 days.
You may need to go to a rehabilitation facility to continue your spinal cord injury rehabilitation program before going home.
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