The World Health Organisation estimates that between 250,000 and 500,000 people in the world suffer some form of spinal cord injury (SCI) every year. The United States alone, according to figures published by the National Spinal Cord Injury Statistical Centre records 54 cases per million population, which translates to 17,000 new SCI cases every year, with the current number of SCI survivors (in the US) exceeding the quarter million mark. Most spinal cord injuries can be attributed to accidents (both traffic and otherwise), falls and to acts of violence. These can be termed as traumatic causes and account for a full 90% of Spinal Cord Injury cases. Disease, degeneration and other causes account for the other 10%.
Information about the Spinal Cord
Although we are conditioned to think of the spinal cord as a single unit, the truth is that it is a column of nerves encased in a fatty substance known medically as a myelin sheath. This column is anchored by 33 vertebrae.
The Spinal Cord can further be divided into 4 major regions. This sub-division serves to give a more accurate diagnosis in case of injury and is crucial to subsequent management therapies and treatments.
From the top, the first region of the spine is referred to simply as the Cervical Spinal Cord. This is the region of the spine where the brain attaches to the spinal cord and where the neck is connected to the back. It contains 7 vertebrae commonly referred to as C1-C7 and labelled in descending fashion with 1 being the first vertebrae at the top.
The Thoracic Spinal Cord is the middle section of the spine. It contains 12 vertebrae and for ease of identification and isolation these vertebrae are labeled as T1-T12.
The Lumbar Spinal Cord is located below and is, physiologically speaking, connected to the Thoracic Spinal Cord. This is the region of the Spinal Cord where the inward bend is first apparent. The five lumbar vertebrae that make up The Lumbar Spinal Cord are tagged as L1-L5.
Finally the lowermost part of the spinal cord is known as the Sacral Spine or Sacrum and is wedge-shaped. Containing 5 vertebrae the Sacral Spine (S1-S5) exhibits a slight outward bend. Situated between the 5th vertebrae of the Lumbar Spinal Cord (L5) and the tailbone (known as the coccyx) the Sacral Spine is less prone to injury unless it is the direct target of serious trauma. The tailbone itself (the coccyx) is a single vertebra and sits at the base of the spine.
Spinal Cord Injuries Explained
Just as the spine is subdivided for ease in tagging injuries, these same injuries to the Spinal Cord may be divided into two major categories: incomplete and complete. As the name implies, incomplete injuries refer to a situation where partial severance of the spinal cord has occurred and the victim retains some degree of function. The function retained depends on the extent of the injury in question.
It is wrong to assume that a complete spinal cord injury means that the spinal cord is completely severed. This is not always the case. A complete spinal cord injury means there is no movement or sensation below the level of the injury, regardless of what the spinal cord looks like. A small contusion to the spinal cord can result in complete lack of movements and sensation.
Further, injuries to the Spinal Cord have different labels depending on the location and severity of the injury.
Paraplegia refers to the end result of spinal cord injuries which ‘kill’ sensation (and by implication, movement) in the lower half of the body. These injuries arise when the Thoracic Spinal Cord is damaged. The severity of the injury is directly proportionate to its location on the column. The higher up it is the more severe and debilitating the injury.
Quadriplegia (also referred to as Tetraplegia) refers to injuries arising out of damage to the Cervical Spinal Cord. These injuries, usually the most severe of all spinal cord injuries, result in paralysis of all limbs. The severity of the paralysis may vary depending on the seriousness of the injury. Quadriplegia makes movement below the sight of injury impossible. This means that the further up the injury is on the Cervical Spinal Cord, the more debilitating the injury will be. Such an injury has serious health implications, including bladder and bowel control.
Triplegia is also among the most common Spinal Cord Injuries. Typically one arm and both legs will lose sensation and movement and it is caused by an incomplete Spinal Cord Injury.
Spinal Cord Injury Symptoms
The very nature of this traumatic occurrence can leave no doubt (or give rise to ambiguities) as to its presence. The diagnosis will obviously differ depending on the particular part of the spine that has sustained the injury.
Aside from the obvious physical injury that indicates one has a Spinal Cord Injury, chronic pain including headaches will be recurring features.
The direct result of injuries to the spine is paralysis, and this will manifest itself in varying degrees depending on the severity of the injury.
- Control of the bladder and bowel is compromised, making incontinence one of the main symptoms of Spinal Cord Injuries.
- Pneumonia is especially prevalent among cervical spinal cord injury patients.
- Mood swings and personality changes are also symptoms of spinal cord Injuries.
- Loss of fertility and sexual dysfunction will invariably appear in the aftermath of spinal cord injuries.
- Bed sores too will appear given the patient’s newfound, although wholly unwelcome, immobility.
Sometimes the severity of the injury may necessitate the patient to use a feeding tube and/or a breathing tube. This procedure, necessary as it is, is fraught with problems and lays one open to the risk of frequent infection.
To further compound the distress of the affected person, severe spinal cord injuries have a better-than-even-chance of leading to depression, divorce for those who are married, and even to alcohol and other substance abuse in an effort to cope with the sudden and devastating change in circumstances.
What are some recent advances in treating Spinal Cord Injuries?
Spinal Cord Injury remain one of the most dreaded occurrences for anyone involved in an accident or a fall. The worst-case scenario in most people’s minds is the spectre of being confined to a wheelchair and losing that most cherished of human possessions: independence.
The treatment and management of spinal cord injuries starts with the patients themselves. The most important first step is to do nothing at all. Any unnecessary movement on the part of the survivor may turn a manageable injury into a far graver disability which may alter (irretrievably and negatively) the tenor of subsequent events.
The second stage of treatment and management of SCIs will most likely involve paramedics whose job will be to stabilise the patient (at the site of the accident) by providing a collar to keep the neck immobile and to provide critical assistance in breathing, where such is needed. Blood transfusions may also be performed at this stage. Other outstanding symptoms that fall within the purview of the paramedics’ knowledge will also be handled at this stage.
The third stage in spinal cord injury treatment takes place at a health facility, hopefully a hospital that is equipped to handle severe traumatic injuries. At the hospital, as indeed at the site of the accident, prompt treatment is key to any subsequent recovery. The chances of a robust recovery may hinge on surgical decompression (to relieve pressure or compression in the spine) and stabilization of the patient. Rehabilitation and physical therapy after the surgery further boost the patient’s chances of recovery. Generally speaking the recovery period has a window of 6 months after the accident. Any restoration of function and movement following treatment occurs during this time period. Whatever function that has not been recovered by then will most likely be permanent.
The use of assistive devices such as wheelchairs, crutches and Zimmer frames play their part in reintegrating SCI patients into society. Some measure of freedom and independence is retained this way but this is generally only useful to patients who have suffered incomplete injury to the spine.
What cannot be emphasised enough in the treatment of SCI injuries is the cultivation and maintenance of a positive outlook. One cannot do this alone. Joining a support group is critical in removing the sense of isolation that an SCI patient would naturally feel and serves a critical purpose in maintaining (or rekindling) the will to live. A supportive home environment is also vital as a Spinal Cord Injury patient’s predicament will have repercussions on the immediate family who, by default, will be the patient’s first support group.
The nature of the spinal cord (nerves piled high one on top of the other) makes treatment a complicated affair. There is an element of hit-and-miss to the surgical procedures that follow the accident. Sadly this is borne out by the great number of patients who do not show a full enough recovery with a significant number having to endure paralysis for the rest of their lives.
Spinal Cord Injury Treatment Breakthrough: Epidural Stimulation
At Unique Access Medical we recognise the dynamism of Science in general and Medicine in particular. While we acknowledge the efforts and methods of previous medical practice (and the relief they have brought to many) we are always at the forefront in seeking out more efficient and less invasive ways of tackling disease and disorders.
Epidural Stimulation is considered to be the most progressive Spinal Cord Injury Treatment breakthrough. The Epidural Stimulation device is a cutting edge Spinal Cord Injury device that has already changed the lives of SCI patients who have been fitted with it. Both patients with incomplete and complete spinal injuries have benefitted from it. The device is surgically connected to the nerve systems, with the patient learning how to control it for dexterity and easy limb movement.
The device sits on the myelin sheath (touched on earlier) where, through the application of an electrical current, it is able to stimulate movement that would ordinarily result from brain impulses. This ability to activate the nerve circuitry in the spinal cord while bypassing the normal route that has been interrupted by the injury is what makes the device such an important breakthrough in the management of spinal cord injuries.
The 16 Electrodes plate is implanted over a specific group of spinal nerves (around at T10-T12 vertebral level) into the epidural space. The low frequency electrical currents are used to stimulate these nerves which ultimately result in muscle contraction.
Even with a complete spinal injury the device is able, through the patient’s own control of it, to pass on commands to the affected limbs.
The surgical fitting of the Epidural Stimulation device is the easy part. The rehabilitation process where the patient must learn how to control the device (and integrate it into his or her psyche so that it becomes an integral part of the human body) is where the real work lies. Typically this process is spread out over a month to 40 days, during which time the patient has to learn how to initiate and follow through voluntary movements when the device is activated. This retraining of the brain, muscles and nerves, with the active participation of the patient, is known as ‘Mapping’. The experience and know-how of the ‘Mapping Therapist’ is critical to the speed and full success of the entire process.
Once the patient is discharged from our facilities we continue to offer support. With pre-installed and tailored exercise programmes, and a full orientation on the device’s operation, our medical team continues to offer support, not only to implement new programmes, but to journey together with the patient, back to a life of freedom, independence and usefulness.
We have many success stories with patients who have been able to walk again following Epidural Stimulation treatment. Andrew Bell from the UK was left paralysed from the chest down following an accident involving his motorcycle and a negligent driver. His journey to recovery – and walking again – makes for compelling reading and viewing.
Steven Edge from Australia was left paralysed and unable to use his legs, the result, too, of a road accident. Steven underwent the Epidural Stimulation treatment and is now able to move his legs.
We always welcome queries for further information regarding the treatment of Spinal Cord Injuries and other conditions. Please feel free to contact us at any time for fuller details on the processes involved and to learn how we can facilitate your stay with us as we work together towards restoring your health.