Symptoms, Diagnosis, and Treatment of Spinal Cord Injuries

Signs and Symptoms of Spinal Cord Injuries

• Extreme pain or pressure in the neck, head, or back
• Tingling or loss of sensation in the hand, fingers, feet, or toes
• Partial or complete loss of control over any part of the body
• Urinary or bowel urgency, incontinence, or retention
• Difficulty with balance and walking
• Abnormal band-like sensations in the thorax (pain, pressure)
• Impaired breathing after injury
• Unusual lumps on the head or spine

Diagnosis
A neck fracture, as well as a spinal cord injury, is a medical emergency. The patient should undergo a full neurological exam as quickly as possible to assess for instability and/or SCI. Diagnosis is made based on the incident, symptoms, a physical examination, and results of radiological tests, including the following:

• Computed tomography scan (CT or CAT scan): A diagnostic image created after a computer reads x-rays. It can show the shape and size of the spinal canal, its contents, and the structures around it.
• Magnetic resonance imaging (MRI): A diagnostic test that produces three-dimensional images of body structures using powerful magnets and computer technology. It can show the spinal cord, nerve roots, and surrounding areas, as well as enlargement, degeneration, and tumors.
• X-ray: Application of radiation to produce a film or picture of a part of the body. It can show the structure and alignment of the vertebrae and the outline of the joints.

Treatment
Treatment varies depending on the following factors:

• The severity of the fracture
• If there is an associated dislocation or instability
• Which cervical bones are fractured
• Whether there is spinal cord or nerve injury, with muscle weakness or paralysis

A minor (compression) fracture is often treated with a cervical collar or brace worn for six to eight weeks until the bone heals on its own. A more severe or complex fracture may require traction or surgical interventions, including spinal instrumentation (fusion, etc.) with or without surgical decompression.

Surgical decompression of the spinal cord is often done after an injury occurs, although the timing of this intervention varies widely. Surgery involves the removal of various tissue or bone fragments that are compressing and comprising the spinal cord. Depending on the unique circumstances of the injury, decompression is accomplished through a variety of surgical approaches, including approaching the compressed cord from either the front (anterior) or back (posterior). Increasingly it has become clear that decompression and stabilization in patients with SCI should be done as soon as medically safe and reasonable.

American Association of Neurological Surgeons
Neurosurgerytoday.org
Sports-related Neck Injury, September 2008

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