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Spinal Cord Injury (SCI): Damage Control and Treatment

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Treatment
Treatment begins with the emergency medical personnel who make an initial evaluation and immobilize the patient for transport. Immediate medical care within the first 8 hours following injury is critical to the patient's recovery.

When injury occurs and for a period of time thereafter, the spinal cord responds by swelling. Treatment starts with steroid drugs such as methylprednisolone. These drugs reduce inflammation in the injured area and help to prevent further damage to cellular membranes that can cause nerve death. Sparing nerves from further damage and death is crucial.

Each patient's injury is unique. Some patients require surgery to stabilize the spine, correct a gross misalignment, or to remove tissue causing cord or nerve compression. Spinal stabilization often helps to prevent further damage.

Surgery
Depending on the circumstances, when surgery is required, it may be performed within 8 hours following injury. Surgery may be considered if the spinal cord is compressed and when the spine requires stabilization. The surgeon decides the procedure that will provide the greatest benefit for the patient.

Different tissue and bony structures including vertebrae misaligned from the force of injury, a herniated intervertebral disc, or a hematoma can cause spinal cord compression. An unstable spine may require spinal instrumentation and fusion to build in support.

Spinal instrumentation and fusion can be used to provide permanent stability to the spinal column. These procedures correct, join, and solidify the level where a spinal element has been damaged or removed (e.g., intervertebral disc).

Instrumentation uses medically designed hardware such as rods, bars, wires and screws. Instrumentation is combined with fusion (bone grafts) to permanently join two or more vertebrae.

Recovery
Once the patient is stabilized, care and treatment focuses on supportive care and rehabilitation. Family members, nurses, or specially trained aids give supportive care. This care might include helping the patient bathe, dress, change positions to prevent bedsores, and other assistance.

Rehabilitation often includes physical therapy, occupational therapy, and counseling for emotional support. Each program is designed to meet the patient's unique needs.

The services may be initially provided while the patient is hospitalized. Following hospitalization, some patient's are admitted to a rehabilitation facility. Other patients can continue rehab on an outpatient basis and/or at home.

A physical therapy (PT) program can facilitate the restoration of muscle strength, flexibility, improve mobility, coordination, and maintain body functions through exercise. Massage, hydrotherapy, and other modalities can relieve pain.

Gait training may be taught to patients with difficulty walking, which could include teaching the patient how to use assistive devices (e.g., walker, cane). Physical therapy benefits the patient be preventing complications from surgery or illness.

Occupational therapy (OT) teaches the patient how to cope with everyday life. OT encourages independence by helping the patient with daily tasks such as dressing, bathing, food preparation, going to the toilet, and other activities of daily living (ADLs).

Speech and language therapy may be included. These skills cross over to the workplace, helping the patient develop their full potential. This might include teaching the patient how to use different muscles to complete tasks such as writing.

Sometimes more than the support from family and friends is needed to cope with spinal cord injury. Many types of counseling are available including psychiatrists, psychologists, and group therapy.

Updated on: 09/07/12
Michael G. Fehlings, MD
The tissue damage after SCI results from the primary, mechanical trauma to the spinal cord and the secondary effects of reduced blood supply, compression, instability, deregulation of metabolic and biochemical parameters and genetically programmed cell death (apoptosis). Through basic and clinical research, new treatments for SCI are being developed. In this article, Dr. Benzel describes the key aspects of acute care of SCI with emphasis on the important role of neuroprotective drugs to reduce cord inflammation and swelling and surgical treatment to reduce compression and instability. In addition, of key importance in the early management of SCI is the prevention and treatment of hypoxia (reduced oxugen supply) and hypotension (low blood pressure).
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Glossary defining terms related to spinal cord injury.
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