Spinal cord injury (SCI) is a damage to the spinal cord, which causes neurological impairments (paralysys, loss of sensation or both) down the site of injury.
The prominent causes of spinal cord injury are,
Trauma such as automobile crashes, falls, gunshots, diving accidents, war injuries, etc.
Tumors
Developmental disorders, such as spina bifida, kyphosis, scoliosis etc.
Deseases like, transverse myelitis, multiple sclerosis, Friedreich’s ataxia.
Complete and Incomplete Injury
SCI is classified into ‘Complete’ and ‘Incomplete’ depending upon the severity of cord damage.
In a complete injury, motor and sensory functions below the injury level is lost, including bladder, bowel and sexual functions. Spinal cord is considerable damaged and results in permenant paralysis with very few chances of recovery.
In an incomplete injury, some sensation and/or movement below the level of the injury is retained. The spinal cord is only partially damaged and recovery chances of motor functions are high.
The ability to contract the anal or bladder sphincter voluntarily or to feel pinprick or touch, below the injury is considered to be incomplete.
Consequences of SCI
The consequences of a spinal cord injury vary depending on the type, level, and severity of injury, but in general,
Sensation: Feeling of touch, pain, temperature, fatigue etc are completely or partially lost, below the injury level.
Movement: Muscles are paralysed or weak below level.
Bowel and bladder function: it is very common to experience dysfunction of the bowel and bladder, including infections of the bladder and anal incontinence.
Sexual function : Ability for erection, ejaculation etc are lost. Woman
Breathing: Injuries at the C-1/C-2 levels will often result in loss of breathing, necessitating mechanical ventilators. The vital capacity is also reduced.
Inability or reduced ability to regulate heart rate, blood pressure, sweating and hence body temperature.
Spasticity (increased reflexes and stiffness of the limbs).
Neuropathic pain and phantom pain.
Autonomic dysreflexia or abnormal increases in blood pressure, sweating, and other autonomic responses to pain or sensory disturbances.
Atrophy of muscle.
Superior Mesenteric Artery Syndrome.
Osteoporosis (loss of calcium) and bone degeneration.
Gallbladder, renal and bladder stones.
Level or Location of the injury
Defining the Injury level is often confusing. Sometimes
In general, the level of injury is defined as the first spinal segmental level that shows abnormal neurological loss. Sometimes the lowest spinal segmental level that is normal is used. Thus, if a person has normal C3 sensations and absent C4 sensations, the first method will define injury as C4 and the second as C3.
Sometimes the vertebra level at which the injury resides is used. This method will cause a lot of discrepancy at lower spinal levels. For example, a T8 vertebral injury will result in a T12 spinal cord or neurological level. A T11 vertebral injury, in fact, will result in a L5 spinal cord level.
The American Spinal Injury Association (ASIA) recommends to define the injury level by the lowest spinal cord segment where motor and sensory function is normal on both sides. The injury is ‘Complete’ if the person do not have motor and sensory function in the anal and perineal region, representing the lowest sacral cord (S4-S5, otherwise it is ‘Incomplete’.
Paraplegea, quadriplegia(tetraplegia) and hemiplegia.
‘Plegia’ means ‘paralysis’.
Spinal cord injury which affects both lower limbs are termed as paraplegia.’ Para’ means two. Thoracic, lumbar, or sacral regions injury to spinal cord results in paraplegia.
If both upper limbs are also affected it is called quadriplegia( or tetraplegia). ‘Quad’ and tetra both means 4. Cervical (neck) level spinal injuryies result in quadriplegia.
Hemiplegia is the paralysis of one half side of the body. This is rarely caused by spinal cord injury. Stroke and other injuries to the brain result in hemiplegia.
Treatment
There is no current established treatement for spinal cord injury. Scientists are investigating many promising avenues for treatment of spinal cord injury.
A. Human embryonic stemcell colonies that are not differentiated
B. Nerve cellsThe stem cell therapy, which uses the stem cells to regenerate the damaged neurons are gaining popularity.
Stem cell are cells that have the ability to renew themselves through cell division and develop into a diverse range of specialized cell types, including nerve cells. Researchers injected human embryonic stem cells into paralyzed mice, which resulted in the mice regaining the ability to move and walk four months later. Stemcells are usually generated from human embryo (then it is called embyonic stem cel)l, or from other sources, like olfactory lining (lining of nose), somatic cells etc. Stem cells taken either from a donor or the person itself is administered to the injury site.
Clinical trials on human are done in many countries, however the safety of this treatement method is highly debated. It is not proved at this moment, that the therapy doesnot produce any unintentional consequences.
A few other treatments are being researched, including biomaterial solutions, cell replacement therapies, and electronic stimulative devices.
Institutions offering stemcell treatment in india.
Rehabilitation
Rehabilitation has a key role in the life of person with spinal cord injury. The goal of rehabilitation is to minimize disability and to make him independent and functional as much as possible.
The areas focused include,
Education of the person and his family about the injury.
Overcome the psychological and social problems that often interfere with adjustment to life ahead
Improve existing muscle strenth and mobility
Develop the skills to perform daily activities
Adaptive technologies and environment modifications