Spinal Cord Anatomy, Injury Etiology, and Paralysis

Spinal Cord

• The spinal cord is a complex arrangement of nerve cells
• It is responsible for movement and sensation
• It helps carry signals from the brain
• The spinal cord relays information to the brain
• The spinal cord is responsible for reflex responses
• Spinal cords are between 40-50 cm long and 1-1.5 cm in diameter

Etiology

• Motor vehicle accidents are a major cause of spinal cord injuries, accounting for 46% of cases
• Falls account for 22% of spinal cord injuries
• Acts of violence lead to 16% of spinal cord injuries
• Sports and recreational injuries account for 12% of spinal cord injuries
• Vascular ischemia and cervical myelopathy are diseases that can cause spinal cord injuries

Classifications of Spinal Cord Injuries

• A complete spinal cord injury results in a total loss of sensory and motor functions below the injury site
• With an incomplete spinal cord injury, some functions remain below the injury site

Types of Paralysis

• Tetraplegia/Quadriplegia is characterized by paralysis in the arms and legs
• Paraplegia is characterized by paralysis typically from the waist down
• Hemiplegia is characterized by paralysis on one side of the body
• Triplegia is characterized by paralysis of 3 limbs; 1 arm, both legs

Cervical Spinal Cord Injury

• A cervical spinal cord injury occurs in the neck, specifically from C1 to C7
• Cervical spinal cord injuries typically result in tetraplegia/quadriplegia
• Cervical spinal cord injuries are considered the most severe type of spinal cord injury

Thoracic Spinal Cord Injury

• A thoracic spinal cord injury occurs between T1 to T5, affecting the upper chest, mid-back and abdominal muscles
• A thoracic spinal cord injury occurs between T6 to T12 affecting the abdominal and back muscles
• Thoracic spinal cord injuries usually result in paraplegia
• Thoracic spinal cord injuries are also known as vertebral compression fractures

Lumbar Spinal Cord Injury

• Lumbar spinal cord injuries occur from L1 to L5, impacting the lower back
• Lumbar spinal cord injuries cause loss of function in the hips and legs
• There is little or no voluntary control in bowel or bladder function following injury

Sacral Spinal Cord Injury

• S1 nerves affects the hips and groin
• S2 nerves affects the back of the thighs
• S3 nerves affects the medial buttock
• S4-S5 nerves affects the perineal area

Recognizing Spinal Cord Injury

• Signs of spinal injury after an accident may include pressure in the head, neck, or back
• One might experience intense back pain
• Paralysis, lack of coordination, or weakness in any part of the body could occur
• Loss of sensation or numbness or tingling in the hands, feet, fingers, or toes can occur
• There may be a twisted or oddly positioned neck or back
• Breathing may be impaired
• Loss of control of the bladder or bowels could signal a spinal cord injury
• Trouble walking and balancing difficulties are possible

Contributing Factors

• Being male is a contributing factor for spinal cord injuries
• Substance abuse is a contributing factor
• Risky behavior plays a role
• Pre-existing spinal conditions can be a contributing factor

Collaborative Actions

• Emergency care is needed
• Medication is needed
• Immobilization can help
• Surgical management may be necessary
• Rehabilitation plays a role

Surgical Management: Laminectomy

• During a laminectomy, a vertebral bone is removed
• Laminectomies are indicated for herniated discs
• Laminectomies are indicated for tumors

Surgical Management: Spinal Fusion

• During a spinal fusion, two or more vertebrae are permanently fused together
• Spinal fusions are performed for spinal stenosis
• Spinal fusions are performed for spondylolisthesis