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Spinal cord injury (SCI)
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Spinal cord injury (SCI)

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Spinal Cord Injury (SCI) is damage to the spinal cord that results in a loss of function such as mobility or feeling. A diagnosis of spinal cord injury can be devastating.

Accidents - motor vehicle accidents, falls and sports injuries - and acts of violence cause most injuries to the spinal cord. The injury interferes with your brain's ability to communicate through your nervous system with other parts of your body.

When to seek medical advice

Spinal cord injury isn't always obvious. Numbness or paralysis may result immediately after a spinal cord injury or gradually as bleeding or swelling occurs in or around the spinal cord. In either case, the time between injury and treatment is a critical factor that can determine the extent of complications and the level of recovery.

Anyone who has experienced significant trauma to the head or neck needs immediate medical evaluation for the possibility of spinal cord injury. In fact, it's safest to assume that trauma victims have an unstable spine fracture until proved otherwise.

If you suspect a back or neck injury, don't move the injured person. Permanent paralysis and other serious complications may result.

Take these steps once you suspect someone has a spinal injury:

  • Call for emergency medical assistance.

  • Keep the person still.

  • Place heavy towels on both sides of the neck to prevent it from moving, until emergency care arrives.

  • Provide basic first aid, such as stopping any bleeding and making the person comfortable, without moving the head or neck.

Screening and diagnosis

Paramedics and emergency workers are trained to treat people who have suffered a traumatic head or neck injury as if they have a spinal cord injury or an unstable spinal column, until a thorough screening and diagnosis can be completed. A key step in the initial treatment is immobilizing the spine.

Immobilizing the spine can prevent injury to the spine or prevent worsening of any injury that is already present. For this reason, emergency personnel receive training in handling an injured person without moving the neck and back. They use rigid collars around the injured person's neck and place the injured person on a rigid board, until a complete evaluation can take place.

In the emergency room, a doctor may be able to rule out spinal cord injury by carefully inspecting an injured person, testing for sensory function and movement, and asking some questions about the accident. But if the injured person complains of neck pain, isn't fully awake, or has obvious signs of weakness or neurologic injury, emergency diagnostic tests may be needed.

These tests may include:

  • X-rays. Medical personnel typically order these tests on all trauma victims suspected of having a spinal cord injury. X-rays can reveal vertebrae problems, tumors, fractures or degenerative changes in your spine.

  • Computerized tomography (CT) scan. A CT scan may provide a better look at abnormalities seen on an X-ray. This scan uses computers to form a series of cross-sectional images that can define bone, disk and other problems.

  • Magnetic resonance imaging (MRI). MRI uses a strong magnetic force and radio waves to produce computer-generated images. This test is extremely helpful for looking at the spinal cord and identifying herniated disks, blood clots or other masses that may be compressing the spinal cord. But MRI can't be used on people with pacemakers or on trauma victims who need certain life-support machines or cervical traction devices.

  • Myelography. Myelography allows your doctor to visualize your spinal nerves more clearly. After a special dye is injected into your spinal canal, X-rays or CT scans of your vertebrae can suggest a herniated disk or other lesions. This test is used when MRI isn't possible or when it may yield important additional information that isn't provided by other tests.

If your doctor suspects a spinal cord injury, he or she may prescribe traction to immobilize your spine, as well as high doses of the corticosteroid drug methylprednisolone (Medrol). This drug significantly improves neurologic functioning by reducing nerve damage and decreasing inflammation — if given within eight hours of injury.

Diagnosis doesn't stop there, though. About three days after the injury, your doctor will conduct a neurologic exam to determine the severity of the injury and predict the likely extent of recovery. This may involve more X-rays, MRIs or more advanced imaging techniques.

It's often impossible for your doctor to make a precise prognosis right away. Recovery typically starts between a week and six months after injury if it occurs, with the majority of recovery taking place within one year. Doctors generally regard any impairment remaining after 12 to 24 months as likely to be permanent.

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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.
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