Spinal cord injuries often occur in connection with spinal injuries in accidents. However, the cause can also be a stroke or neurological disease. Depending on the extent of the injury, nerve damage in the area of the spinal cord generally leads to movement disorders and even paraplegia.
A spinal cord injury is defined by doctors as an injury to the spinal cord or its immediate surroundings. Unlike spinal injuries, such as a vertebral fracture, spinal cord injuries are often irreversible depending on their severity and lead to symptoms of paralysis.
The spinal cord transmits messages between the brain and other body organs @ bilderzwerg /AdobeStock
Depending on the severity and extent of the spinal cord injury, a distinction is made between three stages:
Spinal cord concussion is the "simplest" form of spinal cord injury. As a result of a force acting on the spinal column and the spinal cord, there is a temporary (reversible) dysfunction of nerve conduction.
Spinal cord concussion is characterized by a loss of function without any changes being found on imaging. The exact type of dysfunction depends on the severity and localization of the spinal cord injury.
The following disorders may occur for a maximum of 48 hours:
However, all without signs of paralysis.
In contrast to the aforementioned spinal cord concussion, a spinal cord contusion is a non-reversible spinal cord injury. The type of force used is stronger and more direct than in the case of spinal cord concussion.
This leads to a contusion or bruising of the spinal cord. Hence the name "spinal cord contusion". Bleeding or edema may also occur.
Depending on the severity, the symptoms range from slight motor and sensory nerve loss to partial or complete paraplegia.
Spinal cord contusion is the most severe form of spinal cord injury. It usually occurs following direct pressure on the spinal cord. Such pressure occurs, for example, after an accident or as a result of vertebral body fragments, hematomas (bleeding), herniated discs or tumors.
Acute spinal cord contusions often lead to
On the other hand, subacute or chronic cases mainly lead to back pain.
A spine that is sensitive to tapping also indicates tumors or hematomas in the area of the spinal cord.
Doctors make a suspected diagnosis of spinal cord injury based on the symptoms.
The following symptoms usually occur:
These are often detected during a neurological examination.
To confirm the diagnosis, the doctor usually carries out a magnetic resonance imaging (MRI) scan. This allows soft tissue such as nerves and the spinal cord to be visualized in a cross-sectional image. An X-ray may also be necessary to rule out fractures following an accident.
To rule out other causes of nerve loss, such as infections or meningitis , a lumbar puncture may be useful. This involves doctors taking spinal fluid (cerebrospinal fluid or CSF) for laboratory examination.
X-ray image of the spinal cord @ Anastasiia /AdobeStock
The treatment options for a spinal cord injury depend primarily on its severity. A spinal cord concussion, for example, primarily requires a lot of rest and physical protection.
On the other hand, the effects of a spinal cord contusion cannot always be reversed. Doctors only treat concomitant symptoms such as edema, cysts, vertebral fractures or herniated discs conservatively or surgically. The aim is to reduce the pressure on the spinal nerves.
If the compression was not too long, the nerve tracts can regenerate and the sensations and mobility can return.
On the other hand, partial paralysis - or even complete paraplegia - cannot be cured by current means. However, various aids, physiotherapeutic measures and training programs enable those affected to lead a relatively self-determined life.
The prognosis is closely linked to the type of spinal cord injury. For example, spinal cord concussion has a good prognosis. The damage can be reversed within a few days to weeks by taking it easy.
On the other hand, spinal cord contusions tend to have an unfavorable prognosis. This condition leads to irreversible injuries to the spinal cord that cannot be cured with current medical means. Patients are often dependent on assistance and, depending on the extent of the paralysis, may have to use a wheelchair. This often leads to a further deterioration in health, as muscle groups are no longer sufficiently challenged and regress. Added to this are psychological problems, such as depression, or difficulties in the social sphere and with friends.
With suitable physiotherapeutic measures and if those affected come to terms with their situation, their life situation and quality of life improves. A happy life with the disease is possible.
Studies show that taking an optimistic view of life despite the limitations increases the quality of life despite spinal cord injury.
As spinal cord injuries very often occur in connection with accidents, emergency physicians are the first experts on the scene.
Depending on the type and severity of the neurological injury, the following specialists may also be involved:
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