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spinal cord injury (SCI)

Etiology: -> traumatic event a) contusion b) compression c) lacerations d) central cord syndrome Pathology: 1) damage to cells within the spinal cord 2) severing nerve tracts Clinical manifestations: 1) paralysis 2) loss of sensation & reflex function below the point of injury a) autonomic activity (breathing) b) bowel & bladder control 3) delayed manifestations a) pain or sensitivity to stimuli b) muscle spasms c) sexual dysfunction 4) sensory loss best determined by ascending pinprick exam, including the trunk [3] 5) distal spinal cord lesions may cause lower motor neuron signs - muscle weakness, decreased muscle tone, areflexia Radiology: - CT of neck if neurologic evaluation is compromised - CT angiography if vertebral artery injury is suspected [2] - MRI of entire spinal cord if spinal cord compression is suspected [3] Complications: 1) urinary tract infections 2) pneumonia 4) pressure ulcers Management: 1) immediate relief of cord compression 2) high-dose methylprednisolone of benefit if administered within 8 hours of injury - duration of therapy - 24 hours if administered within 3 hours - 48 hours if administered 3-8 hours after injury [4] 3) stabilization of the vertebral column to prevent further injury if: a) altered cognition b) neck pain c) focal neurologic deficit d) distracting injury [2] 4) prognosis a) depends on: 1] the severity of the injury 2] the segment of spinal cord at which the injury occurs 3] nerve fibers are injured b) most people regain some functions between a week & 6 months after injury c) the likelihood of spontaneous recovery diminishes after 6 months 5) neurorehabilitation strategies can minimize long-term disability Notes: - Reanimation technology using a microchip implanted in the brain - can identify an electrical activity pattern when the subject thinks about moving the hand - this pattern is transmitted through a cable to a computer, which translates the signal so that a sleeve worn on the forearm can stimulate the muscles to move the hand [5] - a specific population of neurons in the spinal cord appears to be responsible for electrical stimulation-enhanced recovery [[6]] - lumbar cord neurons are not killed by spinal cord injuries but instead are disconnected from the brain & thus rendered functionless - epidural electrical stimulation of the lumbar spinal cord during neurorehabilitation improves walking ability - one specific type of neuron with a distinctive gene-expression pattern has been identified [6]

Interactions

disease interactions

Related

spinal cord (spinal marrow)

Specific

anterior cord syndrome Brown-Sequard syndrome central cord syndrome (central cervical cord syndrome) posterior cord syndrome spinal cord compression; compressive myelopathy spinal cord concussion

General

spinal cord disease; myelopathy (disease/disorder primarily affecting spinal cord) CNS trauma

References

  1. Genova A. In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  2. Physician's First Watch, April 16, 2013 David G. Fairchild, MD, MPH, Editor-in-Chief - Journal Watch, Emergency Medicine Massachusetts Medical Society http://www.jwatch.org - Resnick DK. Updated guidelines for the management of acute cervical spine and spinal cord injuries. Neurosurgery 2013 Mar; 72:1. PMID: 23417171
  3. Medical Knowledge Self Assessment Program (MKSAP) 16, 17 American College of Physicians, Philadelphia 2012, 2015.
  4. Bracken MB. Steroids for acute spinal cord injury. Cochrane Database Syst Rev. 2012 Jan 18;1:CD001046. PMID: 22258943
  5. Bouton CE, Shaikhouni A, Annetta NV et al Restoring cortical control of functional movement in a human with quadriplegia Nature. 2016 Apr 13. PMID: 27074513 http://www.nature.com/nature/journal/vaop/ncurrent/full/nature17435.html
  6. Kathe C et al. The neurons that restore walking after paralysis. Nature 2022 Nov; 611:540. PMID: 36352232 PMCID: PMC9668750 Free PMC article https://www.nature.com/articles/s41586-022-05385-7
  7. NINDS references - NINDS Spinal Cord Injury Information Page https://www.ninds.nih.gov/Disorders/All-Disorders/Spinal-Cord-Injury-Information-Page - Spinal Cord Injury: Hope Through Research https://www.ninds.nih.gov/disorders/patient-caregiver-education/hope-through-research/spinal-cord-injury-hope-through-research
  8. Eunice Kennedy Shriver National Institute of Child Health and Human Development Spinal Cord Injury (SCI): Condition Information https://www.nichd.nih.gov/health/topics/spinalinjury/conditioninfo/default