Spinal Cord Injuries
As an Emergency Medical Technician (EMT), when someone has a spinal injury,
additional movement may cause further damage to the spine. EMT’s must always
immobilize the patient’s head and torso in the position found. The purpose of an EMT is
to prevent further harm to the patient until more professional medical help can be
obtained. If in doubt about whether a person has received a spinal injury, always assume
he or she has. A spinal cord injury (SCI) is very serious because it can mean the loss of
sensation and function in the parts of the body below the site of the injury.
SCI’s are caused in many different ways. Some of the most common ways a
person may obtain a SCI are- motor vehicle accidents, bullet or stab wound, diving
accidents, electric shock, awkward positioning of the body, falls, sports injuries (such as
football or diving), industrial accidents, assault and gunshot wounds. Polio, Spina Bifida
and Friedreich’s Ataxia are some of the frequent diseases that cause SCI. SCI may also be
know in other names such as spinal cord compression (SCC) and spinal cord trauma
(SCT). According to an article in , SCI’s occur in approximately 12,000 to 15,000 people
per year in the U.S. About 10,000 of these people are permanently paralyzed, and many
of the rest die as a result of their injuries. Most spinal cord trauma occurs to young,
healthy individuals. Males between the ages of 15 and 35 are most commonly affected.
The spinal cord is about 18 inches long and extends from the base of the brain,
down the middle of the back, to about the waist. It is composed of 33 bones called
vertebrae, 31 pairs of nerves, 40 muscles and numerous connecting tendons and ligaments
running from the base of the skull to the tailbone. Between the vertebrae are fibrous,
elastic cartilage called discs. These absorb shock and keep your spine flexible and cushion
the hard vertebrae as it moves.
The nerves that lie within the spinal cord are upper motor neurons (UMN’s) and their
function is to carry the messages back and forth from the brain to the spinal nerves along
the spinal tract. The spinal nerves that branch out from the spinal cord to the other parts
of the body are called lower motor neurons (LMN’s). These spinal nerves exit and enter
at each vertebral level and communicate with specific areas of the body. The sensory
portions of the LMN carry messages about sensation from the skin and other body parts
and organs to the brain. The motor portions of the LMN send messages from the brain to
the various body parts to begin actions such as muscle movement.
The brain and the spinal cord both make up the Central Nervous System. Motor
and sensory nerves outside the central nervous system make up the Peripheral Nervous
System and another diffuse system of nerves that control involuntary functions such as
blood pressure and temperature regulation are the Sympathetic and Parasympathetic
Nervous Systems.
Rings of bone called vertebra surround the spinal cord, and these bones make up
the spinal column or backbones. Most often, the higher in the spinal column the injury
occurs, the more dysfunction a person will experience. The vertebras are named
according to their location. The 8 vertebra in the neck are called the Cervical Vertebra.
The top vertebra is called C-1; the next is C-2, and etc. Cervical SCI’s usually cause loss
of function in the arms and legs, resulting in quadriplegia. The 12 vertebra in the chest are
called the Thoracic Vertebra. The first is called the T-1 and it’s where the top rib
attaches. Injuries to this region usually affect the chest and the legs and result in
paraplegia. The vertebra in the lower back between the thoracic and the pelvis, are called
the Lumbar Vertebra. The sacral vertebras run from the pelvis to the end of the spinal
column. Injuries to the 5 Lumbar vertebra and similarly to the 5 sacral vertebra generally
result in some loss of functioning in the hips and legs.
The effects of SCI depend on the type of injury and the level of the injury. SCI
can be divided into two types of injury- complete and incomplete. A complete injury
means that there is no function below the level of the injury, no sensation and no voluntary
movement. Both sides of the body are equally affected. An incomplete injury means that
there is some functioning below the primary level of injury. A person with an incomplete
injury may be able to move one limb more than another, may be able to feel parts of the
body that cannot be moved, or may have more functioning on one side of the body than
the other. With the advances in treatment of SCI, incomplete injuries are becoming more
common.
The level of injury is very helpful in predicting what parts of the body paralysis and
loss of function might affect. Injuries above the C-4 level may require a ventilator for the
person to breathe. C-5 injuries often result in shoulder and biceps control, but no control
at the wrist or hand. C-6 injuries generally affect wrist control, but no hand function.
Individuals with C-7 and T-1 injuries can straighten their arms but still may have problems
with the hand and fingers. At T-1 to T-8 there is most often control of the hands, but
poor trunk control as the result of lack of abdominal muscle control. T-9 to T-12 injuries
allows good trunk and good abdominal muscle control.
Individuals with SCI also experience other changes. They may have dysfunction of
the bowel and bladder. Sexual functioning is frequently with SCI. Men have their fertility
affected, while women’s fertility is not affected. Other affects of SCI include low blood
pressure, inability to regulate blood pressure effectively, reduced control of body
temperature, inability to sweat below the level of injury and chronic pain. SCI may also
bring other possible complications like Skin Breakdown (also termed as ?decubitus ulcers?
or ?pressure sores?), which occurs as a result of excessive pressure over the bones of the
buttock. Osteoporosis and Fractures occurs when muscle activity is decreased or
eliminated and the legs no longer bear the body’s weight and begin to lose calcium and
phosphorus which makes them become weak and brittle. Usually occurring 2 years after
the initial SCI. Pneumonia, Atelectasis and Aspiration are the injuries above the T-4 level
of injury that are at risk of developing restriction in respiratory functions 5-10 years after
the SCI. Heterotopic Ossification happens within 12-18 months, occurs when the joints
stiffen and fusion.
Safety practices during work and recreation can prevent many SCI’s. Use proper
protective equipment if an injury is possible, and practice appropriate safety measures.
Always check the depth of water before diving, and look for rocks or other possible
obstructions. Football and sledding injuries often involve sharp blows or abnormal
twisting and bending of the back or neck and can result in SCT. Use caution when
sledding and inspect the area for obstacles. Use appropriate techniques and equipment
when playing football or other contact sports. Falls while climbing at work or during
recreational activities may cause serious SCI’s. Always use defensive driving practices
and improved vehicular design may prevent many automobile accidents, and the use of
seat belts will greatly reduce the risk of serious injury if there is an automobile accident.
Using and remembering these tips will always reduce your chances of ever encountering a
situation where you could be the victim of a spinal cord injury.
Bibliography
1) ?Spinal Cord Injury: Spinal Cord 101? (15 March. 2000).
2) ?Spinal Cord Injury: Possible Complications? (15 March. 2000).
3) ?Spinal Cord Injury: Basic Anatomy of the Spinal Cord? (15 March. 2000).
4) ?Spinal Cord Trauma? (18 March. 2000).
5) ?Spinal and Neck injuries? (19 March. 2000).
