Patients with spinal cord injury (SCI) usually have permanent and often devastating neurological deficits and disability. Because spinal cord injuries happen predominantly to people under the age of 30, the human cost is high. Major improvements in emergency and acute care have improved survival rates but have also increased the number of individuals who have to cope with severe disabilities for the rest of their lives. The cost to society, in terms of health care costs, disability payments, and lost income, is disproportionately high compared to other medical conditions.
SCIs may be primary or secondary: (1) Primary SCIs arise from mechanical disruption, transection, or distraction of neural elements. This injury usually occurs with fracture and/or dislocation of the spine. However, a primary SCI may occur in the absence of spinal fracture or dislocation. Penetrating injuries due to bullets or weapons may also cause primary SCI. More commonly, displaced bone fragments cause penetrating spinal cord and/or segmental spinal nerve injuries. Spinal cord compression from metastatic disease is a common oncology emergency. (2) Vascular injury to the spinal cord caused by arterial disruption, arterial thrombosis, or hypoperfusion due to shock is the major causes of secondary SCI.
An SCI usually begins with a sudden, traumatic blow to the spine that fractures or dislocates vertebrae. The damage begins at the moment of injury when displaced bone fragments, disc material, or ligaments bruise or tear into spinal cord tissue. Most injuries to the spinal cord do not completely severe it. Instead, an injury is more likely to cause fractures and compression of the vertebrae, which then crush and destroy the axons, extensions of nerve cells that carry signals up and down the spinal cord between the brain and the rest of the body. An injury to the spinal cord can damage a few, many, or almost all of these axons. Some injuries will allow almost complete recovery. Others will result in complete paralysis.
SCIs are classified as either complete or incomplete. An incomplete injury means that the ability of the spinal cord to convey messages to or from the brain is not completely lost. People with incomplete injuries retain some motor or sensory function below the injury. A complete injury is indicated by a total lack of sensory and motor function below the level of injury. People who survive a spinal cord injury will most likely have medical complications such as chronic pain and bladder and bowel dysfunction, along with an increased susceptibility to respiratory and heart problems. Successful recovery depends upon how well these chronic conditions are handled day to day.
Improved emergency care for people with SCIs and aggressive treatment and rehabilitation can minimise damage to the nervous system and even restore limited abilities. Respiratory complications are often an indication of the severity of a spinal cord injury. About one-third of those with injury to the neck area will need help with breathing and require respiratory support. Rehabilitation programmes combine physical therapies with skill-building activities and counselling to provide social and emotional support.
"Nothing is impossible". This was the philosophy of Christopher Reeve (1952-2004), one of the world's most recognisable and tireless advocates of SCI research and treatment.
