Spinal cord injuries: Welcome back to “The Science Of Health”, ABP Live’s weekly health column. Last week, we discussed why the higher a spinal cord injury, the more severe the damage. This week, we explain whether spinal cord injuries are irreversible, and discuss science advances that can cure spinal cord injuries in the future. Spinal cord injuries can occur due to traffic accidents, sports-related injuries, medical malpractice, slip-and-fall accidents, acts of violence, and health conditions such as arthritis, degenerative bone disease, and cancer.
Spinal cord injuries are serious medical conditions that can lead to severe morbidity and permanent disability, and occur when the axons of nerves running through the spinal cord are disrupted, resulting in loss of motor and sensory function below the level of injury, according to the US National Institutes of Health (NIH). Spinal cord injuries usually occur as a result of major trauma, and primary spinal cord injuries are often irreversible.
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Spinal cord injuries are costly and disabling especially when they affect patients aged less than 30 years. This is because these injuries act as a significant functional impairment for the remainder of the individual’s life, and put the individual at risk for other complications, resulting in increased morbidity and mortality. Spinal cord injury is estimated to have a lifetime economic impact of two to four billion dollars.
According to Hauptman, O’Brien, Wolf & Lathrop, a personal injury law firm, spinal cord injuries are serious because the brain and spinal cord together form the central nervous system, and any damage to this complex system disrupts movement and sensation throughout the body, and prevents the brain and body from communicating effectively below the level of the spinal cord injury.
A severe spinal cord injury is one which results in paralysis, a condition in which the brain cannot communicate with the rest of the body through the spinal cord, and is characterised by a loss of motor function and sensation below the level of injury.
Spinal cord injuries can be diagnosed through magnetic resonance imaging (MRI), which shows the brain and spinal trauma from injury, vascular irregularities in the spine, bleeding and inflammation that might compress the spine, herniated discs or problems with the cartilage located between the vertebrae, and injuries to the ligaments supporting the cervical spine, among others. Computerised tomography, which detects bone fractures, bleeding, and spinal stenosis, or narrowing of the spinal canal, and X-rays, which can detect misalignment of the vertebrae, and fractures within minutes of injury, are also used to diagnose spinal cord injuries.
How are spinal cord injuries treated?
If someone suffers from a spinal cord injury, emergency personnel at the accident scene place a rigid collar around the neck of the individual on a backboard to prevent further damage to the spinal cord, or give sedatives to relax the person and prevent movement. In some cases, a breathing tube is inserted when the person suffers from breathing problems, or their body does not receive enough oxygen from the lungs.
At the trauma centre, immediate treatment includes realignment of the spine using a rigid brace or mechanical force as soon as possible to stabilise the spine and prevent additional damage; use of spinal decompression surgery to relieve pressure within the spinal column days after the injury; and surgery to remove fractured vertebrae, herniated discs, bone fragments, and other objects pressing on the spinal column, among others.
Spinal cord injuries may result in breathing problems, pneumonia, circulatory problems, stiffness in muscle tone, and autonomic dysreflexia, a life-threatening reflex action that affects those with injuries to the neck or upper back, and is characterised by symptoms such as flushing, sweating, a pounding headache, a sudden increase in blood pressure, goose bumps on the arms and legs, anxiety, and vision changes. Spinal cord injuries can also lead to pressure sores or pressure ulcers, which are areas of skin that have broken down due to continuous pressure on the skin and reduced blood flow to the area, bladder and bowel problems, decreased sexual function and fertility problems, depression, and intense neurogenic pain or burning and stinging sensations.
When spinal cord injuries occur between the C1 and C4 segments, the person may have difficulty breathing because the nerves in that region cause the diaphragm to move and the lungs to expand, and injuries in that region can disrupt these functions. Therefore, when spinal cord injuries lead to breathing problems, the person may require a breathing tube, or special training regarding breathing and swallowing.
In some cases, people with spinal cord injuries may suffer from pneumonia as a result of which they may require a ventilator, or should take precautions to avoid food and liquids from being sucked into the lungs.
Circulatory problems such as unstable blood pressure, arrhythmias, and blood clots may appear days after a spinal cord injury. Since blood flow in the large veins in the legs becomes stagnant after a spinal cord injury, the chances of developing blood clots increase. Therefore, such people may be given anticoagulant drugs and compression stockings to increase blood flow in the lower legs and feet, and reduce the risk for blood clots.
Stiffness and changes in muscle tone may occur because reflexes become exaggerated over time.
People with autonomic dysreflexia must be kept in a sitting position to keep blood flowing to the legs and feet, and reduce blood pressure.
Pressure sores usually occur in people with paraplegia (paralysis in the thoracic region due to damage to the spinal cord below the cervical area but above the waist) and tetraplegia (paralysis from the neck down, in the arms, torso, and legs, due to an injury high on the spinal cord, or in the cervical region). Such individuals must move and change their position periodically, either with the help of assistive devices, or a caregiver.
People with spinal cord injuries who suffer from intense neurogenic pain must undergo treatments such as medications, acupuncture, spinal or brain electrical stimulation, and surgery.
When a spinal cord injury leads to bladder and bowel problems, people should change their diet, and learn new ways to empty their bowels.
Science advances that can cure spinal cord injuries in the future
People with spinal cord injuries can also enrol themselves in rehabilitation programmes which include physical therapy to strengthen muscles, occupational therapy to redevelop fine motor skills and to cope with stiff muscles, autonomic dysreflexia, and neurogenic pain, vocational rehabilitation to identify basic work skills and cognitive capabilities that support paid work, and identify potential workplaces that will be required for a user-friendly workplace, educational training to develop skills for a new line of work, and recreational therapy to encourage people with spinal cord injuries to participate in sports, arts, and leisure activities.
The lives of people with spinal cord injuries can be improved through supportive braces, electronic simulators, neural prosthetics, which are assistive devices that may stimulate the nerves to restore lost functions, wheelchairs, assisted training with walking, and computer-assisted technology such as computer adaptations and adaptive devices which can help with communication skills like writing and typing.
Most spinal cord injuries are irreversible because of the inability of the spine to generate new nerve cells, and the inability of injured nerve cells to easily regulate themselves. Therefore, spinal cord injuries usually lead to permanent paralysis or sensory deficits. However, some science advances may help people completely recover from spinal cord injuries in the future. These include regenerative therapies, neuroprosthetics, and gene therapy, among others.
“Spinal cord injuries may be very difficult to recover from, but it is still very difficult to say that they are completely permanent. Nowadays, the majority of these injuries are irreversible, but ongoing research might find remedies for this. The main limitation of spinal cord injuries is the irreversibility of the inability to generate nerve cells. Normally, nerve cells on the injured segment do not easily regulate themselves. That is why, people who are diagnosed with this damage usually suffer from permanent paralysis or sensory deficits. Nevertheless, today’s scientific and technological advancements may discover some comprehensive treatments for spinal cord damage. Scientists are working on various techniques like regenerative therapies, neuroprosthetics, and gene therapy,” Dr Neeraj Kumar Tulara, General Medicine & Infectious Disease Specialist, Dr LH Hiranandani Hospital, Powai, told ABP Live.
Scientists are working on the regeneration of nerve cells in the spinal cord, said Dr Tulara. “Stem cell testing has given a ray of hope while in animal investigations and human trials.”
Dr Tulara explained that neuroprosthetics, which are new technologies such as brain-computer interfaces and neural implants, are being explored to bypass injured spinal cord segments. Such neuroprosthetics may allow communication between the brain and the body, and restore movement.
“Genetic engineering techniques are also under investigation in order to promote nerve cell growth and repairment in the spinal cord,” said Dr Tulara.
Exoskeleton and rehabilitation are also helping people with spinal cord injuries. This is because the use of advanced exoskeletons and continued rehabilitation programs are helping them regain some independent movement, said Dr Tulara. “These scientific investigations give a sense of hope and promise for the future of spinal cord injury treatment. Researchers are working hard to find any reliable technique for regaining lost function and improving the condition of people suffering from paralysis attacks. Until then, these assistive technologies, physical therapies, and rehabilitation are the common ways for helping people regain consciousness and get back to their old life happily.”
A medicine called Riluzole has also shown promising results in treating spinal cord injuries. Epidural electrical stimulation, in which the region around the spinal nerves in the lower back can be stimulated, is being explored to see if it can be used to improve the lives of people with spinal cord injuries.
“The prognosis of spinal cord injury not only depends on the level of injury but also on the time taken to start the treatment. In case spinal cord compression is seen during investigations, then surgical decompression should be done as soon as the patient is stable enough for the surgery. Permanent changes can develop in the spinal cord if there is intrinsic damage to the cord or decompression is delayed. In such cases, the spinal cord injuries usually do not recover. A timely decompression can provide the best opportunity for spinal cord function to recover. There is a great deal of scientific work in progress in the hope of getting a cure for spinal cord injuries. There are several trials and multi-centric research studies evaluating the role of newer medicines such as Riluzole which have shown some promising work. Cellular regenerative therapies, including stem cells, have not yet shown any great results in terms of significant functional recovery,” Dr Tarun Suri, Head, Department of Spine Surgery, Amrita Hospital, Faridabad, told ABP Live.
He also explained that several spine associations, including the Association of Spine Surgeons of India, have issued position statements in the past to warn people against the dangers of unauthorised use of stem cells for spinal cord injuries. “Several other technologies to rehabilitate spinal cord injury patients are also in the research phase, such as epidural electrical stimulation, exoskeletons, body weight supported treadmills and virtual reality.”
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