Spinal cord injury

Medicine > Neurosciences

Background knowledge 🧠

Definition

Spinal cord injury (SCI) refers to damage to the spinal cord resulting in loss of function, such as mobility or sensation.
Injuries can be complete or incomplete, depending on the extent of the damage.

Epidemiology

Incidence: Approximately 10-20 per million population per year in the UK.
More common in males and young adults.
Common causes: trauma (e.g., road traffic accidents, falls), sports injuries, violence.

Aetiology and Pathophysiology

Trauma (e.g., fractures, dislocations).
Non-traumatic causes (e.g., tumours, infections).
Primary injury: mechanical damage to neurones and blood vessels.
Secondary injury: inflammation, ischaemia, and cell death following initial injury.

Clinical Features 🌡️

Symptoms

Loss of sensation below the level of injury.
Loss of motor function below the level of injury.
Autonomic dysreflexia (in high-level injuries).
Pain or intense stinging sensation.
Bladder and bowel dysfunction.
Sexual dysfunction.

Signs

Decreased or absent reflexes below the level of injury.
Muscle atrophy and weakness.
Spasticity.
Positive Babinski sign (in upper motor neurone lesions).
Loss of proprioception and vibration sense.
Hypotension and bradycardia (in high cervical injuries).

Investigations 🧪

Tests

MRI spine (gold standard).
CT spine (if MRI not available).
X-rays (initial evaluation).
Neurological examination.
Blood tests (e.g., electrolytes, full blood count).

Management 🥼

Management

Immobilisation (e.g., cervical collar, spine board).
High-dose corticosteroids may be used in some specific cases (e.g., methylprednisolone).
Surgical intervention (e.g., decompression, stabilisation).
Rehabilitation and physiotherapy.
Pain management.
Bladder and bowel management.
Psychological support.

Complications

Pressure sores.
Respiratory complications (e.g., pneumonia).
Urinary tract infections.
Autonomic dysreflexia.
Deep vein thrombosis and pulmonary embolism.
Chronic pain.

Prognosis

Varies depending on the level and completeness of the injury.
Early intervention improves outcomes.
Chronic SCI can lead to significant disability.
Multidisciplinary care is essential for long-term management.
Potential for partial recovery with rehabilitation.

Key Points

Early recognition and treatment are crucial.
Multidisciplinary approach improves outcomes.
Regular monitoring and rehabilitation are essential.

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