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Spinal cord injury

Background knowledge ๐Ÿง 

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., tumors, infections)
  • Primary injury: mechanical damage to neurons and blood vessels
  • Secondary injury: inflammation, ischemia, and cell death following initial injury

Clinical Features ๐ŸŒก๏ธ

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 neuron lesions)
  • Loss of proprioception and vibration sense
  • Hypotension and bradycardia (in high cervical injuries)

Investigations ๐Ÿงช

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 ๐Ÿฅผ

Management

  • Immobilization (e.g., cervical collar, spine board)
  • High-dose corticosteroids may be used in some specific cases (e.g., methylprednisolone)
  • Surgical intervention (e.g., decompression, stabilization)
  • 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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