It is important to know that you are NOT alone. Every year in Russia and other countries, thousands of people receive similar injuries annually. For example, in the UK there are about 1,000 people each year. And the number of people living with spinal cord injury in the United States is about 36,000.
- Paraplegia. Paralysis of the legs and lower body. Usually occurs as a result of injuries at T2 or lower.
- Tetraplegia. Paralysis below the neck, including both arms and legs. Also known as quadriplegia. Usually occurs as a result of injuries at T1 or higher.
The nervous system and how it works
To understand your trauma, first consider the way your healthy nervous system functions. Its main components are the brain, spinal cord and nerves. They communicate with each other and work together to help you move your body, feel physical pressure and control body functions, such as breathing, bowel and bladder function, blood pressure. The spinal cord is the largest nerve in the body. It has a length of about 45 cm and extends from the base of the brain to the middle of the back to about the waist. Nerves are structures made up of nerve fibers. Nerve fibers are responsible for the transmission of impulses throughout the body.
When the spinal cord is damagedThe nervous system cannot function normally. Nerves over the injury work fine, but those under the injury cannot receive or send the necessary messages. When messages stop, mechanical movements stop, sensations below the level of injury disappear.
A complete injury means that the sensory or motor function is not preserved in the S4-S5 segments (see figure below). If the injury is incomplete, some sensory and / or motor functions may persist in or through the S4-S5 (more on this is written here). To find out if your injury is complete or incomplete, a neurologist should conduct an examination. You must be checked several times in both inpatient and outpatient settings, because the fullness of your injury can change over time.
As the body grows, the spinal column grows longer than the spine. Because of this, a discrepancy often arises between the skeletal level of vertebral fracture and the neurological level of spinal cord damage. The neurological level of injury refers to the lowest level of the spinal cord, which still has normal sensory and motor function after the injury. Below is a list of the effects of trauma at each level of the spine (see also figure).
Spinal cord segments and their corresponding functions
C1-3 - Limited head control
C4 - Breath and Shrug
C5 - Raising the arms in the shoulders, bending at the elbows
C6 - Elbow flexion and extension of the wrists
C7 - Extension of the arms at the elbows, extension of the fingers
C8 - Finger Flexion
T1 - Finger movements (lateral movement, coordinated actions)
T2-T12 - Deep breaths, deep breathing
T6-L1 - Deep exhale, stability when sitting
L1-L2 - Leg Curl
L2-L3 - Moving the hips to the midline of the body
L3-L4 - Extension of the knees
L4-L5 - Ankle Extension
L5 - Toe Extension
S1 - Foot and ankle movements
S1-S2 - Toe Movements
S2-S4 - Bowel and Bladder Functions
Your hospital rehabilitation
The first days after a spinal cord injury, an examination and a variety of diagnostics are performed. Medications can be prescribed to reduce spinal cord inflammation and prevent blood clots. X-rays and testing of body areas for sensitivity, in which you help doctors, make it possible to most accurately determine the level and type of your injury. In the event that the spine is broken and / or it compresses the spinal cord, an operation to stabilize it is possible. The higher and wider the injury, the more equipment and accessories you will need for everyday life. The level of injury will indicate which wheelchair you need: electric or manual. You may need someone who will constantly help you in your daily life (toilet, moving, dressing, bathing).
See articles and books for patients in more detail, and books and research for specialists.
Exercises
Exercise is necessary to maintain a healthy cardiovascular system, maintain physical strength and facilitate everyday life. Exercise also provides benefits such as increased flexibility, improved muscle tone, increased stamina, vitality, and stress management. Initially, the exercise program should be aimed at increasing strength so that you can perform a number of new activities, such as using a wheelchair, moving the body, and moving in bed. Learning the proper technique in these steps is important to maintain your safety. You need to create a program that matches your specific needs. If you enjoyed playing sports or exercising before getting injured, you will certainly want to continue these activities. Many of the people with spinal cord injuries continue to practice athletics and team sports.
Complexes of exercises for yourself can be selected here (text, photo) and here (video).
Spasticity
Spasticity is a sudden involuntary muscle contraction. Many people with spinal cord injuries and certain illnesses (such as multiple sclerosis, for example) have problems with uncontrolled spasms of the hands or feet. In a certain sense, spasticity has a positive effect, as it helps to maintain muscle tone and increases blood circulation in the legs. But often spasms can be painful and make life difficult. If you have cramps, then the question of how to manage them must be discussed with your doctor.
The site has a number of articles on spasticity and spasticity management.
After an injury like yours, many experience pain. 2 types of pain are common: neuropathic and musculoskeletal. Neuropathic pain is often described as burning or cold, needle pricking, or electric shock. Neuropathic pain is felt at or below the level of trauma. Musculoskeletal pain often occurs in the back, shoulders, wrists and is usually the result of physical stress and tension from lifting, moving and training. Often pain can be an indicator of injury or infection. If you experience pain, you should consult your doctor for diagnosis and treatment.
The site has a number of articles on pain in people with spinal cord injury.
After a spinal cord injury, you are at risk of pressure sores. The fact is that now, due to the lack of sensations below the level of injury, you do not feel the need to periodically change the position of the body. As a result of prolonged sitting or lying down without a change in posture, the skin and adjacent tissues are deprived of blood flow and oxygen access. Necrosis (necrosis) of tissues located between the bone and the surface on which the person lies or sits begins.
Dragging the body along a horizontal or inclined surface, as well as prolonged exposure of body parts in the wet state increase the risk of pressure sores. One sign of a problem may be a red spot, a hardened or discolored area of the skin that supports body weight. Check the areas of greatest pressure at least twice a day, or ask someone to do it for you. The regional branch of the Social Insurance Fund will help you get an anti-decubitus cushion for a wheelchair and other equipment that can help reduce the risk of pressure sores.
Some of the most likely pressure sore areas
When sitting, relieve pressure from the hazardous areas at least every 20 minutes. It is very important to keep the decubitus cushion on the wheelchair in good condition and replace it if necessary.
Pressure ulcer prevention tips
- Change your body position often in bed and in a wheelchair.
- Relieve pressure from hazardous areas every 15-20 minutes.
- Use a mirror to check your skin condition twice a day.
- Learn the technique of moving the body over the surface so that the skin does not get jammed.
- Be careful not to bump or scratch your skin.
- Keep your skin clean and clear of air.
- Do not expose the skin to prolonged exposure to urine or feces.
- Avoid prolonged sitting and lying in wet clothes or on wet surfaces.
- Eat nutritious, healthy foods, drink plenty of fluids.
- Maintain a normal body weight, do not overweight.
- Wear shoes that are one size larger than the one you wore before the injury - this will prevent excessive pressure on the feet and toes, help to avoid the appearance of edema and pressure sores.
- Do not massage the reddened areas. Do not use heat lamps or attempt to dry sores.
If a patch appears on the skin with a suspicion of pressure sores, do not sit down or lie down on it. Call your doctor. Remember that bedsores are treated differently than other types of injuries or skin problems. You may need to limit your activity and use special dressings to help protect the damaged area during its treatment. In severe cases, surgery, hospitalization, treatment, and skin transplantation may be required.
The site has a well-illustrated book on bedsores. See also full list of articles.
Burn prevention
Due to the fact that after an injury areas that you don’t feel appear on your body, you need to carefully monitor the body: how it is located, touches. Many people with spinal cord injuries due to lack of sensitivity were severely burned using hot grills, coffee cups, cigarettes, while washing in the bathroom and shower. So check your skin regularly and be aware of hot or extremely cold surfaces. Extreme temperatures can cause deep skin damage. And this, in turn, can take several months of treatment and cause the risk of a serious infection.
Urinary tract infections
With a disorder of the bladder, episodic or frequent urinary tract infections may occur. If you suspect that you have an infection, consult your doctor. Your urine will be checked, and if an infection is present, medication will be prescribed. For frequent infections, your doctor may recommend additional diagnostics or procedures.
You may experience these symptoms if you have a urinary tract infection:
- Urinating more often than usual.
- Leakage of urine between normal urination or catheterization.
- Turbid or dark urine.
- Bad smelling urine.
- Increased muscle cramps.
- Heat.
- Backache.
Sexuality and intimate life
Most people with spinal cord injuries are interested in sex, so you will be happy to learn that you can have a healthy sex life and relationship. Sexual desire continues after a spinal cord injury, and the need to love and be loved (loved) does not change.
For sexuality after injury, see here and here.
The mechanics of sex will be different from what they were before. You will have to experiment with various activities and postures. You may need to warn your partner that you may suffer from his (her) unnecessarily violent activity. You may also need to teach him or her what touches and parts of the body you enjoy most. Women with spinal cord injuries have menstrual periods and can become pregnant. Vaginal birth is possible, and although pregnancy is usually managed at a high-risk birth center, it most often leads to a healthy birth. Some men with spinal cord injuries may receive and maintain an erection, while others must use medications, devices, or other options to achieve this.
For erectile problems of men after injury, see here and here.
Retrograde ejaculation (semen enters the bladder) is a frequent consequence of spinal cord damage in men, and this can reduce the possibility of paternity.
On fertility of male spinalists, see here and here.
Remember that the risk of contracting a sexually transmitted infection is the same as before the injury. Safe sex practices include using condoms with sexual intercourse, limiting the number of sexual partners, and using effective birth control methods.
Date of publication (update): October 15, 2017
The structure and role of the human spinal cord
The human spinal cord performs the function of coordinating the work of organs and muscles, through it information from all parts of the body enters the brain. Through the spinal cord, human organs "communicate" with each other and even control each other.
The spinal cord has a cylinder structure usually with a diameter of 1–1.5 centimeters, as well as a soft (vascular, internal), arachnoid (middle) and hard (external) membranes, which are separated from each other by cerebrospinal fluid (cerebrospinal fluid) and directly cover the spinal cord the brain within which the central cerebral canal passes. In this case, the human spine is additionally protected by dense muscle tissue.
The nature and causes of spinal cord injury
From the point of view of the causes of pathology of the spinal cord, three groups of its diseases (injuries) can be distinguished:
- Malformations of the spinal cord - congenital or postpartum abnormalities in its structure,
- Spinal cord diseasescaused by neuroinfections, tumors and hereditary diseases of the nervous system, disorders of the spinal circulation,
- Spinal cord injuries, which include fractures, bruises, concussions, squeezing, hemorrhages, dislocations - can occur both autonomously and in combination with fractures.
The consequences of any diseases of the spinal cord are always very serious, but here we pay attention to the most common type of disease - spinal cord injury. The causes of most spinal injuries are quite mundane and prosaic. According to statistics, they can be conditionally divided into three large groups:
- Car accident. The most common cause of spinal cord injuries, which is not surprising given our statistics on car accidents. Moreover, injuries in car accidents get both motorists and pedestrians. Driving motorbikes is especially traumatic, as they do not have a rear seat back that can reduce the risk of spinal injuries.
- Falling from height. Falling from a height can be either intentional or accidental - in any case, there is a high risk of spinal injury. This is the most common cause of spinal injury in athletes, but also in amateurs to jump into the water in an unfamiliar place or from a bridge using a safety rope.
- Spinal cord injuries in domestic and extraordinary conditions. These are falls during an unsuccessful descent in unfamiliar places, falls from a ladder, with ice, on a slippery floor, bullet and knife wounds and many other situations.
The consequences of spinal cord injury
Although the spinal cord, like the brain, is the most protected human organ, a sharp and unexpected rotation of the body can result in a fracture of the spine, and microscopic or large fragments of the vertebrae in this case damage the delicate brain tissue. In the future, the following happens: part of the nerve cells die immediately, another part later, due to oxygen starvation, and the third after some time due to the launch of the cell self-destruction program (apoptosis). The consequences of spinal cord injury can be either general or selective in nature - depending on the nature of the injury, the timeliness of treatment and the quality of the measures taken to restore the spinal cord.
The consequences of a spinal injury depend on its severity, on which particular cells of the spinal cord are affected.
So, if only peripheral nerve cells responsible for the nearest organs and muscles are affected, then the consequences of the injury can be insignificant, because neighboring cells will take on their function. And if the spinal cord is damaged more deeply and fragments of the vertebrae destroyed the pathways that bind together several parts of the spinal cord, then the consequences of spinal injury are catastrophic. The brain, which controls the whole body through the spinal cord, is simply deprived of information about what happens to the body below the site of the spinal injury.
In addition, the consequences of spinal trauma can be of varying severity also depending on how quickly and expertly the medical care was provided.
И вот почему: так как непосредственно после травмы позвоночника происходит гибель клеток спинного мозга, необходимо немедленно и в достаточном количестве сделать инъекции препаратов, препятствующих отмиранию нервных клеток. Then, no later than the first few hours after the injury, an operation must be performed to remove all vertebral fragments so that they no longer compress and rupture the spinal cord. The next steps are the maximum possible restoration of blood circulation, which will allow supplying the cells of the spinal cord with oxygen and preventing their further death, as well as fixing the injured part of the spine. Untimely or unskilled actions of a neurosurgeon can lead to irreversible death of the damaged area of the spinal cord.
After a severe injury to the spinal cord, its shock state sets in: the spinal cord "turns off", temporarily "ceases to exist." Therefore, with spinal shock, it is impossible to detect and check a single reflex, not a single organ functions correctly, with the exception of the heart and lungs, which can work autonomously - you just have to wait (usually a few weeks) until the shock condition of the spinal cord ends. At this time, the muscles do not work the same way, so it is especially important to keep them in good shape with electric pulses so that they do not atrophy. However, their stimulation should not be started too early or too intensively so as not to aggravate the state of nerve cells and not send the spinal cord into a shock state for the second time.
After the end of spinal shock, the body is divided into two parts: controlled and autonomous (below the spinal cord injury). At this moment, the next stage begins, the stage of restoration of the spinal cord.
So, the consequences of a spinal cord injury depend on two things: the severity and nature of the spinal cord injury itself and the speed and professionalism of the surgeon's actions. But to minimize the effects of spinal cord injury, further treatment and rehabilitation will be required.
Recovery from spinal cord injury
Reconstructive treatment after undergoing spinal shock takes several months, but most often it will take a year and a half. During this period, the nerve cells of the spinal cord will begin to systematically recover, at a millimeter per day speed, if there is damage, but there is no complete rupture. In the event of a rupture, cell regeneration is impossible, and both the patient and his relatives will have to come to terms with this reality and begin a new life.
The attending neurosurgeon can tell about the possibility and predictions of rehabilitation treatment and rehabilitation after a spinal injury only after a thorough magnetic resonance examination. An MRI scan will show the presence or absence of a rupture of the spinal cord, which will give the doctor a reason to determine the prospects for its recovery.
In the case of restoration of the spinal cord, the processes of its cells are initially regenerated by themselves, then - day after day - they establish a connection with their "neighbors" and other segments of the brain. For this reason, in the first year and a half after a spinal injury, there is hope for a positive result from rehabilitation. The effect of it depends on the timeliness of rehabilitation measures and the correct choice of methodology.
Rehabilitation after spinal cord injury is always a comprehensive approach that consists of many factors, starting with the most basic, such as:
- Proper diet and nutrition
- Psycho-emotional atmosphere and fresh air,
- Physiotherapy exercises and massage,
- Household and socio-psychological adaptation.
and ending with such specific ones as:
- Regular laboratory and hardware diagnostics,
- Drug therapy
- Correction of neuro-urological problems,
- Physio-, kinesio-, hydrokinesio-, acupuncture and ergotherapy,
- Examination by narrow specialists from various fields of medicine.
Full rehabilitation after spinal cord injury is the professionalism and attentiveness of doctors, their rich experience and scientific knowledge, the ability to combine traditional and latest techniques.
Types of spinal cord injuries:
- concussion,
- injury,
- spinal cord hemorrhage,
- destruction of the roots of nerve adolescents,
- compression, displacement.
Separately, injuries of a stable and unstable nature are distinguished. Unstable are considered fractures explosive type, rotation, dislocation and fractures of various degrees. All these injuries are necessarily accompanied by a rupture of the ligaments, because of which the structures of the spinal column are displaced and injured by the spinal roots or the canal itself.
Complications include hemorrhages in the tissue of the spinal cord and under the lining of the spinal cord.
The work and integrity of the spinal cord may be impaired due to:
- falling from a height or accident,
- gunshot and stab wounds, blows,
- some activities sports (motorcycling, diving and others),
- tumors, malignant neoplasms,
- vascular aneurysm,
- congenital and postpartum abnormalities in the structure of the spinal cord,
- inflammatory processes
- infections, neuroinfections,
- spinal circulation disorders,
- arthritis
- degenerative processes in the spine.
Symptoms of an accident depend on the type and place of damage.
Ergotherapy as a successful method of comprehensive rehabilitation
Ergotherapy is an interdisciplinary medical specialty supplementing traditional medicine with knowledge from the socio-psychological sciences: pedagogy, psychology and sociology. The effectiveness of ergotherapy methods is confirmed in practice. They consist in the individual selection, training and development of focused everyday, productive household activities of the patient in order to improve his functional capabilities and gain independence from others. The task of the occupational therapist is to ensure the patient’s adaptation to the new realities of life in physical and emotional terms and to help him adapt to new circumstances and find the meaning of life. In the process of training with an occupational therapist, a person simultaneously learns familiar or new activities and restores his physical and nervous activity.
Thus, if recovery from a spinal cord injury is, in principle, possible for medical reasons, it must be started immediately. But even if there are no such positive forecasts, a person will still have to learn to live in new conditions. And he should also feel the taste for life and his own independence from those around him as quickly as possible, which is difficult to achieve without professional medical assistance from doctors at rehabilitation centers.
Symptoms of concussion and contusion of the spinal cord
- sharp and severe pain at the site of injury,
- weakness,
- numbness in the limbs
- pain in the spine,
- loss of sensitivity in certain areas of the body in the area of the destroyed spinal cord,
- impaired motor function,
- involuntary emptying of the bladder or intestines,
- violation breathing,
- cramps below the fracture zone,
- loss of consciousness,
- back / neck curvature,
- partial paralysis.
Spinal cord compression occurs when the vertebral bodies or their fragments are displaced, as well as with the formation of hematomas and cerebral edema. It is possible the loss of sensory activity and the inability to move the limbs or the whole body.
Most serious injuries lead to disorders of the intestinal tract, urinary system, respiratory system and stool. Frequently injured people suffer from chronic pain.
The most serious consequences of spinal cord injury are:
Important! Any back injury requires urgent medical attention, an ambulance or the nearest emergency room. After any spinal injury, emergency care is crucial. The sooner a qualified neurosurgeon stops the pathological process in the spine, the less pronounced the consequences. Do not delay rehabilitation measures to exclude the long-term effects of spinal cord injury.
To clarify the diagnosis, roentgenographyif necessary computer and magnetic resonance imaging (CT, MRI), which can help detect blood clots in the spinal substance. An x-ray of the spine will help determine the location of the injury and the type of injury. Lumbar puncture (lumbar puncture, spinal puncture, lumbar puncture) and myelography may also be needed.
Hematomyelia- bleedingin which blood can accumulate in the hematoma, or fill the spinal cord component. It spreads along it, provoking the destruction of nerve tissues, compression of the motor paths and brain structures. Causes partial damage to the spinal cord, can affect the entire diameter. It is accompanied by excessive outflow of blood into the space of the brain.
The danger of spinal cord rupture
Spinal cord rupture - an extremely serious and painful condition, leading a person to disability, and threatening his life. When a spinal cord ruptures in areas of the body below the rupture site, communication with the brain is broken, they lose their functions. Also, many patients are interested in the question, will there be spasticity with a rupture of the spinal cord? If such a phenomenon is observed, then the probability of restoring lost functions increases. However, spastic events require strict control and should not be triggered.
Rupture of the spinal cord poses a direct threat to human life. If it is possible to survive the most difficult period, a person will need to undergo a long rehabilitation course to adapt to life with disabilities.
Where to get rehabilitation after an injury
High-class professional rehabilitation treatment at the Three Sisters rehabilitation center is based on a combination of classic, latest and original methods developed by the center’s doctors based on many years of practice.
A wide range of specialists in various fields of medicine allows patients to receive almost any medical consultation and individually selected treatment.
The rehabilitation program for the restoration of people who have suffered a spinal injury meets all Western standards, and most importantly, you do not have to overpay for additional services. The Three Sisters Rehabilitation Center operates on an all-inclusive basis, which means that patients will be able to receive all the necessary medical and hardware treatment, balanced nutrition and physiotherapy exercises, the services of all doctors and nursing care, without unnecessary overpayments.
Accommodation in a single comfortable room, meals in a restaurant, or, if desired, in a room, service at the level of a 4-star hotel. But the main thing is the professionalism and attentive attitude of the staff to the patient.
License of the Ministry of Health of the Moscow Region No. LO-50-01-009095 dated October 12, 2017.
Treatment and rehabilitation after spinal cord injuries
Immediately after damage to the spine and spinal cord, a person needs to provide emergency medical care, the help of a neurosurgeon and a neurologist.
In the event of a fracture or fragmentation of the vertebrae, it is urgently necessary to remove parts of the bone from the damaged area so that they do not continue to destroy the cells of the spinal cord. It is also important to restore blood supply to the spinal cord lesion as soon as possible to supply cells oxygen
, oxygen should flow unhindered to the injured part of the spine. At this stage of treatment, it is important to maintain muscle tone. Further, the spine is fixed to prevent repeated injuries. When it is not possible to check for the presence or absence of reflexes, the muscles are supported by electrical impulses. An electric impulse acts on the sleeping nerve endings of the spinal cord and contributes to their activation, while gymnastics and exercise therapy improve muscle activity.
Approaches to treatment can be divided into conservative and surgical methods, each of which has its own goals and objectives.
Conservative treatment consists in rehabilitation of the patient, recovery from trauma, prevention of pressure sores and contractures. It is effective with the preservation of the anatomical integrity of the spinal cord, and the absence of compression from the surrounding tissues (as a rule, fragments of broken bone structures, epidural hematomas).
The release of the spinal roots and spinal cord from scars restores the circulation of cerebrospinal fluid (cerebrospinal fluid), improves blood supply and trophism of the spinal cord, and intraoperative electrical stimulation and electrodiagnostics have a positive result on the speed of restoration of the conduction function of the spinal cord, and therefore on the effectiveness of the rehabilitation methods.
Epidural electrical stimulation spinal cord, with which you can achieve a new impetus in the restoration of motor function, reduce spasticity in the limbs, analgesic effect.
If the above interventions are not effective or impossible, interventions on the peripheral nerves are possible, as well as a number of orthopedic surgeries.
Orthopedic operations consist in changing the attachment points of muscle tendons. The peculiarity of the structure of the human body is that one function is often duplicated by different muscles, and if you cross one tendon, there will be no loss of motor function, since other muscles will perform this function. So it is possible to restore flexion in the hand with the help of extensors, as well as the back flexion of the foot due to plantar flexors.
A separate group can distinguish antispastic and analgesic operations (rhizotomies, radicotomies, DRES-tomies, commissurotomies), as well as brain operations. Each individual patient requires an individual approach, and the success of neurosurgical treatment depends on the qualifications and capabilities of specialists and the corresponding latest technical support in the departments of reconstructive neurosurgery.
Good results in physical and psychological recovery can be achieved in specialized rehabilitation centers, even with severe injuries. The sooner rehabilitation measures are started, the more chances there are to restore a person to a full life, to avoid disability and severe mental disorders, and to adapt to new conditions and changes in life.
Treatment and rehabilitation are carried out strictly under the supervision of experienced doctors, and are built on the basis of which cells are affected. The severity of the injury depends on how timely and competent medical care is provided. An individual treatment and rehabilitation program for spinal cord injuries is built for each patient, and the success of the rehabilitation program depends directly on the efforts of the injured person and on the qualifications of the doctor.
The article used information from open sources and scientific publications.
