Spinal Cord Injuries
The spinal cord is one of the most important parts of the body. This system of tissue and nerve fibers interlinks the brain with most parts of the body, allowing a person to sense and move properly. Basically, the spinal cord transmits messages between the body parts and the brain. There are 31 sets of parallel spinal nerves along the cord, which is enclosed by meninges, protective membranes, and the spinal column, a stack of connected vertebrae that surround the cord while allowing it to flex and move properly. Between each set of vertebrae is a spinal disc, a flat, circular area of tissue that absorbs pressure and allows the bones to move without scraping against each other. Taken together, the spinal cord and brain compose the central nervous system, which controls coordination and other important operations. The four segments of the spinal cord (cervical, thoracic, lumbar, and sacral, from the neck down to the base of the spine) have varying widths, depending on surrounding structures and their functions.
The damaging effects of a spinal cord injury may appear immediately or develop on a delayed basis.
Unfortunately, trauma, disorder, and disease can damage the spinal cord, impairing its function. Spinal cord injuries can impair patients' motor function, mobility, and overall quality of life. They can also lead to spasms, respiratory issues, sexual dysfunction, loss of bowel and bladder function, and mild to extreme discomfort. Spinal cord injuries may be complete, meaning that patients lose all sensation in the affected limbs and experience paralysis, or incomplete, meaning that patients retain some sensory or motor function at and below the site of the injury. The damaging effects of a spinal cord injury may appear immediately or develop on a delayed basis.
A blow to the spine, orthopedic surgery complications, bacterial or viral infection, chemical exposure, or spinal decompression can cause arachnoiditis, or swelling of the arachnoid membrane that encloses the spinal cord. This is the central meninge that protects the spine. Patients with arachnoiditis experience a wide diversity of symptoms, including:
- A prickling or tingling sensation that may feel like a foreign substance on the skin.
- Shooting pains up and down the limbs.
- Sexual dysfunction.
- Abnormal or impaired bowel and bladder function.
- Numbness or weakness in the legs.
- A stinging sensation.
Arachnoiditis is often progressive, meaning that symptoms worsen over time. In some patients, this disorder is temporary, but others experience permanent discomfort and disability as a result of arachnoiditis. In addition, the inflammation in the membrane can lead to other spinal nerve conditions. Aracnoiditis is incurable, but neuro-spinal specialists can help patients manage symptoms with physical therapy, painkilling medications, psychological therapy, electrical stimulation, and corticosteroid injections. Some doctors perform surgery for arachnoiditis, but many do not recommend this treatment method because it has not been proven effective.
Arterial-venous malformations are tangled bunches of arteries and veins that typically develop in fetuses and infants. While they can occur in any area of the body, these defects are most common in the spinal cord and brain. Arterial-venous malformations can interfere with proper spinal cord function by causing bleeding, putting undue pressure on it, and preventing oxygen from reaching the tissue. 88 percent of patients with arterial-venous malformations never even realize they have this condition, but in the other 12 percent, this condition can cause uncomfortable symptoms, such as:
- Seizures and muscle spasms
- Mild to severe headaches
- Muscle weakness, which could lead to paralysis
- Ataxia (loss of coordination and balance)
- Impaired cognitive function
- Loss of sensitivity in the limbs
- A stinging sensation
- Mental confusion
- Learning disabilities
- Behavioral issues
- White noise sounds, which may appear at specific moments or chronically
Most patients develop these symptoms later in life, between their 20s and 50s. However, in very rare cases, infants suffer from severe arterial-venous malformations that may damage important blood vessels or cause a fluid build-up in the brain, which can cause permanent disability or even death.
Neurologists typically treat symptomatic arterial-venous malformations with painkillers and anti-seizure medications. Radiation therapy may also help alleviate symptoms and diminish defects. In some cases, they may recommend surgery to remove the abnormal growths, but these procedures can be difficult to perform, may have limited efficacy, and carry serious risks.
Patients who suffer from spinal cord tumors, infection, spinal fractures, inflammatory disease, multiple sclerosis, stroke, or traumatic injury (from a blow to the spine, gunshot, or knife wound) may develop Brown-Sequard syndrome. This condition involves lesions or other damage to one side of the spinal cord and can be debilitating. It most often affects the cervical region of the spinal cord, which extends through the neck from the head to the shoulders. This disorder is extremely rare, and most often results from stab wounds to the neck. Symptoms of Brown-Sequard syndrome may appear suddenly or develop over time, and can include:
- Numbness near the damaged region or lesion
- Paralysis in one side of the body
- Spasms or overactive reflexes near the site of the injury or disorder
- Chronic discomfort
- Loss of mobility and motor function
Neurologists or spinal specialists may prescribe steroid medications as a temporary solution to ease swelling and minimize discomfort. However, to fully treat Brown-Sequard syndrome, doctors and surgeons typically recommend identifying and addressing the root cause of this issue. For example, if a traumatic injury causes Brown-Sequard syndrome, the wound and underlying damage will need to receive proper care.
Central Cord Syndrome
Damage from osteoarthritis or a traumatic injury in the cervical region of the spinal cord can cause nerve damage that prevents the cerebral cortex from communicating with the spinal cord, leading to central cord syndrome, or CCS. This is one of the most prevalent spinal cord injuries. Common symptoms of CCS include:
- Impaired hand, arm, or leg function
- Loss of bowel or bladder control
- Soreness in the neck and other regions of the spinal cord
- A prickling or burning sensation at the injury site and in surrounding areas
- Compression or spinal disc hernia development in the cervical area
CCS cannot be cured, but its symptoms may be managed such that patients can restore close to normal function. Physicians and neurological specialists may recommend one or more of the following treatments to alleviate symptoms and improve spinal cord health in patients suffering from CCS:
- Anti-inflammatory, steroid, or painkilling medications for temporary relief of symptoms
- Rest, since overexertion can exacerbate CCS
- Physical or occupational therapy
- Surgery to repair spinal disc hernias and diminish compression
Patients who undergo efficient, appropriate treatment improve their chances for successful recovery.
The facets of the spine are the joints that connect two vertebrae. Arthritis, strain, aging, trauma, misalignment, or other spinal disorders can damage these joint structures, causing facet disease. This condition usually causes localized soreness, tightness, and discomfort around the affected joint. Any of the vertebrae can experience facet disease. As the first course of treatment for this disorder, doctors typically recommend local anesthetic injections, which can provide temporary relief and, in some cases, resolve the condition. If symptoms continue, a spine specialist may perform laser facet thermal ablation, a procedure to modify the diseased nerve so that it can no longer cause soreness. If a herniated disc or spinal stenosis is the cause of facet disease, doctors may need to treat these disorders to alleviate symptoms.
Spinal discs sit between vertebrae to hold them in place and shield them from harm. The outer portion of disc tissue is firmer, while the internal portion is softer with a gelatinous texture, allowing it to cushion the surrounding bone. The aging process, overuse, strain, or injury can cause the inner portion of the disc, called the nucleus pulposus, to protrude through its tougher exterior, creating a hernia. Many people have herniated discs without ever knowing it, but this condition can cause unpleasant symptoms if the tissue irritates surrounding nerves. Common symptoms of herniated discs include:
- Localized pain in the arm, leg, buttocks, calf, thigh, or foot (depending on the location of the herniated disc)
- Muscular weakness in the area surrounding the disc, which can restrict patients' range of motion and abilities
- A stinging sensation or numbness near the affected disc
90 percent of patients can alleviate the uncomfortable symptoms of a herniated disc simply by taking painkillers and making lifestyle modifications, such as exercising more and avoiding uncomfortable positions. For more complex or severe cases, doctors may recommend nerve pain drugs, muscle relaxants, corticosteroid injections, narcotics (to be taken on a short-term basis only), ultrasonic treatment, electrical stimulation, braces, traction therapy, or surgery to modify (or in some cases replace) the damaged disc.
Ideally, the spinal column should be relatively straight, if slightly curved forward. However, some patients suffer from kyphosis, an exaggerated rounding due to improper development, wedged spinal bones, disc damage, congenital defects, spinal syndromes, or, most commonly, osteoporosis. The most obvious symptom of kyphosis is the condition itself (a noticeably rounded spine), as well as tightness and discomfort. Doctors may use one or more of the following treatments to correct kyphosis:
- Osteoporosis medications, which help fortify the bones.
- Dietary changes. Getting plenty of vitamin D and calcium can help strengthen the bones and prevent complications from kyphosis, such as fractures.
- A brace to help realign the spine and hold it in proper position.
- Exercise and activity to improve muscular health and maintain a healthy weight (being overweight can put pressure on the spine).
- Physical therapy to improve posture and abdominal strength.
- Spinal fusion surgery to connect two or more vertebrae and modify spinal posture.
Lumbar Disc Disease
Typically due to aging, the spinal discs between vertebrae in the lumbar (lower back region) can begin to dry out and deteriorate, sometimes causing herniation. This can cause them to move abnormally along the spine or become swollen and upset nearby nerves. Strain, overuse, genetic conditions, and traumatic injury can also cause or worsen lumbar disc disease. This condition is relatively widespread-three out of every ten adults over age 30 suffer from a degree of lumbar disc disease. The most common symptom of this disorder is a lower backache, but lumbar disc disease can also cause muscular weakness, numbness, and leg pain. Unlike other spinal cord injuries, the discomfort associated with lumbar disc disease tends to diminish rather than worsen over time. In the meantime, doctors can help patients manage their symptoms with painkillers, rest, or, in severe cases, surgery to modify the offending disc.
Poliomyelitis, or "polio" for short, is a potentially life threatening disease. In many people, this infection is asymptomatic, but it can cause flu-like symptoms in some. In rare but serious cases, polio infects the spinal cord, impairing its function. Polio in the spinal cord can cause a tingling sensation, paralysis, muscle weakness, or meningitis, an infection of the membranes around the spinal cord. Fortunately, due to vaccination, polio has been largely eradicated in the United States. Polio is incurable, but doctors can help patients manage spinal cord infection with painkillers, lifestyle modifications, physical therapy, orthopedic appliances, and, in some cases, surgical procedures to correct the damage caused by this disease.
In patients who suffer from scoliosis, the spine curves to one side. The spinal development process, muscular dystrophy, cerebral palsy, birth defects, infection, and injuries can contribute to this disorder, but doctors are not entirely sure what causes this condition. Scoliosis can cause poor posture and an uneven body shape, which patients may not notice since this disorder develops gradually. Severe scoliosis can interfere with breathing and cause discomfort. Children and adolescents are at higher risk for scoliosis, so their spinal health should be carefully monitored. Doctors often treat scoliosis with corrective braces or, in severe cases, spinal fusion surgery.
Spinal Cord Tumor
Abnormal growths can develop in the spinal cord or surrounding areas. There are two kinds of spinal cord tumors: intramedullary growths originate within the spinal cord, while extramedullary tumors begin in surrounding tissues and grow into the spinal cord. Not all spinal cord tumors are cancerous, but even benign growths can unfortunately be life threatening. Common symptoms of spinal cord tumors include:
- Back soreness, which occasionally spreads to other areas
- Impaired motor function and mobility
- Diminished ability to sense heat, cold, or pain
- Muscle weakness
- Loss of bladder or bowel function
Discomfort from spinal cord tumors can be differentiated from symptoms of other spinal disorders because it is chronic, progressive, worse in the evening, and unrelated to movement or activity. Doctors are not sure what causes abnormal growths in the spinal cord, but they suspect that a patient's family history and exposure to certain substances may play a role. If a spinal specialist identifies a spinal cord tumor before it becomes particularly large or causes unpleasant symptoms, he or she may simply monitor it for any troubling changes. Doctors may also use radiation and chemotherapy to destroy these growths, or perform surgery to remove tumors without disrupting spinal cord function. They may also prescribe painkillers, steroids, or anti-inflammatory medications to temporarily relieve symptoms.
Spina bifida is a birth defect in which the embryo's neural tube, the tissue that covers the brain and spinal cord, does not develop properly. There are three types of spina bifida. Spina bifida occulta is the least problematic type, in which the baby has just a small gap over one or several vertebrae. Meningocele occurs when the meninges protrude through the opening in the neural tube. In babies with the most severe type of spina bifida, myelomeningocele, the meninges and the spinal cord itself bulge out of the middle of the back, sometimes protected by skin. Myelomeningocele can impair bowel and bladder function, cause muscle weakness or paralysis, lead to seizures, or create orthopedic deformities.
Many patients suffer from nerve damage and other symptoms even after spina bifida surgery, thus requiring ongoing treatment and therapy.
Spina bifida occulta may require no treatment, but more severe forms of this disorder often require surgery to close the opening over the spinal cord. This can be performed after birth or, in some cases, prenatally. Unfortunately, many patients suffer from nerve damage and other symptoms even after spina bifida surgery, thus requiring ongoing treatment and therapy.
Aging, hormonal changes, and vitamin deficiencies can weaken the bones, creating a condition called osteoporosis. About 10 million Americans suffer from this common disorder. When it affects the spine, this condition can make vertebrae more vulnerable to fracture, collapse, and other spinal issues. Spinal osteoporosis can also cause a hunched posture, backache, or a gradual loss of height. Doctors may prescribe certain medications to help prevent fractures in patients who suffer from osteoporosis. Biophosphonates can protect the bones, but they may cause abdominal discomfort, esophageal conditions, nausea, or difficulty swallowing. Women who suffer from post-menopausal osteoporosis may benefit from hormone treatments, as well.
Herniated discs, thickened ligament tissue, spinal cord tumors, overactive bone development, the aging process, strain, and traumatic injuries can cause the spinal canals to narrow, creating spinal stenosis. Having thinner gaps between vertebrae and discs can exert undue pressure on the spinal cord. Patients who suffer from spinal stenosis may experience:
- Bladder or bowel incontinence
- Leg cramps after prolonged activity
- Reduced sensitivity, prickling, weakness, or stinging or numbness in the legs, feet, arms, or hands
Doctors may prescribe anti-inflammatory drugs, opioids, muscle relaxants, anti-seizure medications, or antidepressants for this condition. Steroid injections, physical therapy, and surgery may also help alleviate these symptoms.
Excessive bleeding, blood clots, or blocked arteries can cut off blood flow to the spinal cord, causing a spinal stroke. This relatively rare condition prevents the transmission of nerve communications throughout the body, disrupting the function of the central nervous system. The symptoms of spinal stroke typically manifest spontaneously, and can include:
- General discomfort, aching, or pain
- Bowel and bladder malfunction
- Leg muscle weakness or even paralysis
- Numbness or abnormal sensation below the torso
- A burning or tingling sensation
- Muscle spasms
- Sexual dysfunction
- Depression and anxiety
Doctors typically create customized treatment plans for patients who have suffered spinal strokes, according to the cause of this condition and the specific symptoms experienced.
Spondylosis is a general term for any type of spinal deterioration, including that caused by lumbar disc disease, spinal stenosis, facet disease, osteoarthritis, and other spinal conditions. Spondylosis can affect the cervical (neck), thoracic (middle back), or lumbar (low back) regions of the spine. This condition can cause numbness, muscle weakness, tingling, coordination issues, or impaired bowel or bladder function. Spondylosis is typically a symptom rather than a diagnosis, so treating this condition involves identifying and treating its root cause.
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Fluid-filled growths, called syrinxes, can develop within the spinal cord, causing syringomyelia. A brain condition called Chiari malformation, spinal cord injuries, inflammation, and tumors can cause these cysts, which may gradually grow larger, if left untreated. Patients who suffer from syringomelia often experience:
- Muscle atrophy and weakness
- Diminished temperature and pain sensation
- Bowel and bladder issues
- Facial discomfort or numbness
- Loss of normal reflexes
- Muscle spasms, particularly in the legs
- Neck, back, and arm pain
- Scoliosis symptoms
Small, asymptomatic growths may simply require regular neurological check-ups for monitoring. However, if syringomyelia interferes with a patient's daily life, doctors may recommend surgery to allow for improved fluid circulation or drain the syrinxes. Procedures to correct the source of syringomyelia, such as Chiari malformation, tumors, bony growths, or spinal irregularities, may also alleviate symptoms.
Infection, inflammatory conditions, multiple sclerosis, or autoimmune disorders can lead to swelling of the myelin fibers n the spinal cord, creating transverse myelitis. This condition can cause changes in sensation, muscle weakness, bowel or bladder issues, and neck or back pain. Plasma exchange therapy, oral medications, intravenous steroids, physical therapy, and psychotherapy can help treat transverse myelitis and limit the disability associated with this disease.
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