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Category Archives: Spinal Cord Injury Treatment

Traumatic Spinal Cord Injury Treatment & Rehab …

Posted: December 16, 2017 at 7:43 pm

Treatment of spinal cord injury may involve medication, and surgery, and always requires physical therapy. Spinal cord injury may be due to either traumatic or non-traumatic causes. Non-traumatic causes of spinal cord injury occur over time and include arthritis, cancer, infection, blood vessels problems, bleeding, and inflammation.

In the case of traumatic spinal cord injury due to an accident, immediate, comprehensive trauma care is crucial for both survival and long-term outcome. A competent trauma team can do much to minimize the spread of damage from a spinal cord injury. The long-term prognosis for a spinal cord injury depends on the nature and location of the injury, as well as the quality of care received.

If emergency medical personnel suspect you have sustained a spinal injury, they will do everything possible to prevent further injury. While medics work to stabilize your heart rate, breathing, and blood pressure, your head and neck will be put into a special brace to prevent movement and additional injury. You will be put on stiff back board to prevent injury while you are being loaded in the ambulance and taken to the hospital.

Once at the trauma center, doctors will continue to work to make sure that you are stabilized and that no further injury will occur. You will continue to be immobilized while undergoing tests such as CAT scans and MRIs; these imaging tests will help the doctors determine the extent of your injury.

In cases of severe injury to the neck area of the spinal cord, respiratory problems may occur. Doctors may need to help you breathe by giving you oxygen through a tube inserted down your throat; this process is called intubation.

Spinal cord injuries have a tendency to worsen after the initial injury. Blood pressure and blood flow may drop dramatically immediately after the injury or may remain fairly normal in the first few hours only to drop dramatically within a day or so. As blood pressure drops and blow flow decreases, inflammation sets in and nerve cells at a distance from the injury begin to die. Researchers still do not understand all of the reasons why the injury spreads in this way, but a corticosteroid drug first used for spinal cord injuries in the early 1990s may help reduce the extent of the spread.

Doctors may give you this powerful corticosteroid, methylprednisolone (Medrol). When given within eight hours of the initial injury, methylprednisolone has been known to prevent further damage and to promote recovery in some people. Methylprednisolone reduces nerve damage and decreases inflammation around the injury. The use of methylprednisolone is controversial. It can cause serious side effects and some doctors believe it provides little benefit; however, other doctors are convinced that the drug is worth the risks and should be used to in most spinal cord injuries.

During the first few hours and days after a traumatic spinal cord injury, doctors may need to operate remove foreign objects, bone fragments, fractured vertebrae or herniated disks that are compressing the spine (decompressive surgery). Sometimes surgery is necessary to stabilize the spine; however, the precise time to perform emergency surgery is controversial. Some doctors believe that the sooner such an operation is performed, the greater chance a patient has of full recovery. Other doctors are convinced that surgery should be postponed for several days, so that the patients condition will be more stable.

The debate over when to perform surgery is yet to be settled, but in 2008 a comprehensive study seemed to indicate that earlier invention is better. According to the Surgical Treatment of Acute Spinal Cord Injury Study (STASCIS) 24% of people who underwent decompressive surgery within a day of their initial injury showed significant improvement when measured by the American Spinal Injury Association (ASIA) scale. The condition of these patients improved by two grades or better on this scale. While doctors are encouraged by the studys results, it is still too early for a definitive decision on these results. More research must be done.

In the meanwhile, patients and their families desiring early intervention should understand that such a procedure is not advisable for all spinal cord injuries. If you have had a severe spinal cord injury, but experienced no problems with your heart, blood pressure, breathing, and other vital functions, you may be eligible for early intervention. Unfortunately, many people who sustain a spinal cord injury have complications which delay surgery; they frequently have other injuries beside the spinal cord injury.

There are also other surgical procedures which may help you later in your road to recovering as much function as possible. Tendon transfer surgery can sometimes help people with a spinal cord injury gain more control of their arms and hands. A nonessential muscle which still has nerve function can be transferred to a place in the shoulders or arms to assist in motor function. Naturally, tendon transfer surgery is utilized only for people in relatively good health; it requires a period of being immobile for a length of time prior to the surgery, which can cause you to temporarily lose muscle gains you have made. Tendon transfer surgery will not be considered until at least a year after the initial injury.

Adjusting to a spinal cord injury is difficult because all physical aspects of your body are affected. You may lose control of your bladder and/or your bowels and you may experience urinary tract infections. You may experience pressure sores from being in one position for long time. You are at greatly increased risk of blood clots in your limbs and lungs (deep vein thrombosis and pulmonary embolism). Lung and breathing problems are common. You may experience spastic muscles. You are also at risk for a dangerous condition called autonomic dysreflexia and at risk of experiencing a new injury because you lack sensation in your limbs. Although these conditions are very disheartening, they are not insurmountable; your rehabilitation team will help you learn to manage each problem.

The extent of bladder control problems depends on the extent of your injury. In the hospital your bladder function will likely be managed with a catheter which stays in place. A catheter is a thin tube inserted into the bladder; the tube empties into a bag. Later you may benefit from intermittent catherization. You or a caregiver will insert a catheter at regular intervals, so that your bladder may empty completely; intermittent catheterization is less likely to lead to an infection, than leaving the catheter in around the clock. Emptying your bladder on schedule and careful monitoring can help you avoid urinary tract infections; if you do develop an infection, early intervention with antibiotics can help clear it.

A spinal cord injury can cause either a lack of bowel control or constipation. A high fiber diet and medications can help manage bowel function. Your rehabilitation team will help you device a schedule to help regulate bowel elimination.

Pressure sores are a real problem for people with spinal cord injury; they can become seriously infected if left untreated. Because you must sit or lay in the same position for a long period of time, your skin can break down; since you may have little or no sensation in the affected area, you may not realize that there is a problem. Pressure sores can be prevented by regularly changing position. Once you are stable, in the hospital and rehabilitation center, you will be routinely turned through the night, generally at intervals of two hours; this not only helps eliminate pressure sores, it also prevents fluid from accumulating in one area of your body and it helps protect the lungs from pneumonia. You will be turned or repositioned in the day time as well while you are immobile. Once at you will be reminded to change positions frequently, either on your own or with the help of a caregiver.

Staying immobile for long periods of time also slows blood circulation and can cause clots to form. Clots may develop deep within the vein of a muscle (deep vein thrombosis) and these can cause an artery in the lungs to be blocked (pulmonary embolism). Both conditions are extremely risk and can cause death.

You may be given medications to thin your blood and improve your circulation. Some people benefit from inflatable pumps which are placed on the legs to increase circulation and prevent fluid build. Special support stockings can help as well.

Spinal cord injuries can weaken the abdominal and chest muscles; sometimes movement of these muscles is completely impaired. If your diaphragm muscles (chest muscles used to breath with) are completely paralyzed you will be intubated and you may have to stay on a ventilator for a period of time; some people can learn to consciously breath and can thus stay off the ventilator for periods of time.

Even if your breathing is not directly impaired, you are still at greater risk of pneumonia. You will be given respiratory exercises and medications to help prevent lung infections and improve your lung function.

You may experience muscles spasms and your arms and legs may jump. This is relatively rare and unfortunately it is not an indication that you are regaining sensation or movement in these areas. These involuntary movements occur because some of your nerves have become more sensitive, yet your damaged spinal cord will not allow the brain to interpret and regulate their signals.

If your spinal cord was injured above the middle of the chest, you can be subject to autonomic dysreflexia, a dangerous, sometimes fatal problem. Pain or irritation below your injury may send a signal which cannot reach the brain. The interrupted signal causes a reflex which constricts your blood vessels; the blood pressure may rise while the heart rate drops, leading to a stroke or a seizure. Even a simple problem such as a full bladder or irritating clothes may trigger such a signal; eliminating the source of irritation can help relieve the problem. Sometimes a change of position will help.

Because you may not be able to feel pain or other stimuli on some areas of your body it is possible to injure yourself without realizing it. People with spinal cord injuries may experience severe burns or cuts without realizing it. Extra vigilance on your part and on your caregivers part can help eliminate this danger. Be on the lookout for cuts or sores that may require medical treatment.

When you have a spinal cord injury you are sometimes able to feel pain within areas of your body that cannot feel exterior sensations. Pain can come as a result of your initial injury. Your doctor can prescribe medication to help with this pain.

If you are able to regain some mobility, such as using your arms to work a wheelchair or using a walker, you may experience muscle pain from overuse or strain. You may experience less pain as you gains strength and stamina. Your physical therapist may also be able to show you new techniques that will reduce your muscle strain.

Once your condition has been stabilized, rehabilitation can begin. It is important that rehabilitation begin as soon as possible so that your muscles do not atrophy. Today, new technology can assist physical therapists in providing you with the best chance of recovery. A number of specialists may assist your recovery, including a physical therapist, an occupational therapist, a recreation therapist, a rehabilitation nurse, a rehabilitation psychologist, a social worker, and a physician specializing in physical medicine (physiatrist).

Physical therapy will begin in the hospital. At first you will be usually helped to regain strength in your arms and legs. An occupational therapist will help you with fine motor skills and you will be taught new ways of accomplishing every day tasks. You will learn to use adaptive equipment such as a wheelchair and equipment that can make self-care and every day tasks easier (such as an adaptor to help fasten your clothes and specially designed phone to facilitate dialing).

Later, according to your needs and your personal preferences, you may be transferred to a rehabilitation facility or allowed to go home and receive daily physical therapy at home. Severe injuries generally require a period of recuperation in a rehabilitation facility so that all of your medical needs can be attended to and you can receive more intensive therapy than you might at home.

At the rehabilitation center you will receive more and advanced therapy as your condition improves. You and your family will be taught techniques for managing skin care and dealing with possible urinary tract infections. You will also receive help with adapting your home to your new situation.

Newer technology can greatly assist your adjustment to your new limitations. Modern wheelchairs are lighter weight and easier to maneuver than past models. Electronic wheelchairs with adaptive controls can assist people with limited or no use of their arms. Some wheelchairs can elevate to allow you to reach objects above your head and to converse at high level with someone. Other wheelchairs allow the owner to negotiate curbs and climb stairs without assistance.

Computer driven devices can assist you with a wide-range of activities. Voice-activated computers can assist you with online bill paying and other computer work; they can also allow you to dial and answer a phone without using your hands. New computer devices also can help with personal hygiene and with reading.

In recent years an exciting technology called functional neuromuscular stimulation (FNS) has helped many people with a spinal cord injury increase their muscle strength and sometimes regain function. FNS works by stimulating intact peripheral nerves to cause muscle contractions in paralyzed muscles. Electrodes for this stimulation can be placed on the skin surface or can be implanted.

An implantable system can allow people with a certain type of spinal injury to grasp objects with their hands. The device is controlled by the shoulders position. FNS is commonly used with tendon transfer surgery.

The legs may also benefit from FNS. When electrodes are places on the skin of the legs, people with certain forms of spinal cord injury can ride a stationary bicycle. This strengthens the muscles, the bones, and the cardiovascular system. It also provides a psychological boost.

FNS can also stimulate gait for some patients. This can allow you to walk short distances with the aid of a walker. Soon FNS technology may allow people with spinal cord injuries a near return to their former level of function.

In addition to physical changes that can be dangerous, people with spinal cord injury also experience physical changes that directly affect them emotionally. Sexual dysfunction is a common problem for males with a spinal cord injury.

Although men with a spinal cord injury may still experience erections, they may have trouble maintaining an erection. The majority of men with a spinal cord injury have difficulty ejaculating. If you are a man with a spinal cord injury and concerns about your sexual function, consult a urologist or a fertility specialist.

Women with spinal cord injury are generally still able to experience intercourse and become pregnant, but sexual intimacy may not be as pleasurable. Pregnancy for a woman with a spinal cord injury is considered high risk. If you are a woman with concerns about how your spinal cord injury will affect your sexuality and ability to have children consult with a fertility specialist or an obstetrician gynecologist.

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Traumatic Spinal Cord Injury Treatment & Rehab …

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Spinal cord injury – Diagnosis and treatment – Mayo Clinic

Posted: at 7:43 pm

Diagnosis

In the emergency room, a doctor may be able to rule out a spinal cord injury by careful inspection and examination, testing for sensory function and movement, and by asking some questions about the accident.

But if the injured person complains of neck pain, isn’t fully awake, or has obvious signs of weakness or neurological injury, emergency diagnostic tests may be needed.

These tests may include:

A few days after injury, when some of the swelling may have subsided, your doctor will conduct a more comprehensive neurological exam to determine the level and completeness of your injury. This involves testing your muscle strength and your ability to sense light touch and pinprick sensations.

Unfortunately, there’s no way to reverse damage to the spinal cord. But researchers are continually working on new treatments, including prostheses and medications that may promote nerve cell regeneration or improve the function of the nerves that remain after a spinal cord injury.

In the meantime, spinal cord injury treatment focuses on preventing further injury and empowering people with a spinal cord injury to return to an active and productive life.

Urgent medical attention is critical to minimize the effects of any head or neck trauma. Therefore, treatment for a spinal cord injury often begins at the scene of the accident.

Emergency personnel typically immobilize the spine as gently and quickly as possible using a rigid neck collar and a rigid carrying board, which they’ll use to transport you to the hospital.

In the emergency room, doctors focus on:

If you do have a spinal cord injury, you’ll usually be admitted to the intensive care unit for treatment. You may even be transferred to a regional spine injury center that has a team of neurosurgeons, orthopedic surgeons, spinal cord medicine specialists, psychologists, nurses, therapists and social workers with expertise in spinal cord injury.

After the initial injury or the condition stabilizes, doctors turn their attention to preventing secondary problems that may arise, such as deconditioning, muscle contractures, pressure ulcers, bowel and bladder issues, respiratory infections, and blood clots.

The length of your hospitalization depends on your condition and the medical issues you’re facing. Once you’re well enough to participate in therapies and treatment, you may transfer to a rehabilitation facility.

Rehabilitation team members will begin to work with you while you’re in the early stages of recovery. Your team may include a physical therapist, an occupational therapist, a rehabilitation nurse, a rehabilitation psychologist, a social worker, a dietitian, a recreation therapist, and a doctor who specializes in physical medicine (physiatrist) or spinal cord injuries.

During the initial stages of rehabilitation, therapists usually emphasize maintenance and strengthening of existing muscle function, redeveloping fine motor skills and learning adaptive techniques to accomplish day-to-day tasks.

You’ll be educated on the effects of a spinal cord injury and how to prevent complications, and you’ll be given advice on rebuilding your life and increasing your quality of life and independence.

You’ll be taught many new skills, and you’ll use equipment and technologies that can help you live on your own as much as possible. You’ll be encouraged to resume your favorite hobbies, participate in social and fitness activities, and return to school or the workplace.

Medications may be used to manage some of the effects of spinal cord injury. These include medications to control pain and muscle spasticity, as well as medications that can improve bladder control, bowel control and sexual functioning.

Inventive medical devices can help people with a spinal cord injury become more independent and more mobile. Some devices may also restore function. These include:

Your doctor may not be able to give you a prognosis right away. Recovery, if it occurs, typically starts a week to six months after an injury. The fastest rate of recovery is often seen in the first six months, but some people experience small improvements for up to one to two years.

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

An accident that results in paralysis is a life-changing event. Suddenly having a disability can be frightening and confusing, and adapting is no easy task. You may wonder how your spinal cord injury will affect your everyday activities, job, relationships and long-term happiness.

Recovery from such an event takes time, but many people who are paralyzed progress to lead productive and fulfilling lives. It’s essential to stay motivated and get the support you need.

If you’re newly injured, you and your family will likely experience a period of mourning and grief. Although the grieving process is different for everyone, it’s common to experience denial or disbelief, followed by sadness, anger, bargaining and, finally, acceptance.

The grieving process is a common, healthy part of your recovery. It’s natural and important to grieve the loss of the way you were. But it’s also necessary to set new goals and find a way to move forward with your life.

You’ll probably have concerns about how your injury will affect your lifestyle, your financial situation and your relationships. Grieving and emotional stress are normal and common.

However, if your grief and sadness are affecting your care, causing you to isolate yourself from others, or prompting you to abuse alcohol or other drugs, you may want to consider talking to a social worker, psychologist or psychiatrist. Or you might find a support group of people with spinal cord injuries helpful.

Talking with others who understand what you’re going through can be encouraging, and members of the group may have good advice on adapting areas of your home or work space to better accommodate your current needs. Ask your doctor or rehabilitation specialist if there are any support groups in your area.

One of the best ways to regain control of your life is to educate yourself about your injury and your options for reclaiming an independent life. A range of driving equipment and vehicle modifications is available today.

The same is true of home modification products. Ramps, wider doors, special sinks, grab bars and easy-to-turn doorknobs make it possible for you to live more autonomously.

Because the costs of a spinal cord injury can be overwhelming, you may want to find out if you’re eligible for economic assistance or support services from the state or federal government or from charitable organizations. Your rehabilitation team can help you identify resources in your area.

Your friends and family may respond to your disability in different ways. Some may be uncomfortable and unsure if they’re saying or doing the right thing.

Being educated about your spinal cord injury and willing to educate others is helpful. Children are naturally curious and sometimes adjust rather quickly if their questions are answered in a clear, straightforward way. Adults also can benefit from learning the facts.

Explain the effects of your injury and what your family and friends can do to help. At the same time, don’t hesitate to tell friends and loved ones when they’re helping too much. Although it may be uncomfortable at first, talking about your injury often strengthens your relationships with family and friends.

Your spinal cord injury may affect your body’s response to sexual stimuli. However, you’re a sexual being with sexual desires. A fulfilling emotional and physical relationship is possible but requires communication, experimentation and patience.

A professional counselor can help you and your partner communicate your needs and feelings. Your doctor can provide the medical information you need regarding sexual health. You can have a satisfying future complete with intimacy and sexual pleasure.

By nature, a spinal cord injury has a sudden impact on your life and the lives of those closest to you. When you first hear your diagnosis, you may start making a mental list of all of the things you can’t do anymore. However, as you learn more about your injury and your treatment options, you may be surprised by all you can do.

Thanks to new technologies, treatments and devices, people with spinal cord injuries play basketball and participate in track meets. They paint and take photographs. They get married, have and raise children, and have rewarding jobs.

Today, advances in stem cell research and nerve cell regeneration give hope for a greater recovery for people with spinal cord injuries. At the same time, new treatments are being investigated for people with long-standing spinal cord injuries.

No one knows when new treatments will be available, but you can remain hopeful about the future of spinal cord research while living your life to the fullest today.

Traumatic spinal cord injuries are emergencies, and the person who’s injured may not be able to participate in his or her care in the beginning.

A number of specialists will be involved in stabilizing the condition, including a doctor who specializes in nervous system disorders (neurologist) and a surgeon who specializes in spinal cord injuries and other nervous system problems (neurosurgeon), among others.

A doctor who specializes in spinal cord injuries will lead your rehabilitation team, which will include a variety of specialists.

If you have a possible spinal cord injury or you accompany someone who’s had a spinal cord injury and can’t provide the necessary information, here are some things you can do to facilitate care.

For a spinal cord injury, some basic questions to ask the doctor include:

Don’t hesitate to ask any other questions you have.

Your doctor is likely to ask questions, including:

Dec. 16, 2017

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Spinal cord injury – Diagnosis and treatment – Mayo Clinic

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Spinal Cord Injury | Paralyzed Veterans of America

Posted: at 7:43 pm

Every year, more than 12,000 people in the United States sustain a spinal cord injury. A spinal cord injury / disease (SCI/D) changes a persons life in an instant, and can have life-changing consequences. Veterans who have experienced an SCI can take advantage of ongoing support and helpful resources and benefits through aParalyzed Veterans of America membership.

More than 5 million Americans are living with paralysis, one in 4 of them a result of spinal cord injury or disease. The spinal cord is the major channel through which motor and sensory information travels between the brain and body.

When injury or disease of the spinal cord occurs, conduction of sensory and motor signals across the site of lesion(s) is impaired, resulting in loss of motor and/or sensory function. To further define, tetraplegia refers to impairment of function in the arms as well as the trunk, legs and pelvic organs. Paraplegia refers to impairment of arm functioning is spared and trunk, legs and pelvic organ involvement is dependent of the level of injury.

Injuries are classified as incomplete if partial preservation of sensory and/or motor function is present below the level of injury, to include sensation at the lowest segment of spinal cord; and complete when sensory and motor function is absent in the lowest segment of the spinal cord.

Prior to the 1970s, life expectancy for people with SCI/D was significantly reduced, mostly because of urological or respiratory infections. Since the improved management of infections, life expectancy has increased; however, respiratory diseases and septicemia remain the leading cause of death for individuals with SCI/D. It is important for caregivers and clinicians to recognize atypical signs and symptoms of infection, including, but not limited to fever, chills, spasms, nausea, vomiting, and fatigue as warning signs of infection in individuals with SCI/D.

Autonomic Dysreflexia (AD) is a preventable condition that can result in death if not quickly treated. Those with spinal cord injury at the sixth nerve of the thoracic spine or above are most commonly at risk, and in some cases the seventh and eighth nerve. AD can affect individuals with complete and incomplete injuries.

Common signs and symptoms of AD include sudden/significant elevation of blood pressure, severe headache, profuse sweating, goosebumps, blurred vision, seeing spots, flushed skin, nasal congestion, slowed pulse, tightness in chest, and anxiety. If any of these are experienced, emergency treatment must be initiated to include: sit up or raise head to 90 degrees and remain upright until blood pressure is normal, based on individuals baseline blood pressure; check/empty bowel or bladder; loosen or remove tight clothing; monitor blood pressure every 5 minutes; and call health care professional, even if symptoms resolve.

In addition to those injured traumatically, neurologic impairment of the spinal cord (myelopathy) may predominantly occur in diseases such as multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), benign or malignant tumors, spinal stenosis, arterio-venous malformations, epidural abscess, and other vascular, inflammatory, or infections of the spinal cord itself.

Similar to spinal cord injury, spinal cord disease causes various patterns of deficits depending on which nerve tracts within the spinal cord or which spinal roots outside of the cord are damaged. Common warning signs of spinal cord disease include paresis, loss of sensation, change in reflexes, and autonomic dysfunction (bowel/bladder, erectile dysfunction, loss of ability to sweat).

With increased longevity for persons with SCI/D, co-morbidities such as metabolic disease, endocrine disease, and musculoskeletal disorders are becoming increasingly common and require comprehensive specialty care for the prevention or early detection of health complications seen in the aging population.

Within the Veterans Health Administration, the Spinal Cord Injury and Disease System of Care provides an interdisciplinary team approach to manage the physical, psychological, environmental, and interpersonal support of individuals living with SCI/D. At the onset of rehabilitation and throughout life time, this comprehensive system of care helps individuals with SCI/D attain, preserve, and enhance the health and quality of life.Heres how to find one near you.

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Spinal Cord Injury | Paralyzed Veterans of America

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Spinal cord injury – Symptoms and causes – Mayo Clinic

Posted: at 7:43 pm

Overview

A spinal cord injury damage to any part of the spinal cord or nerves at the end of the spinal canal (cauda equina) often causes permanent changes in strength, sensation and other body functions below the site of the injury.

If you’ve recently experienced a spinal cord injury, it might seem like every aspect of your life has been affected. You might feel the effects of your injury mentally, emotionally and socially.

Many scientists are optimistic that advances in research will someday make the repair of spinal cord injuries possible. Research studies are ongoing around the world. In the meantime, treatments and rehabilitation allow many people with spinal cord injuries to lead productive, independent lives.

Your ability to control your limbs after a spinal cord injury depends on two factors: the place of the injury along your spinal cord and the severity of injury to the spinal cord.

The lowest normal part of your spinal cord is referred to as the neurological level of your injury. The severity of the injury is often called “the completeness” and is classified as either of the following:

Additionally, paralysis from a spinal cord injury may be referred to as:

Your health care team will perform a series of tests to determine the neurological level and completeness of your injury.

Spinal cord injuries of any kind may result in one or more of the following signs and symptoms:

Emergency signs and symptoms of a spinal cord injury after an accident may include:

Anyone who experiences significant trauma to his or her head or neck needs immediate medical evaluation for the possibility of a spinal injury. In fact, it’s safest to assume that trauma victims have a spinal injury until proved otherwise because:

Spinal cord injuries may result from damage to the vertebrae, ligaments or disks of the spinal column or to the spinal cord itself.

A traumatic spinal cord injury may stem from a sudden, traumatic blow to your spine that fractures, dislocates, crushes or compresses one or more of your vertebrae. It also may result from a gunshot or knife wound that penetrates and cuts your spinal cord.

Additional damage usually occurs over days or weeks because of bleeding, swelling, inflammation and fluid accumulation in and around your spinal cord.

A nontraumatic spinal cord injury may be caused by arthritis, cancer, inflammation, infections or disk degeneration of the spine.

The central nervous system comprises the brain and spinal cord. The spinal cord, made of soft tissue and surrounded by bones (vertebrae), extends downward from the base of your brain and is made up of nerve cells and groups of nerves called tracts, which go to different parts of your body.

The lower end of your spinal cord stops a little above your waist in the region called the conus medullaris. Below this region is a group of nerve roots called the cauda equina.

Tracts in your spinal cord carry messages between the brain and the rest of the body. Motor tracts carry signals from the brain to control muscle movement. Sensory tracts carry signals from body parts to the brain relating to heat, cold, pressure, pain and the position of your limbs.

Whether the cause is traumatic or nontraumatic, the damage affects the nerve fibers passing through the injured area and may impair part or all of your corresponding muscles and nerves below the injury site.

A chest (thoracic) or lower back (lumbar) injury can affect your torso, legs, bowel and bladder control, and sexual function. A neck (cervical) injury affects the same areas in addition to affecting movements of your arms and, possibly, your ability to breathe.

The most common causes of spinal cord injuries in the United States are:

Although a spinal cord injury is usually the result of an accident and can happen to anyone, certain factors may predispose you to a higher risk of sustaining a spinal cord injury, including:

At first, changes in the way your body functions may be overwhelming. However, your rehabilitation team will help you develop the tools you need to address the changes caused by the spinal cord injury, in addition to recommending equipment and resources to promote quality of life and independence. Areas often affected include:

Bladder control. Your bladder will continue to store urine from your kidneys. However, your brain may not be able to control your bladder as well because the message carrier (the spinal cord) has been injured.

The changes in bladder control increase your risk of urinary tract infections. The changes also may cause kidney infections and kidney or bladder stones. During rehabilitation, you’ll learn new techniques to help empty your bladder.

Skin sensation. Below the neurological level of your injury, you may have lost part of or all skin sensations. Therefore, your skin can’t send a message to your brain when it’s injured by certain things such as prolonged pressure, heat or cold.

This can make you more susceptible to pressure sores, but changing positions frequently with help, if needed can help prevent these sores. You’ll learn proper skin care during rehabilitation, which can help you avoid these problems.

Circulatory control. A spinal cord injury may cause circulatory problems ranging from low blood pressure when you rise (orthostatic hypotension) to swelling of your extremities. These circulation changes may also increase your risk of developing blood clots, such as deep vein thrombosis or a pulmonary embolus.

Another problem with circulatory control is a potentially life-threatening rise in blood pressure (autonomic hyperreflexia). Your rehabilitation team will teach you how to address these problems if they affect you.

Respiratory system. Your injury may make it more difficult to breathe and cough if your abdominal and chest muscles are affected. These include the diaphragm and the muscles in your chest wall and abdomen.

Your neurological level of injury will determine what kind of breathing problems you may have. If you have a cervical and thoracic spinal cord injury, you may have an increased risk of pneumonia or other lung problems. Medications and therapy can help prevent and treat these problems.

Fitness and wellness. Weight loss and muscle atrophy are common soon after a spinal cord injury. Limited mobility may lead to a more sedentary lifestyle, placing you at risk of obesity, cardiovascular disease and diabetes.

A dietitian can help you eat a nutritious diet to sustain an adequate weight. Physical and occupational therapists can help you develop a fitness and exercise program.

Following this advice may reduce your risk of a spinal cord injury:

Drive safely. Car crashes are one of the most common causes of spinal cord injuries. Wear a seat belt every time you drive or ride in a car.

Make sure that your children wear a seat belt or use an age- and weight-appropriate child safety seat. To protect them from air bag injuries, children under age 12 should always ride in the back seat.

Dec. 16, 2017

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Spinal cord injury – Symptoms and causes – Mayo Clinic

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Spinal cord injury Treatments and drugs – Mayo Clinic

Posted: December 11, 2017 at 12:42 pm

Diagnosis

In the emergency room, a doctor may be able to rule out a spinal cord injury by careful inspection, testing for sensory function and movement and asking some questions about the accident.

But if the injured person complains of neck pain, isn’t fully awake or has obvious signs of weakness or neurological injury, emergency diagnostic tests may be needed.

These tests may include:

A few days after injury, when some of the swelling may have subsided, your doctor will conduct a neurological exam to determine the level and completeness of your injury. This involves testing your muscle strength and your ability to sense light touch and a pinprick.

Unfortunately, there’s no way to reverse damage to the spinal cord. But researchers are continually working on new treatments, including prostheses and medications that may promote nerve cell regeneration or improve the function of the nerves that remain after a spinal cord injury.

In the meantime, spinal cord injury treatment focuses on preventing further injury and empowering people with a spinal cord injury to return to an active and productive life.

Urgent medical attention is critical to minimize the effects of any head or neck trauma. That’s why treatment for a spinal cord injury often begins at the scene of the accident.

Emergency personnel typically immobilize the spine as gently and quickly as possible using a rigid neck collar and a rigid carrying board, which they’ll use to transport you to the hospital.

In the emergency room, doctors focus on:

You may be sedated so that you don’t move and sustain more damage while undergoing diagnostic tests for spinal cord injury.

If you do have a spinal cord injury, you’ll usually be admitted to the intensive care unit for treatment. You may even be transferred to a regional spine injury center that has a team of neurosurgeons, orthopedic surgeons, spinal cord medicine specialists, psychologists, nurses, therapists and social workers with expertise in spinal cord injury.

Medications. Intravenous (IV) methylprednisolone (A-Methapred, Solu-Medrol) is a treatment option for an acute spinal cord injury. If methylprednisolone is given within eight hours of injury, some people experience mild improvement.

It appears to work by reducing damage to nerve cells and decreasing inflammation near the site of injury. However, it’s not a cure for a spinal cord injury.

After the initial injury or disease stabilizes, doctors turn their attention to preventing secondary problems that may arise, such as deconditioning, muscle contractures, pressure ulcers, bowel and bladder issues, respiratory infections and blood clots.

The length of your hospitalization depends on your condition and the medical issues you’re facing. Once you’re well enough to participate in therapies and treatment, you may transfer to a rehabilitation facility.

Rehabilitation team members will begin to work with you while you’re in the early stages of recovery. Your team may include a physical therapist, occupational therapist, rehabilitation nurse, rehabilitation psychologist, social worker, dietitian, recreation therapist and a doctor who specializes in physical medicine (physiatrist) or spinal cord injuries.

During the initial stages of rehabilitation, therapists usually emphasize maintenance and strengthening of existing muscle function, redeveloping fine motor skills and learning adaptive techniques to accomplish day-to-day tasks.

You’ll be educated on the effects of a spinal cord injury and how to prevent complications, and you’ll be given advice on rebuilding your life and increasing your quality of life.

You’ll be taught many new skills, and you’ll use equipment and technology that can help you live on your own as much as possible. You’ll be encouraged to resume your favorite hobbies, participate in social and fitness activities and return to school or the workplace.

Medications may be used to manage some of the effects of spinal cord injury. These include medications to control pain and muscle spasticity, as well as medications that can improve bladder control, bowel control and sexual functioning.

Inventive medical devices can help people with a spinal cord injury become more independent and more mobile. Some devices may also restore function. These include:

Your doctor may not be able to give you a prognosis right away. Recovery, if it occurs, typically starts a week to six months after an injury. However, some people experience small improvements for up to one year or longer.

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

An accident that results in paralysis is a life-changing event. Suddenly having a disability can be frightening and confusing, and adapting is no easy task. You may wonder how your spinal cord injury will affect your everyday activities, job, relationships and long-term happiness.

Recovery from such an event takes time, but many people who are paralyzed progress to lead productive and fulfilling lives. It’s essential to stay motivated and get the support you need.

If you’re newly injured, you and your family will likely experience a period of mourning and grief. Although the grieving process is different for everyone, it’s common to experience denial or disbelief, followed by sadness, anger, bargaining and, finally, acceptance.

The grieving process is a common, healthy part of your recovery. It’s natural and important to grieve the loss of the way you were. But it’s also necessary to set new goals and find a way to move forward with your life.

You’ll probably have concerns about how your injury will affect your lifestyle, your financial situation and your relationships. Grieving and emotional stress are normal and common.

However, if your grief and sadness are affecting your care, causing you to isolate yourself from others or prompting you to abuse alcohol or other drugs, you may want to consider talking to a social worker, psychologist or psychiatrist. Or you might find a support group of people with spinal cord injuries helpful.

Talking with others who understand what you’re going through can be encouraging, and members of the group may have good advice on adapting areas of your home or work space to better accommodate your current needs. Ask your doctor or rehabilitation specialist if there are any support groups in your area.

One of the best ways to regain control of your life is to educate yourself about your injury and your options for reclaiming an independent life. A range of driving equipment and vehicle modifications is available today.

The same is true of home modification products. Ramps, wider doors, special sinks, grab bars and easy-to-turn doorknobs make it possible for you to live more autonomously.

Because the costs of a spinal cord injury can be overwhelming, you may want to find out if you’re eligible for economic assistance or support services from the state or federal government or from charitable organizations. Your rehabilitation team can help you identify resources in your area.

Your friends and family may respond to your disability in different ways. Some may be uncomfortable and unsure if they’re saying or doing the right thing.

Being educated about your spinal cord injury and willing to educate others is helpful. Children are naturally curious and sometimes adjust rather quickly if their questions are answered in a clear, straightforward way. Adults can also benefit from learning the facts.

Explain the effects of your injury and what your family and friends can do to help. At the same time, don’t hesitate to tell friends and loved ones when they’re helping too much. Although it may be uncomfortable at first, talking about your injury often strengthens your relationships with family and friends.

Your spinal cord injury may affect your body’s response to sexual stimuli. However, you’re a sexual being with sexual desires. A fulfilling emotional and physical relationship is possible but requires communication, experimentation and patience.

A professional counselor can help you and your partner communicate your needs and feelings. Your doctor can provide the medical information you need regarding sexual health. You can have a satisfying future complete with intimacy and sexual pleasure.

By nature, a spinal cord injury has a sudden impact on your life and the lives of those closest to you. When you first hear your diagnosis, you may start making a mental list of all of the things you can’t do anymore. However, as you learn more about your injury and your treatment options, you may be surprised by all you can do.

Thanks to new technologies, treatments and devices, people with a spinal cord injury play basketball and participate in track meets. They paint and take photographs. They get married, have and raise children, and have rewarding jobs.

Today, advances in stem cell research and nerve cell regeneration give hope for a greater recovery for people with spinal cord injuries. At the same time, new medications are being investigated for people with long-standing spinal cord injuries.

No one knows when new treatments will be available, but you can remain hopeful about the future of spinal cord research while living your life to the fullest today.

Traumatic spinal cord injuries are emergencies, and the person who’s injured may not be able to participate in his or her care in the beginning.

A number of specialists will be involved in stabilizing the condition, including a doctor who specializes in nervous system disorders (neurologist) and a surgeon who specializes in spinal cord injuries and other nervous system problems (neurosurgeon), among others.

The rehabilitation team, which will include a variety of specialists, will be led by a doctor who specializes in spinal cord injury.

If you have a possible spinal cord injury or you accompany someone who’s had a spinal cord injury and can’t provide the necessary information, here are some things you can do to facilitate care.

For a spinal cord injury, some basic questions to ask the doctor include:

Don’t hesitate to ask any other questions you have.

Your doctor is likely to ask questions, including:

Oct. 08, 2014

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Spinal cord injury Treatments and drugs – Mayo Clinic

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Stem Cell Treatment for Spinal Cord Injury – Beike …

Posted: at 12:42 pm

Acupuncture

Acupuncture is a technique in which practitioners stimulate specific points on the body – most often by inserting thin needles through the skin. It is one of the most effective practices used in traditional Chinese medicine. Acupuncture stimulates nerve fibers to transmit signals to the spinal cord and brain, activating the bodys central nervous system. The spinal cord and brain then release hormones responsible for making us feel less pain while improving overall health. Acupuncture may also: increase blood circulation and body temperature, affect white blood cell activity (responsible for our immune function), reduce cholesterol and triglyceride levels, and regulate blood sugar levels.

Aquatherapy

Aquatic Physical Therapy is the practice of physical therapy in a specifically designed water pool with a therapist. The unique properties of the aquatic environment enhance interventions for patients with neurological or musculoskeletal conditions. Aquatic therapy includes a wide range of techniques allowing patients to improve their balance, muscle strength and body mechanics. Aquatic therapy works to enhance the rehabilitation process and support effectiveness of stem cell treatment.

Epidural Stimulation

Hyperbaric Oxygen Therapy

Hyperbaric Oxygen Therapy (HBOT) is the medical use of oxygen at a level higher than atmospheric pressure. The equipment required consists of pressure chamber, which may be of rigid or flexible construction, and a means of delivering 100% oxygen into the respiratory system. Published research shows that HBOT increases the lifespan of stem cells after injection and provides an oxygen-rich atmosphere for the body to function at optimum levels.

Nerve Growth Factor (NGF)

Nerve growth factor (NGF) is a member of the neurotrophic factor (neurotrophin, NTFS) family, which can prevent the death of nerve cells and has many features of typical neurotransmitter molecules. NGF plays an important role in the development and growth of nerve cells. NGF is synthesized and secreted by tissues (corneal epithelial, endothelial, and corneal stromal cells), and it can be up-taken by sympathetic or sensory nerve endings and then transported to be stored in neuronal cell bodies where it can promote the growth and differentiation of nerve cells.NGF can exert neurotrophic effects on injured nerves and promote neurogenesis (the process of generating neurons from stem cells) that is closely related to the development and functional maintenance and repair of the central nervous system. It is also capable of promoting the regeneration of injured neurons in the peripheral nervous system, improving the pathology of neurons and protecting the nerves against hypoxia (lack of oxygen)/ischemia (lack of blood supply).

Nutrition Therapy

Occupational Therapy

Occupational therapy interventions focus on adapting the environment, modifying the task and teaching the skill, in order to increase participation in and performance of daily activities, particularly those that are meaningful to the patient with physical, mental, or cognitive disorders. Our Occupational Therapists also focus much of their work on identifying and eliminating environmental barriers to independence and participation in daily activities, similar to everyday life.

Physiotherapy

Physical therapy or physiotherapy (often abbreviated to PT) is a physical medicine and rehabilitation specialty that, by using mechanical force and movements, remediates impairments and promotes mobility, function, and quality of life through examination, diagnosis, prognosis, and physical intervention. We combine our PT with stem cells for maximum physical rehabilitation improvements.

Transcranial Magnetic Stimulation

Research has shown that TMS can effectively treat symptoms of depression, anxiety, neurological pain, stroke, spinal cord injuries, autism and more. This procedure is very simple and noninvasive. During the procedure, a magnetic field generator or coil is placed near the head of the person receiving the treatment. The coil produces small electrical currents in the region of the brain just under the coil via electromagnetic induction. This electrical field causes a change in the transmembrane current of the neuron which leads to depolarization or hyperpolarization of the neuron and the firing of an action potential.

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Levels of Spinal Cord Injury – Brain and Spinal Cord

Posted: at 12:42 pm

Basic Spinal Cord Anatomy

To understand this confusion and what you are actually being told when your injury is described as being at a certain level, it is necessary to understand basic spinal anatomy. The spine and the spinal cord are two different structures. The spinal cord is a long series of nerve cells and fibers running from the base of the brain to shortly above the tailbone. It is encased in the bony vertebrae of the spine, which offers it some protection.

The spinal cord relays nerve signals from the brain to all parts of the body and from all points of the body back to the brain. Part of the confusion regarding spinal cord injury levels comes from the fact that the spine and the spinal cord each are divided into named segments which do not always correspond to each other. The spine itself is divided into vertebral segments corresponding to each of the vertebrae.

The spinal cord is divided into neurological segmental levels, meaning that the focus is on what part of the body the nerves from each section control. The spine is divided into seven neck (cervical) vertebrae, twelve chest (thoracic) vertebra, five back (lumbar) vertebrae, and five tail (sacral) vertebrae. The segments of the spine and spinal cord are designated by letters and numbers; the letters used in the designation correspond to the location on the spine or the spinal cord. For example:

The spinal cord segments are named in the same fashion, but their location does not necessarily correspond to the spinal segments location. For example:

The spinal cord is responsible for relaying the nerve messages that control voluntary and involuntary movement of the muscles, including those of the diaphragm, bowels, and bladder. It relays these messages to the rest of the body via spinal roots which branch out from the cord.

The spinal roots are nerves that go through the spines bone canal and come out at the vertebral segments of the spinal cord. Bodily functions can be disrupted by injury to the spinal cord. The amount of the impairment depends on the degree of damage and the location of the injury.

The head is held by the first and second cervical segments. The cervical cord supplies the nerves for the deltoids, biceps, triceps, wrist extensors, and hands. The phrenic nucleus (a group of cell bodies with nerve links to the diaphragm) is located in the C3 cord.

The thoracic vertebral segments compose the rear wall of the ribs and pulmonary cavity. In this area, the spinal roots compose the between the ribs nerves (intercostal nerves) which control the intercostal muscles.

The spinal cord does not travel the entire length of the spine. It ends at the second lumbar segment (L2). Spinal roots exit below the spinal cords tip (conus) in a spray; this is called the cauda equine (horses tail). Damage below the L2 generally does not interfere with leg movement, although it can contribute to weakness.

In addition to motor function, the spinal cord segments each innervate different sections of skin called dermatomes. This provides the sense of touch and pain. The area of a dermatome may expand or contract after a spinal cord injury.

The differences between some of the spinal vertebral and spinal cord levels have added to the confusion in developing a standardized rating scale for spinal cord injuries. In the 1990s, the American Spinal Cord Association devised a new scale to help eliminate ambiguities in rating scales. The ASIA scale is more accurate than previous rating systems, but there are still differences in the ways various medical specialists evaluate an SCI injury.

Dr. Wise Young, founding director of Rutgers W. M. Keck Center for Collaborative Neuroscience explains that usually neurologists (nerve specialists) will rate the level of injury at the first spinal segment level which exhibits loss of normal function; however, rehabilitation doctors (physiatrists) usually rate the level of injury at the lowest spinal segment level which remains normal.

For example, a neurologist might say that an individual with normal sensations in the C3 spinal segment who lacks sensation at the C4 spinal segment should be classified as a sensory level C4, but a physiatrist might call it a C3 injury level. Obviously, these differences are confusing to the patient and to the patients family. People with a spinal cord injury simply want to know what level of disability they will have and how much function they are likely to regain. Adding to the confusion is the debate over how to define complete versus incomplete injuries.

For many years, a complete spinal cord injury was thought of as meaning no conscious sensations or voluntary muscle use below the site of the injury; however, this does not take in to account that partial preservation of function below the injury site is rather common. This definition of a complete injury also failed to take into account the fact that may people have lateral preservation (function on one side).

In addition, a person may later recover a degree of function, after being labeled in the first few days after the injury as having a complete injury. In 1992, the American Spinal Cord Association sought to remedy this dilemma by coming up with a simple definition of complete injury.

According to the ASIA scale, a person has a complete injury if they have no sensory or motor function in the perineal and anal region; this area corresponds to the lowest part of the sacral cord (S4-S5). A rectal examination is used to help determine function in this area. The ASIA Scale is classified as follows:

At this point, if you are a patient with a spinal cord injury or the family member of a spinal cord injury patient you may be more confused than ever. How do these ratings apply to the daily life of someone with a spinal cord injury? A brief overview of the basic definitions may help.

This is the greatest level of paralysis. Complete C1-C4 tetraplegia means that the person has no motor function of the arms or legs. He or she generally can move the neck and possibly shrug the shoulders. When the injury is at the C1-C3 level, the person will usually need to be on a ventilator for the long-term; fortunately, new techniques may be able to reduce the need for a ventilator.

A person whose injury is at the C4 level usually will not need to use the ventilator for the long-term, but will likely need ventilation in the first days after the injury. People with complete C1-C4 quadriplegia may be able to use a power wheelchair that can be controlled with the chin or the breath. They may be able control a computer with adaptive devices in a similar fashion and some can work in this way. They can also control light switches, bed controls, televisions and so with the help of adaptive devices. They will require a caregivers assistance for most or all of their daily needs.

People with C5 tetraplegia can flex their elbows and with the help of assistive devices to help them hold objects, they can learn to feed and groom themselves. With some help they can dress their upper body and change positions in bed. They can use a power wheelchair equipped with hand controls and some may be able use a manual wheelchair with grip attachments for a short distance on level ground.

People with C5 will need to rely on caregivers for transfers from bed to chair and so forth, and for assistance with bladder and bowel management, as well as with bathing and dressing the lower body. Adaptive technology can help these people be independent in many areas, including driving. People with C5 tetraplegia can drive a vehicle equipped with hand controls.

People with C6 tetraplegia have the use both of the elbow and the wrist and with assistive support can grasp objects. Some people with C6 learn to transfer independently with the help of a slide board. Some can also handle bladder and bowel management with assistive devices, although this can be difficult.

People with C6 can learn to feed, groom, and bath themselves with the help of assistance devices. They can operate a manual wheelchair with grip attachments and they can drive specially adapted vehicles. Most people with C6 will need some assistance from a caregiver at times.

People with C7 tetraplegia can extend the elbow, which allows them greater freedom of movement. People with C7 can live independently. They can learn to feed and bath themselves and to dress the upper body. They can move in bed by themselves and transfer by themselves. They can operate a manual wheelchair, but will need help negotiating curbs. They can drive specially-equipped vehicles. They can write, type, answer phones, and use computers; some may need assistive devices to do so, while others will not.

People with C8 tetraplegia can flex their fingers, allowing them a better grip on objects. They can learn to feed, groom, dress, and bath themselves without help. They can manage bladder and bowel care and transfer by themselves. They can use a manual wheelchair and type, write, answer the phone and use the computer. They can drive vehicles adapted with hand controls.

People with T1-T12 paraplegia have nerve sensation and function of all their upper extremities. They can become functionally independent, feeding and grooming themselves and cooking and doing light housework. They can transfer independently and manage bladder and bowel function. They can handle a wheelchair quite well and can learn to negotiate over uneven surfaces and handle curbs. They can drive specially adaptive vehicles.

People with a T2-T9 injury may have enough torso control to be able to stand with the help of braces and a walker or crutches. People with a T10-T12 injury have better torso control than those with a T2-T9 injury, and they may be able to walk short distances with the aid of a walker or crutches.

Some can even go up and down stairs; however, walking with such an injury requires a great deal of effort and can quickly exhaust the patient. Many people with thoracic paraplegia prefer to use a wheelchair so that they will not tire so quickly.

People with sacral or lumbar paraplegia can be functionally independent in all of their self-care and mobility needs. They can learn to skillfully handle a manual wheelchair and can drive specially equipped vehicles. People with a lumbar injury can usually learn to walk for distances of 150 feet or longer, using assistive devices. Some can walk this distance without assistance devices. Most rely on a manual wheelchair when longer distances must be covered.

There are many other functional scales besides the ASIA scale, but it is the most frequently used. Neurologists find the NLOI (the Neurological level of injury) scale helpful; it is a simply administered test of motor function and range of motion. The Function Independence Measure (FIM) evaluates function in mobility, locomotion, self-care, continence, communication, and social cognition on a 7-point scale.

The Quadriplegic Index of Function (QIF) detects small, clinically significant changes in people with tetraplegia. Other scales include the Modified Barthel Index, the Spinal Cord Independence Measure (SCIM), the Capabilities of Upper Extremity Instrument (CUE), the Walking Index for SCI (WISCI), and the Canadian Occupational Performance Measure (COPM).

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Levels of Spinal Cord Injury – Brain and Spinal Cord

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Spinal cord injury – Mayo Clinic

Posted: December 9, 2017 at 9:43 am

Overview

A spinal cord injury damage to any part of the spinal cord or nerves at the end of the spinal canal often causes permanent changes in strength, sensation and other body functions below the site of the injury.

If you’ve recently experienced a spinal cord injury, it might seem like every aspect of your life will be affected.

Many scientists are optimistic that advances in research will someday make the repair of spinal cord injuries possible. Research studies are ongoing around the world. In the meantime, treatments and rehabilitation allow many people with a spinal cord injury to lead productive, independent lives.

Your ability to control your limbs after spinal cord injury depends on two factors: the place of the injury along your spinal cord and the severity of injury to the spinal cord.

The lowest part of your spinal cord that functions normally after injury is referred to as the neurological level of your injury. The severity of the injury is often called “the completeness” and is classified as either of the following:

Additionally, paralysis from a spinal cord injury may be referred to as:

Your health care team will perform a series of tests to determine the neurological level and completeness of your injury.

Spinal cord injuries of any kind may result in one or more of the following signs and symptoms:

Emergency signs and symptoms of spinal cord injury after an accident may include:

Anyone who experiences significant trauma to his or her head or neck needs immediate medical evaluation for the possibility of a spinal injury. In fact, it’s safest to assume that trauma victims have a spinal injury until proven otherwise because:

Spinal cord injuries result from damage to the vertebrae, ligaments or disks of the spinal column or to the spinal cord itself.

A traumatic spinal cord injury may stem from a sudden, traumatic blow to your spine that fractures, dislocates, crushes, or compresses one or more of your vertebrae. It also may result from a gunshot or knife wound that penetrates and cuts your spinal cord.

Additional damage usually occurs over days or weeks because of bleeding, swelling, inflammation and fluid accumulation in and around your spinal cord.

A nontraumatic spinal cord injury may be caused by arthritis, cancer, inflammation, infections or disk degeneration of the spine.

The central nervous system comprises the brain and spinal cord. The spinal cord, made of soft tissue and surrounded by bones (vertebrae), extends downward from the base of your brain and is made up of nerve cells and groups of nerves called tracts, which go to different parts of your body.

The lower end of your spinal cord stops a little above your waist in the region called the conus medullaris. Below this region is a group of nerve roots called the cauda equina.

Tracts in your spinal cord carry messages between the brain and the rest of the body. Motor tracts carry signals from the brain to control muscle movement. Sensory tracts carry signals from body parts to the brain relating to heat, cold, pressure, pain and the position of your limbs.

Whether the cause is traumatic or nontraumatic, the damage affects the nerve fibers passing through the injured area and may impair part or all of your corresponding muscles and nerves below the injury site.

A chest (thoracic) or lower back (lumbar) injury can affect your torso, legs, bowel and bladder control, and sexual function. In addition, a neck (cervical) injury affects movements of your arms and, possibly, your ability to breathe.

The most common causes of spinal cord injuries in the United States are:

Although a spinal cord injury is usually the result of an accident and can happen to anyone, certain factors may predispose you to a higher risk of sustaining a spinal cord injury, including:

At first, changes in the way your body functions may be overwhelming. However, your rehabilitation team will help you develop the strategies you need to address the changes caused by the spinal cord injury. Areas often affected include:

Bladder control. Your bladder will continue to store urine from your kidneys. However, your brain may not be able to control your bladder as well because the message carrier (the spinal cord) has been injured.

The changes in bladder control increase your risk of urinary tract infections. They also may cause kidney infections and kidney or bladder stones.

During rehabilitation, you’ll learn new techniques to help empty your bladder.

Skin sensation. Below the neurological level of your injury, you may have lost part of or all skin sensations. Therefore, your skin can’t send a message to your brain when it’s injured by certain things such as prolonged pressure, heat or cold.

This can make you more susceptible to pressure sores, but changing positions frequently with help, if needed can help prevent these sores. You’ll learn proper skin care during rehabilitation, which can help you avoid these problems.

Circulatory control. A spinal cord injury may cause circulatory problems ranging from low blood pressure when you rise (orthostatic hypotension) to swelling of your extremities. These circulation changes also may increase your risk of developing blood clots, such as deep vein thrombosis or a pulmonary embolus.

Another problem with circulatory control is a potentially life-threatening rise in blood pressure (autonomic hyperreflexia). Your rehabilitation team will teach you how to address these problems if they affect you.

Respiratory system. Your injury may make it more difficult to breathe and cough if your abdominal and chest muscles are affected. These include the diaphragm and the muscles in your chest wall and abdomen.

Your neurological level of injury will determine what kind of breathing problems you may have. If you have cervical and thoracic spinal cord injury, you may have an increased risk of pneumonia or other lung problems. Medications and therapy can treat these problems.

Fitness and wellness. Weight loss and muscle atrophy are common soon after a spinal cord injury. Limited mobility may lead to a more sedentary lifestyle, placing you at risk of obesity, cardiovascular disease and diabetes.

A dietitian can help you eat a nutritious diet to sustain an adequate weight. Physical and occupational therapists can help you develop a fitness and exercise program.

Sexual health. Sexuality, fertility and sexual function may be affected by spinal cord injury. Men may notice changes in erection and ejaculation; women may notice changes in lubrication.

Doctors, urologists and fertility specialists who specialize in spinal cord injury can offer options for sexual functioning and fertility.

Depression. Coping with all the changes spinal cord injury brings and living with pain causes some people to experience depression.

Therapy and medications are available to treat depression associated with living with a spinal cord injury.

Following this advice may reduce your risk of a spinal cord injury:

Drive safely. Car crashes are one of the most common causes of spinal cord injuries. Wear a seat belt every time you drive or ride in a car.

Make sure that your children wear a seat belt or use an age- and weight-appropriate child safety seat. To protect them from air bag injuries, children under age 12 should always ride in the back seat.

Oct. 08, 2014

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Spinal cord injury – Mayo Clinic

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Spinal Cord Injury Levels – BrainAndSpinalCord.org – Brain …

Posted: December 8, 2017 at 1:44 am

Basic Spinal Cord Anatomy

To understand this confusion and what you are actually being told when your injury is described as being at a certain level, it is necessary to understand basic spinal anatomy. The spine and the spinal cord are two different structures. The spinal cord is a long series of nerve cells and fibers running from the base of the brain to shortly above the tailbone. It is encased in the bony vertebrae of the spine, which offers it some protection.

The spinal cord relays nerve signals from the brain to all parts of the body and from all points of the body back to the brain. Part of the confusion regarding spinal cord injury levels comes from the fact that the spine and the spinal cord each are divided into named segments which do not always correspond to each other. The spine itself is divided into vertebral segments corresponding to each of the vertebrae.

The spinal cord is divided into neurological segmental levels, meaning that the focus is on what part of the body the nerves from each section control. The spine is divided into seven neck (cervical) vertebrae, twelve chest (thoracic) vertebra, five back (lumbar) vertebrae, and five tail (sacral) vertebrae. The segments of the spine and spinal cord are designated by letters and numbers; the letters used in the designation correspond to the location on the spine or the spinal cord. For example:

The spinal cord segments are named in the same fashion, but their location does not necessarily correspond to the spinal segments location. For example:

The spinal cord is responsible for relaying the nerve messages that control voluntary and involuntary movement of the muscles, including those of the diaphragm, bowels, and bladder. It relays these messages to the rest of the body via spinal roots which branch out from the cord.

The spinal roots are nerves that go through the spines bone canal and come out at the vertebral segments of the spinal cord. Bodily functions can be disrupted by injury to the spinal cord. The amount of the impairment depends on the degree of damage and the location of the injury.

The head is held by the first and second cervical segments. The cervical cord supplies the nerves for the deltoids, biceps, triceps, wrist extensors, and hands. The phrenic nucleus (a group of cell bodies with nerve links to the diaphragm) is located in the C3 cord.

The thoracic vertebral segments compose the rear wall of the ribs and pulmonary cavity. In this area, the spinal roots compose the between the ribs nerves (intercostal nerves) which control the intercostal muscles.

The spinal cord does not travel the entire length of the spine. It ends at the second lumbar segment (L2). Spinal roots exit below the spinal cords tip (conus) in a spray; this is called the cauda equine (horses tail). Damage below the L2 generally does not interfere with leg movement, although it can contribute to weakness.

In addition to motor function, the spinal cord segments each innervate different sections of skin called dermatomes. This provides the sense of touch and pain. The area of a dermatome may expand or contract after a spinal cord injury.

The differences between some of the spinal vertebral and spinal cord levels have added to the confusion in developing a standardized rating scale for spinal cord injuries. In the 1990s, the American Spinal Cord Association devised a new scale to help eliminate ambiguities in rating scales. The ASIA scale is more accurate than previous rating systems, but there are still differences in the ways various medical specialists evaluate an SCI injury.

Dr. Wise Young, founding director of Rutgers W. M. Keck Center for Collaborative Neuroscience explains that usually neurologists (nerve specialists) will rate the level of injury at the first spinal segment level which exhibits loss of normal function; however, rehabilitation doctors (physiatrists) usually rate the level of injury at the lowest spinal segment level which remains normal.

For example, a neurologist might say that an individual with normal sensations in the C3 spinal segment who lacks sensation at the C4 spinal segment should be classified as a sensory level C4, but a physiatrist might call it a C3 injury level. Obviously, these differences are confusing to the patient and to the patients family. People with a spinal cord injury simply want to know what level of disability they will have and how much function they are likely to regain. Adding to the confusion is the debate over how to define complete versus incomplete injuries.

For many years, a complete spinal cord injury was thought of as meaning no conscious sensations or voluntary muscle use below the site of the injury; however, this does not take in to account that partial preservation of function below the injury site is rather common. This definition of a complete injury also failed to take into account the fact that may people have lateral preservation (function on one side).

In addition, a person may later recover a degree of function, after being labeled in the first few days after the injury as having a complete injury. In 1992, the American Spinal Cord Association sought to remedy this dilemma by coming up with a simple definition of complete injury.

According to the ASIA scale, a person has a complete injury if they have no sensory or motor function in the perineal and anal region; this area corresponds to the lowest part of the sacral cord (S4-S5). A rectal examination is used to help determine function in this area. The ASIA Scale is classified as follows:

At this point, if you are a patient with a spinal cord injury or the family member of a spinal cord injury patient you may be more confused than ever. How do these ratings apply to the daily life of someone with a spinal cord injury? A brief overview of the basic definitions may help.

This is the greatest level of paralysis. Complete C1-C4 tetraplegia means that the person has no motor function of the arms or legs. He or she generally can move the neck and possibly shrug the shoulders. When the injury is at the C1-C3 level, the person will usually need to be on a ventilator for the long-term; fortunately, new techniques may be able to reduce the need for a ventilator.

A person whose injury is at the C4 level usually will not need to use the ventilator for the long-term, but will likely need ventilation in the first days after the injury. People with complete C1-C4 quadriplegia may be able to use a power wheelchair that can be controlled with the chin or the breath. They may be able control a computer with adaptive devices in a similar fashion and some can work in this way. They can also control light switches, bed controls, televisions and so with the help of adaptive devices. They will require a caregivers assistance for most or all of their daily needs.

People with C5 tetraplegia can flex their elbows and with the help of assistive devices to help them hold objects, they can learn to feed and groom themselves. With some help they can dress their upper body and change positions in bed. They can use a power wheelchair equipped with hand controls and some may be able use a manual wheelchair with grip attachments for a short distance on level ground.

People with C5 will need to rely on caregivers for transfers from bed to chair and so forth, and for assistance with bladder and bowel management, as well as with bathing and dressing the lower body. Adaptive technology can help these people be independent in many areas, including driving. People with C5 tetraplegia can drive a vehicle equipped with hand controls.

People with C6 tetraplegia have the use both of the elbow and the wrist and with assistive support can grasp objects. Some people with C6 learn to transfer independently with the help of a slide board. Some can also handle bladder and bowel management with assistive devices, although this can be difficult.

People with C6 can learn to feed, groom, and bath themselves with the help of assistance devices. They can operate a manual wheelchair with grip attachments and they can drive specially adapted vehicles. Most people with C6 will need some assistance from a caregiver at times.

People with C7 tetraplegia can extend the elbow, which allows them greater freedom of movement. People with C7 can live independently. They can learn to feed and bath themselves and to dress the upper body. They can move in bed by themselves and transfer by themselves. They can operate a manual wheelchair, but will need help negotiating curbs. They can drive specially-equipped vehicles. They can write, type, answer phones, and use computers; some may need assistive devices to do so, while others will not.

People with C8 tetraplegia can flex their fingers, allowing them a better grip on objects. They can learn to feed, groom, dress, and bath themselves without help. They can manage bladder and bowel care and transfer by themselves. They can use a manual wheelchair and type, write, answer the phone and use the computer. They can drive vehicles adapted with hand controls.

People with T1-T12 paraplegia have nerve sensation and function of all their upper extremities. They can become functionally independent, feeding and grooming themselves and cooking and doing light housework. They can transfer independently and manage bladder and bowel function. They can handle a wheelchair quite well and can learn to negotiate over uneven surfaces and handle curbs. They can drive specially adaptive vehicles.

People with a T2-T9 injury may have enough torso control to be able to stand with the help of braces and a walker or crutches. People with a T10-T12 injury have better torso control than those with a T2-T9 injury, and they may be able to walk short distances with the aid of a walker or crutches.

Some can even go up and down stairs; however, walking with such an injury requires a great deal of effort and can quickly exhaust the patient. Many people with thoracic paraplegia prefer to use a wheelchair so that they will not tire so quickly.

People with sacral or lumbar paraplegia can be functionally independent in all of their self-care and mobility needs. They can learn to skillfully handle a manual wheelchair and can drive specially equipped vehicles. People with a lumbar injury can usually learn to walk for distances of 150 feet or longer, using assistive devices. Some can walk this distance without assistance devices. Most rely on a manual wheelchair when longer distances must be covered.

There are many other functional scales besides the ASIA scale, but it is the most frequently used. Neurologists find the NLOI (the Neurological level of injury) scale helpful; it is a simply administered test of motor function and range of motion. The Function Independence Measure (FIM) evaluates function in mobility, locomotion, self-care, continence, communication, and social cognition on a 7-point scale.

The Quadriplegic Index of Function (QIF) detects small, clinically significant changes in people with tetraplegia. Other scales include the Modified Barthel Index, the Spinal Cord Independence Measure (SCIM), the Capabilities of Upper Extremity Instrument (CUE), the Walking Index for SCI (WISCI), and the Canadian Occupational Performance Measure (COPM).

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Spinal cord – Wikipedia

Posted: November 23, 2017 at 12:45 am

The spinal cord is a long, thin, tubular bundle of nervous tissue and support cells that extends from the medulla oblongata in the brainstem to the lumbar region of the vertebral column. The brain and spinal cord together make up the central nervous system (CNS). In humans, the spinal cord begins at the occipital bone where it passes through the foramen magnum, and meets and enters the spinal canal at the beginning of the cervical vertebrae. The spinal cord extends down to between the first and second lumbar vertebrae where it ends. The enclosing bony vertebral column protects the relatively shorter spinal cord. It is around 45cm (18in) in men and around 43cm (17in) long in women. Also, the spinal cord has a varying width, ranging from 13mm (12in) thick in the cervical and lumbar regions to 6.4mm (14in) thick in the thoracic area.

The spinal cord functions primarily in the transmission of nerve signals from the motor cortex to the body, and from the afferent fibers of the sensory neurons to the sensory cortex. It is also a center for coordinating many reflexes and contains reflex arcs that can independently control reflexes and central pattern generators.[1]

The spinal cord is the main pathway for information connecting the brain and peripheral nervous system.[2][3] Much shorter than its protecting spinal column, the human spinal cord originates in the brainstem, passes through the foramen magnum, and continues through to the conus medullaris near the second lumbar vertebra before terminating in a fibrous extension known as the filum terminale.

It is about 45cm (18in) long in men and around 43cm (17in) in women, ovoid-shaped, and is enlarged in the cervical and lumbar regions. The cervical enlargement, stretching from the C5 to T1 vertebrae, is where sensory input comes from and motor output goes to the arms and trunk. The lumbar enlargement, located between L1 and S3, handles sensory input and motor output coming from and going to the legs.

The spinal cord is continuous with the caudal portion of the medulla, running from the base of the skull to the body of the first lumbar vertebra. It does not run the full length of the vertebral column in adults. It is made of 31 segments from which branch one pair of sensory nerve roots and one pair of motor nerve roots. The nerve roots then merge into bilaterally symmetrical pairs of spinal nerves. The peripheral nervous system is made up of these spinal roots, nerves, and ganglia.

The dorsal roots are afferent fascicles, receiving sensory information from the skin, muscles, and visceral organs to be relayed to the brain. The roots terminate in dorsal root ganglia, which are composed of the cell bodies of the corresponding neurons. Ventral roots consist of efferent fibers that arise from motor neurons whose cell bodies are found in the ventral (or anterior) gray horns of the spinal cord.

The spinal cord (and brain) are protected by three layers of tissue or membranes called meninges, that surround the canal . The dura mater is the outermost layer, and it forms a tough protective coating. Between the dura mater and the surrounding bone of the vertebrae is a space called the epidural space. The epidural space is filled with adipose tissue, and it contains a network of blood vessels. The arachnoid mater, the middle protective layer, is named for its open, spiderweb-like appearance. The space between the arachnoid and the underlying pia mater is called the subarachnoid space. The subarachnoid space contains cerebrospinal fluid (CSF), which can be sampled with a lumbar puncture, or “spinal tap” procedure. The delicate pia mater, the innermost protective layer, is tightly associated with the surface of the spinal cord. The cord is stabilized within the dura mater by the connecting denticulate ligaments, which extend from the enveloping pia mater laterally between the dorsal and ventral roots. The dural sac ends at the vertebral level of the second sacral vertebra.

In cross-section, the peripheral region of the cord contains neuronal white matter tracts containing sensory and motor axons. Internal to this peripheral region is the grey matter, which contains the nerve cell bodies arranged in the three grey columns that give the region its butterfly-shape. This central region surrounds the central canal, which is an extension of the fourth ventricle and contains cerebrospinal fluid.

The spinal cord is elliptical in cross section, being compressed dorsolaterally. Two prominent grooves, or sulci, run along its length. The posterior median sulcus is the groove in the dorsal side, and the anterior median fissure is the groove in the ventral side.

The human spinal cord is divided into segments where pairs of spinal nerves (mixed; sensory and motor) form. Six to eight motor nerve rootlets branch out of right and left ventro lateral sulci in a very orderly manner. Nerve rootlets combine to form nerve roots. Likewise, sensory nerve rootlets form off right and left dorsal lateral sulci and form sensory nerve roots. The ventral (motor) and dorsal (sensory) roots combine to form spinal nerves (mixed; motor and sensory), one on each side of the spinal cord. Spinal nerves, with the exception of C1 and C2, form inside the intervertebral foramen (IVF). These rootlets form the demarcation between the central and peripheral nervous systems.

The grey column, (as three regions of grey columns) in the center of the cord, is shaped like a butterfly and consists of cell bodies of interneurons, motor neurons, neuroglia cells and unmyelinated axons. The anterior and posterior grey column present as projections of the grey matter and are also known as the horns of the spinal cord. Together, the grey columns and the gray commissure form the “grey H.”

The white matter is located outside of the grey matter and consists almost totally of myelinated motor and sensory axons. “Columns” of white matter carry information either up or down the spinal cord.

The spinal cord proper terminates in a region called the conus medullaris, while the pia mater continues as an extension called the filum terminale, which anchors the spinal cord to the coccyx. The cauda equina (“horse’s tail”) is a collection of nerves inferior to the conus medullaris that continue to travel through the vertebral column to the coccyx. The cauda equina forms because the spinal cord stops growing in length at about age four, even though the vertebral column continues to lengthen until adulthood. This results in sacral spinal nerves originating in the upper lumbar region.

Within the CNS, nerve cell bodies are generally organized into functional clusters, called nuclei. Axons within the CNS are grouped into tracts.

There are 31 spinal cord nerve segments in a human spinal cord:

In the fetus, vertebral segments correspond with spinal cord segments. However, because the vertebral column grows longer than the spinal cord, spinal cord segments do not correspond to vertebral segments in the adult, particularly in the lower spinal cord. For example, lumbar and sacral spinal cord segments are found between vertebral levels T9 and L2, and the spinal cord ends around the L1/L2 vertebral level, forming a structure known as the conus medullaris.

Although the spinal cord cell bodies end around the L1/L2 vertebral level, the spinal nerves for each segment exit at the level of the corresponding vertebra. For the nerves of the lower spinal cord, this means that they exit the vertebral column much lower (more caudally) than their roots. As these nerves travel from their respective roots to their point of exit from the vertebral column, the nerves of the lower spinal segments form a bundle called the cauda equina.

There are two regions where the spinal cord enlarges:

The spinal cord is made from part of the neural tube during development. There are four stages of the spinal cord that arises from the neural tube: The neural plate, neural fold, neural tube, and the spinal cord. Neural differentiation occurs within the spinal cord portion of the tube.[5] As the neural tube begins to develop, the notochord begins to secrete a factor known as Sonic hedgehog or SHH. As a result, the floor plate then also begins to secrete SHH, and this will induce the basal plate to develop motor neurons. During the maturation of the neural tube, its lateral walls thicken and form a longtitudinal groove called the sulcus limitans. This extends the length of the spinal cord into dorsal and ventral portions as well.[6] Meanwhile, the overlying ectoderm secretes bone morphogenetic protein (BMP). This induces the roof plate to begin to secrete BMP, which will induce the alar plate to develop sensory neurons. Opposing gradients of such morphogens as BMP and SHH form different domains of dividing cells along the dorsal ventral axis.[7] Dorsal root ganglion neurons differentiate from neural crest progenitors. As the dorsal and ventral column cells proliferate, the lumen of the neural tube narrows to form the small central canal of the spinal cord.[8] The alar plate and the basal plate are separated by the sulcus limitans. Additionally, the floor plate also secretes netrins. The netrins act as chemoattractants to decussation of pain and temperature sensory neurons in the alar plate across the anterior white commissure, where they then ascend towards the thalamus. Following the closure of the caudal neuropore and formation of the brain’s ventricles that contain the choroid plexus tissue, the central canal of the caudal spinal cord is filled with cerebrospinal fluid.

Earlier findings by Viktor Hamburger and Rita Levi-Montalcini in the chick embryo have been confirmed by more recent studies which have demonstrated that the elimination of neuronal cells by programmed cell death (PCD) is necessary for the correct assembly of the nervous system.[9]

Overall, spontaneous embryonic activity has been shown to play a role in neuron and muscle development but is probably not involved in the initial formation of connections between spinal neurons.

The spinal cord is supplied with blood by three arteries that run along its length starting in the brain, and many arteries that approach it through the sides of the spinal column. The three longitudinal arteries are the anterior spinal artery, and the right and left posterior spinal arteries.[10] These travel in the subarachnoid space and send branches into the spinal cord. They form anastamoses (connections) via the anterior and posterior segmental medullary arteries, which enter the spinal cord at various points along its length.[10] The actual blood flow caudally through these arteries, derived from the posterior cerebral circulation, is inadequate to maintain the spinal cord beyond the cervical segments.

The major contribution to the arterial blood supply of the spinal cord below the cervical region comes from the radially arranged posterior and anterior radicular arteries, which run into the spinal cord alongside the dorsal and ventral nerve roots, but with one exception do not connect directly with any of the three longitudinal arteries.[10] These intercostal and lumbar radicular arteries arise from the aorta, provide major anastomoses and supplement the blood flow to the spinal cord. In humans the largest of the anterior radicular arteries is known as the artery of Adamkiewicz, or anterior radicularis magna (ARM) artery, which usually arises between L1 and L2, but can arise anywhere from T9 to L5.[11] Impaired blood flow through these critical radicular arteries, especially during surgical procedures that involve abrupt disruption of blood flow through the aorta for example during aortic aneursym repair, can result in spinal cord infarction and paraplegia.

Somatosensory organization is divided into the dorsal column-medial lemniscus tract (the touch/proprioception/vibration sensory pathway) and the anterolateral system, or ALS (the pain/temperature sensory pathway). Both sensory pathways use three different neurons to get information from sensory receptors at the periphery to the cerebral cortex. These neurons are designated primary, secondary and tertiary sensory neurons. In both pathways, primary sensory neuron cell bodies are found in the dorsal root ganglia, and their central axons project into the spinal cord.

In the dorsal column-medial leminiscus tract, a primary neuron’s axon enters the spinal cord and then enters the dorsal column. If the primary axon enters below spinal level T6, the axon travels in the fasciculus gracilis, the medial part of the column. If the axon enters above level T6, then it travels in the fasciculus cuneatus, which is lateral to the fasciculus gracilis. Either way, the primary axon ascends to the lower medulla, where it leaves its fasciculus and synapses with a secondary neuron in one of the dorsal column nuclei: either the nucleus gracilis or the nucleus cuneatus, depending on the pathway it took. At this point, the secondary axon leaves its nucleus and passes anteriorly and medially. The collection of secondary axons that do this are known as internal arcuate fibers. The internal arcuate fibers decussate and continue ascending as the contralateral medial lemniscus. Secondary axons from the medial lemniscus finally terminate in the ventral posterolateral nucleus (VPLN) of the thalamus, where they synapse with tertiary neurons. From there, tertiary neurons ascend via the posterior limb of the internal capsule and end in the primary sensory cortex.

The proprioception of the lower limbs differs from the upper limbs and upper trunk. There is a four-neuron pathway for lower limb proprioception. This pathway initially follows the dorsal spino-cerebellar pathway. It is arranged as follows: proprioceptive receptors of lower limb -> peripheral process -> dorsal root ganglion -> central process -> Clarke’s column -> 2nd order neuron -> medulla oblogata (Caudate nucleus) -> 3rd order neuron -> VPLN of thalamus -> 4th order neuron -> posterior limb of internal capsule -> corona radiata -> sensory area of cerebrum.

The anterolateral system works somewhat differently. Its primary neurons axons enter the spinal cord and then ascend one to two levels before synapsing in the substantia gelatinosa. The tract that ascends before synapsing is known as Lissauer’s tract. After synapsing, secondary axons decussate and ascend in the anterior lateral portion of the spinal cord as the spinothalamic tract. This tract ascends all the way to the VPLN, where it synapses on tertiary neurons. Tertiary neuronal axons then travel to the primary sensory cortex via the posterior limb of the internal capsule.

It should be noted that some of the “pain fibers” in the ALS deviate from their pathway towards the VPLN. In one such deviation, axons travel towards the reticular formation in the midbrain. The reticular formation then projects to a number of places including the hippocampus (to create memories about the pain), the centromedian nucleus (to cause diffuse, non-specific pain) and various parts of the cortex. Additionally, some ALS axons project to the periaqueductal gray in the pons, and the axons forming the periaqueductal gray then project to the nucleus raphes magnus, which projects back down to where the pain signal is coming from and inhibits it. This helps control the sensation of pain to some degree.

The corticospinal tract serves as the motor pathway for upper motor neuronal signals coming from the cerebral cortex and from primitive brainstem motor nuclei.

Cortical upper motor neurons originate from Brodmann areas 1, 2, 3, 4, and 6 and then descend in the posterior limb of the internal capsule, through the crus cerebri, down through the pons, and to the medullary pyramids, where about 90% of the axons cross to the contralateral side at the decussation of the pyramids. They then descend as the lateral corticospinal tract. These axons synapse with lower motor neurons in the ventral horns of all levels of the spinal cord. The remaining 10% of axons descend on the ipsilateral side as the ventral corticospinal tract. These axons also synapse with lower motor neurons in the ventral horns. Most of them will cross to the contralateral side of the cord (via the anterior white commissure) right before synapsing.

The midbrain nuclei include four motor tracts that send upper motor neuronal axons down the spinal cord to lower motor neurons. These are the rubrospinal tract, the vestibulospinal tract, the tectospinal tract and the reticulospinal tract. The rubrospinal tract descends with the lateral corticospinal tract, and the remaining three descend with the anterior corticospinal tract.

The function of lower motor neurons can be divided into two different groups: the lateral corticospinal tract and the anterior cortical spinal tract. The lateral tract contains upper motor neuronal axons which synapse on dorsal lateral (DL) lower motor neurons. The DL neurons are involved in distal limb control. Therefore, these DL neurons are found specifically only in the cervical and lumbosacral enlargements within the spinal cord. There is no decussation in the lateral corticospinal tract after the decussation at the medullary pyramids.

The anterior corticospinal tract descends ipsilaterally in the anterior column, where the axons emerge and either synapse on lower ventromedial (VM) motor neurons in the ventral horn ipsilaterally or descussate at the anterior white commissure where they synapse on VM lower motor neurons contralaterally . The tectospinal, vestibulospinal and reticulospinal descend ipsilaterally in the anterior column but do not synapse across the anterior white commissure. Rather, they only synapse on VM lower motor neurons ipsilaterally. The VM lower motor neurons control the large, postural muscles of the axial skeleton. These lower motor neurons, unlike those of the DL, are located in the ventral horn all the way throughout the spinal cord.

Proprioceptive information in the body travels up the spinal cord via three tracks. Below L2, the proprioceptive information travels up the spinal cord in the ventral spinocerebellar tract. Also known as the anterior spinocerebellar tract, sensory receptors take in the information and travel into the spinal cord. The cell bodies of these primary neurons are located in the dorsal root ganglia. In the spinal cord, the axons synapse and the secondary neuronal axons decussates and then travel up to the superior cerebellar peduncle where they decussate again. From here, the information is brought to deep nuclei of the cerebellum including the fastigial and interposed nuclei.

From the levels of L2 to T1, proprioceptive information enters the spinal cord and ascends ipsilaterally, where it synapses in Clarke’s nucleus. The secondary neuronal axons continue to ascend ipsilaterally and then pass into the cerebellum via the inferior cerebellar peduncle. This tract is known as the dorsal spinocerebellar tract.

From above T1, proprioceptive primary axons enter the spinal cord and ascend ipsilaterally until reaching the accessory cuneate nucleus, where they synapse. The secondary axons pass into the cerebellum via the inferior cerebellar peduncle where again, these axons synapse on cerebellar deep nuclei. This tract is known as the cuneocerebellar tract.

Motor information travels from the brain down the spinal cord via descending spinal cord tracts. Descending tracts involve two neurons: the upper motor neuron (UMN) and lower motor neuron (LMN).[12] A nerve signal travels down the upper motor neuron until it synapses with the lower motor neuron in the spinal cord. Then, the lower motor neuron conducts the nerve signal to the spinal root where efferent nerve fibers carry the motor signal toward the target muscle. The descending tracts are composed of white matter. There are several descending tracts serving different functions. The corticospinal tracts (lateral and anterior) are responsible for coordinated limb movements.[12]

A congenital disorder is diastematomyelia in which part of the spinal cord is split usually at the level of the upper lumbar vertebrae. Sometimes the split can be along the length of the spinal cord.

Spinal cord injuries can be caused by trauma to the spinal column (stretching, bruising, applying pressure, severing, laceration, etc.). The vertebral bones or intervertebral disks can shatter, causing the spinal cord to be punctured by a sharp fragment of bone. Usually, victims of spinal cord injuries will suffer loss of feeling in certain parts of their body. In milder cases, a victim might only suffer loss of hand or foot function. More severe injuries may result in paraplegia, tetraplegia (also known as quadriplegia), or full body paralysis below the site of injury to the spinal cord.

Damage to upper motor neuron axons in the spinal cord results in a characteristic pattern of ipsilateral deficits. These include hyperreflexia, hypertonia and muscle weakness. Lower motor neuronal damage results in its own characteristic pattern of deficits. Rather than an entire side of deficits, there is a pattern relating to the myotome affected by the damage. Additionally, lower motor neurons are characterized by muscle weakness, hypotonia, hyporeflexia and muscle atrophy.

Spinal shock and neurogenic shock can occur from a spinal injury. Spinal shock is usually temporary, lasting only for 2448 hours, and is a temporary absence of sensory and motor functions. Neurogenic shock lasts for weeks and can lead to a loss of muscle tone due to disuse of the muscles below the injured site.

The two areas of the spinal cord most commonly injured are the cervical spine (C1-C7) and the lumbar spine (L1-L5). (The notation C1, C7, L1, L5 refer to the location of a specific vertebra in either the cervical, thoracic, or lumbar region of the spine.) Spinal cord injury can also be non-traumatic and caused by disease (transverse myelitis, polio, spina bifida, Friedreich’s ataxia, spinal cord tumor, spinal stenosis etc.)[13]

In the U.S., 10,000-12,000 people become paralyzed annually as a result of various injuries to the spinal cord.[citation needed]

Real or suspected spinal cord injuries need immediate immobilisation including that of the head. Scans will be needed to assess the injury. A steroid, methylprednisolone, can be of help as can physical therapy and possibly antioxidants.[citation needed] Treatments need to focus on limiting post-injury cell death, promoting cell regeneration, and replacing lost cells. Regeneration is facilitated by maintaining electric transmission in neural elements. Replacement of lost cells is facilitated by transplants with embryonic stem cells, stem cells from the spinal cord, and spinal cord cells from fetuses.

The spinal cord ends at the level of vertebrae L1L2, while the subarachnoid space the compartment that contains cerebrospinal fluid extends down to the lower border of S2.[13]Lumbar punctures in adults are usually performed between L3L5 (cauda equina level) in order to avoid damage to the spinal cord.[13] In the fetus, the spinal cord extends the full length of the spine and regresses as the body grows.

Spinal tumours can occur in the spinal cord and these can be either inside (intradural) or outside (extradural) the dura mater.

Spinal Cord Sectional Anatomy. Animation in the reference.

Diagrams of the spinal cord.

Cross-section through the spinal cord at the mid-thoracic level.

Cross-sections of the spinal cord at varying levels.

A portion of the spinal cord, showing its right lateral surface. The dura is opened and arranged to show the nerve roots.

The spinal cord with dura cut open, showing the exits of the spinal nerves.

The spinal cord showing how the anterior and posterior roots join in the spinal nerves.

The spinal cord showing how the anterior and posterior roots join in the spinal nerves.

A longer view of the spinal cord.

Projections of the spinal cord into the nerves (red motor, blue sensory).

Projections of the spinal cord into the nerves (red motor, blue sensory).

Cross-section of rabbit spinal cord.

Cross-section of adult mouse spinal cord: astrocytes (red) and neurons (green)

Cross section of adult rat spinal cord stained using Cajal method.

An overview of the spinal cord.

Sagittal section of pig vertebrae showing a section of the spinal cord.

The base of the brain and the top of the spinal cord

Spinal cord. Spinal membranes and nerve roots.Deep dissection. Posterior view.

Spinal cord. Spinal membranes and nerve roots.Deep dissection. Posterior view.

Spinal cord. Spinal membranes and nerve roots.Deep dissection. Posterior view.

Spinal cord. Spinal membranes and nerve roots.Deep dissection. Posterior view.

Spinal cord. Spinal membranes and nerve roots.Deep dissection. Posterior view.

Spinal cord. Spinal membranes and nerve roots.Deep dissection. Posterior view.

Spinal cord. Spinal membranes and nerve roots.Deep dissection. Posterior view.

Cerebrum.Inferior view.Deep dissection

Cerebrum.Inferior view.Deep dissection

Spinal cord. Brachial plexus. Cerebrum.Inferior view.Deep dissection.

Spinal cord. Brachial plexus. Cerebrum.Inferior view.Deep dissection.

Medulla spinalis of 8-week-old human embryo

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Spinal cord – Wikipedia

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