Spinal Mechanics 101
Until a recent upsurge in public awareness, bolstered in no small way by actor Christopher Reeve's SCI experience, the only people who knew much about the condition either have suffered a spinal cord injury or a head injury themselves or have a family member or friend who has. Yet in this country alone some 11,000 individuals receive spinal cord injuries each year. The result is a population of at least 250,000 neurologically injured citizens here, all of them desperate for the public to know of their plight. These catastrophic injuries impact all aspects of life, and the recovery process is often long and frustrating for everyone concerned – survivor, family member or friend. There is a definite need for additional research in prevention, treatment, and a cure. But, the first critical step is greater awareness.
Because of an unfortunate incident and the courage of one SCI survivor, the nation had a dramatic lesson in spinal cord injuries. In his first public appearance after his accident, Christopher Reeve shared as no one had done before the devastating effects of this injury. His head held upright by a brace attached to a complex electric wheelchair, he could only speak in short sentences between breaths mechanically induced through his respirator. Nonetheless Mr. Reeve talked candidly of the large numbers of little-noticed spinal cases and of his great hopes for the future.
This hope is shared by everyone who lives with the results of a spinal cord injury. Since his accident, Reeve has never faltered in his quest to make this condition part of public knowledge. As a celebrity, he is making the inroads needed to change the manner in which this country regards spinal cord injury and paralysis. His tireless effort to raise funds for spinal research and paralysis treatment gives hope to us all. We are no longer an unknown and avoided minority.
Every mother warns her children, “Get down before you break your neck!” She has probably never dreamed how incredibly serious an injury to the spinal cord can be... nor has any child who heard that warning.
So just what is a spinal cord injury? Much of the following information is directly from the Spinal Cord Injury Home Care Manual, given to each patient when he or she leaves the Santa Clara Valley Medical Center's Rehabilitation Unit in San Jose, California. The information it contains is extremely valuable in understanding the mystery of spinal cord injury.
The spinal cord is an extension of the brain into a bony canal formed by the spine. It is composed of nerve fibers which connect the brain to the muscles of the arms and legs, and which carry sensations from skin and joints back to the brain. The spinal cord is most frequently injured when the bones of the spine are fractured, dislocated or moved excessively. The bone injury produces a concussion or blow to the spinal cord. The spinal cord is rarely ever cut or severed by this bone injury. It is usually crushed, which leads to internal bleeding and swelling, and to loss of the ability to conduct impulses along the nerve fibers.
The most important element in treatment of spinal injury is to prevent any further movement and to realign any dislocated vertebra into its normal position. Healing of the damaged nerve fibers then depends on the body’s natural ability to heal after the initial swelling resolves. The degree of recovery ultimately achieved relates to the severity of the initial injury and how much the structure of the spinal cord was permanently altered. Spinal cord nerve fibers temporarily not able to function (because of the swelling) may recover their function, but dead nerve fibers do not grow back in the cord and scar tissue does not conduct nerve impulses.
Spinal injuries are described by the level of injury. Spinal nerves come off the spinal cord between the vertebrae. Vertebrae are the bones of the spine: seven in the neck called cervical vertebrae, twelve in the chest called thoracic vertebrae, five in the lower back called lumbar vertebrae, and five more fused as part of the pelvis called the sacrum. The study of anatomy tells us which muscles and which parts of the skin surface are supplied by each nerve. Examination shows the level at which an abnormality occurs; the last normal level is called the level of injury. Often this corresponds to the fracture or dislocation of the bones in the spine, but not always.
Injuries can also be described as complete or incomplete. A complete injury means that there is no sensation or voluntary movement below the level of injury (involuntary movements are called spasms and can occur even when the cord has been cut in two). An incomplete injury means that some feeling or voluntary movement persists below the injury. This is important because in the early stages after a spinal cord injury, incompleteness may be predictive of some recovery. This recovery tends to occur in a standard pattern, usually early after the injury. Spinal injuries that remain complete beyond the first few weeks rarely show recovery. Incomplete injuries that show early changes may continue to improve for several years.
Rehabilitation, much to a patient's disappointment, cannot wait for possible recovery. The manual goes on to suggest: "A good attitude is to hope for the best but prepare for the worst. Muscles in which the nerve supply is intact must be strengthened and skills must be learned to lead a full and independent life whatever disability ultimately remains."
As you can imagine, medical problems frequently complicate one's situation. Some of the accompanying annoyances are due to loss of the regulation of many of the body’s automatic functions – work usually done by or through the spinal cord. Others are caused by the high degree of use placed on the arms and neck when they are called upon to compensate for the lost use of the legs. Still other problems are common to the able-bodied but are magnified by a spinal cord injury. And some combine elements of all these three.
The guide lists the critically important health concerns that spinal cord for which patients must be alert. They are: urinary tract infections, breathing difficulties, skin breakdown, bowel problems, spasticity, erratic blood pressure and automatic dysreflexia, contractures, heterotopic ossification, inadequate temperature regulation and reflex sweating, deep vein thrombosis, edema of the feet and legs, nerve and referred pain, weight changes, sex and fertility problems, and lastly depression. Thankfully this horrendous list doesn’t include ingrown toenails or matted hair!
All of these possible problem areas are important; but if wisely monitored, most are easily controlled. If precautions are taken, many can be avoided altogether. It isn’t the end of the world, although it certainly seems that way at first. Dealing with a spinal cord injury is tough enough without all this excess baggage.
