Injuries Of The Spinal Cord And The Cervical Spine

The spinal cord is one of the most delicate structures that nature has enclosed in the bodies of the humans. It is a wonder pathway which consists of the nerves connection and transmitting millions of messages from the brain all of the body. It is about 18 inches long and approximately half an inch in thickness, running from the Foramen Magnum (an opening in the skull) to the first lumbar vertebra. Surrounding the spinal cord is the Cerebral Spinal Fluid (CSF) which is a clear liquid acting as a shock absorbent for the Cord. Its entire length is enclosed within the bony Vertebral column providing it the ultimate guarding from trauma. At the junction of the 1st and 2nd Lumbar vertebrae, the spinal cord ends. The spinal nerve then go on as group of nerves known as the cauda equina.The Cauda Equina goes down via the spinal canal to the sacrum and then ends at the legs/feet (Cristian, 2004).

The brain transmits motor impulses to the limbs and body through the spinal cord allowing them carry on most of their actions. The Spinal cord acts as a pathway again whenever the rest of our body sends the brain signals about what we feel or touch. These signals are sent via the spinal cord. The spinal cord can act independently without involving the brain. This pathway is known as the Spinal Reflexes which enable us to act quickly and save ourselves by some potential harm. The brain and spinal cord together are called the Central Nervous System, whereas the nerves connecting only the spinal cord to the body are known as the Peripheral Nervous System.

The nerves in the spinal cord are arranged into two bundles which are called Ascending and Descending tracts. The Ascending tracts transmit information from rest of the body, upwards to the brain. The information they these tracts carry are of pain, touch, temperature and the joint positioning. The Descending tracts carry information from the brain downwards for the purpose of starting movements and changing body positions.

The spinals nerves are the nerves coming off the spinal cord. They pass out of the spinal cord by a hole, in their respective vertebrae, called the Foramen. These nerves form channels or wires transmitting impulses between the brain and the body.

The Cervical Spine: The cervical spine starts at the base of the skull. Seven of the vertebrae constitute the cervical spine along with eight pairs of nerves. The cervical vertebrae are known as C1, C2, C3, C4, C5, C6 and C7 (in descending order).

Apparelyzed.com (n.d.).Retrived on February 10, 2009 from http://www.apparelyzed.com/

Injuries to the Spinal Cord and the Cervical Spine

According to a research carried out by the American National Spinal Cord Association, about 450,000 people in the US are managing life with a spinal cord injury (SCI).  Every year, approximately 11,000 Spinal Cord Injuries occur in the United States (according to the Spinal Cord Health Survey, 2008). About 60% of these injuries are a result of vertebral column trauma.  These injuries proved to be major cause affecting the spinal cord’s function of transmitting signals to and from the brain to control sensory, motor and autonomic functions for rest of the body. Mostly, the deficits of movement will occur below the level at which the injury has occurred(Lin, Cardenas, Cutter,& Frost,2002).

            Accidents, falls from heights, gunshots are the most obvious reasons for SCIs while diving (without proper technique) related injuries are the FOURTH leading cause of Spinal Cord injuries.

Types of Spinal Cord Injuries and how their levels affect the Body Parts
Each spinal cord injury may have a different manifestation depending on the level of the cord it occurs at. Severity comes with different levels. Usually, the higher the injury or in other words, the nearer the injury to the brain, more are the chances of the patient losing his or her sensation AND motor control over ALL of the body. The injuries at a lower level mostly entail some remnant sensations and motor control for the patient (Cristian, 2004).

-Quadriplegia is one of the biggest outcomes of SCIs, it results from injuries to the spinal cord in the cervical (neck) region. The loss of muscles power is seen in all four limbs.

-Paraplegia is another possible outcome. It is due to trauma on the spinal cord in the thoracic and/or lumbar areas, resulting in paralysis of the lower body.

Complete SCI
Almost fifty percent of all Spinal Cord injuries are this form. The complete Spinal Cord Injury produces a total deficiency of motor as well as sensory function of the body below the level of injury. Both sides of the body are equally affected and the person is unable to feel or move any part of the body.

Incomplete SCI
In an incomplete spinal cord injury, some minor functions may not be affected and hence may be present below the level of the injury. The person with ISCI is usually able to move one arm or one leg, or may have a better functioning one side than the other.

Anterior cord syndrome

This syndrome is because of injury to the afferent and efferent pathways in the anterior segments of the spinal cord. Those affected can feel some sort of rough/gritty sensations because their posterior pathways in the spinal cord are still intact. However, all movements and fine sensations are lost.

Central cord syndrome

Usually is a direct cause of trauma and results in damage to the large nerve fibers that carry information from the cortex of the cerebrum to the cord. These patients have paralysis and/or loss of fine control of movements in the arms and hands. The feet and legs have a lesser degree of impairment in the functioning. Sensory loss below the level of injury and a failure of bladder control may occur also. The overall manifestation of injury will depend on the severity of the destruction the spinal nerves have suffered.

Acute cervical sprains/strains

Very common occurrence when the diving techniques go wrong.

Cervical Fractures

Cervical fractures and dislocations happen when the axial loading forces applied to the C-spine are more than the strength of the vertebral bodies or the supporting ligamentous structures. A number of outcomes are possible for example (Grant, 2002):

Subluxation, Dislocations or Fractures, with or without neurologic injuries.

A variety of other Fractures/Herniations/Dislocations may also occur for example:

·         Avulsion fractures

·         Compression fractures

·         Facet joint dislocations and herniations

·         Teardrop fractures

·         Vertebral burst fractures(Vaccaro,2002)

References:

Apparelyzed.com (n.d.).Retrived on February 10, 2009 from http://www.apparelyzed.com/

 Clark, C.R., Ducker, T.B. & Cervical Spine Research Society Editorial Committee. (1997) The Cervical Spine. Lippincott Williams & Wilkins
Cristian, A. (2004). Living with Spinal Cord Injury. Demos Medical Publishing
Grant, R. (2002). Physical Therapy of the Cervical and Thoracic Spine. Churchill Livingstone
Johnston, L. (2005). Alternative Medicine and Spinal Cord Injury. Demos Medical Publishing.
Lin, V.W., Cardenas, D.D., Cutter, N.C.& Frost, F.S.(2002). Spinal Cord Medicine: Principles and Practice. Demos Medical Publishing.
Selzer, M. & Dobkin, B. (2008). Spinal Cord Injury: A Guide for Patients and Families. Demos Medical Publishing
Vaccaro. (2002). Fractures of the Cervical, Thoracic, and Lumbar Spine. Informa HealthCare

 

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