Spinal Cord Injury

Myelopathy or spinal cord injury is a problem in the spinal cord that causes numbness and loss of motor (muscular) control. Spinal cord injuries can be caused due to trauma such as accident and falls and Disease caused due to spina bifida, polio, tumors etc. The effect of spinal cord injuries be Complete (total function and sensation is lost below the injured point) or Incomplete (Sensation is not lost and only few functions of the part suffers malfunctioning).

Spinal cord injuries in general occur due to the following:

• Road accident, either car or motorcycle
  
• Injuries caused due to sports
  
• Gunshot wounds
  
• Stabbing with knife
  
• Fall from an elevated structure
  
• Accidents while diving

Symptoms of spinal cord injury include weakness, numbness and reduced synchronization from beneath the point of the injury. There is loss of feelings and tingling sensation. There may be excessive pain or loss of bladder or bowel control. Quadriplegia is an injury at the neck level of the spine and induces difficulty in breathing and paralyzes the arms, legs and trunk. Paraplegia is an injury to the lower spine and results in weakness and loss of mobility and feeling in the legs and the lower part of the body.

• Corticosteroid drugs are prescribed to ease the injury and perk up chances of healing.
  
• Surgery is required for severe cases of damage.
  
• Complete bed rest is required during the recovery period.
  
• Traction might be suggested depending on the case.
  
• Additional treatment for bladder control, urinary infections and bed sore is required.
  
• Muscles have to be strengthened through physiotherapy.

Prevention of spinal cord injuries

• Driving or riding at safe speed limits and following rules thus avoiding traumatic road accidents.
  
• Do not resort in violence, assault and physical fights that can lead to gun shots or knife wounds.
  
• Keep floor dry so as to prevent falls and when working from a height take all precautionary measures to safe guard your spine.
  
• In sports, use the right equipments and gears, and do not over do any activity.
  

Syringomyelia

Syringomyelia is a generic term referring to a neurological disorder where a cyst or cavity is formed within the spinal cord. This cyst called syrinx can expand and elongate over time destroying even the spinal cord leading to pain, paralysis and weakness due to the damage caused. Syringomyelia can lead to inability to feel extremes of hot or cold especially in the hands.

Signs and symptoms of Syringomyelia

Syringomyelia symptoms usually develop slowly over time, and symptoms generally may begin between ages 25 and 40. The symptoms could vary depending upon the extent and location of the syrinx in the spinal cord. Pain is the predominant symptom in Syringomyelia as the nerves are directly under pressure. Patients report pain in the neck, upper back, and shoulders. This is referred to as the cape effect of Syringomyelia - pain where a cape is draped over the shoulders.

There could be pain in the chest, stomach or lower back region for those with a syrinx in the thoracic region of the spinal cord. Neuropathic pain is common among Syringomyelia patients and can be very difficult to treat. Many with Syringomyelia may lose strength and develop numbness in their arms and legs. Controlling body temperature, stiff muscles and loss of bladder and bowel control are other challenges of Syringomyelia. There could be a combination of symptoms experienced by each patient. Symptoms begin in young adulthood. Though the signs of the disorder tend to develop slowly, there could be sudden onset of cough and strain. Some people develop a large syrinx without any symptoms. These people become symptomatic suddenly and deteriorate rapidly.

Causes of Syringomyelia

Syringomyelia is a result of something else and not a disease in itself. The most common cause is a Chiari malformation. Syringomyelia can also result from a spinal cord injury such as a car accident or a fall. Post traumatic Syringomyelia can form months or even years after such an injury. Tumor or mass in spinal cord can also result in Syringomyelia.

Syrinx formation

Although there have been several theories on this, the most recent one states that the cerebellar tonsils act like a piston and beat down the spinal area with every heartbeat. The piston motion forces the cerebrospinal fluid into the spinal cord where it forms a syrinx. However, the reason for the pressure higher inside than outside the fluid does not match CSF.

Diagnosis of Syringomyelia

Spine MRI can show the presence of a syrinx. Usually MRI of the entire spine is done if Chiari malformations are found. CT scan uses a series of X rays to create a detailed view of the spine and spinal cord.

Treatment of Syringomyelia

Most surgeons recommend surgery of some type. While some surgeons recommend surgery anytime there is a syrinx, others monitor the situation with routine MRI and neurological exams. For Chiari related Syringomyelia, surgery will reduce the syrinx, or at least will prevent increase in most cases. Surgery doesn't always effectively restore the flow of cerebrospinal fluid, and the syrinx may remain, despite efforts to drain the fluid from it.

For those with symptoms of an active syrinx, it may eventually lead to paralysis. For the others without symptoms, the future is less clear and uncertain. Surgery can reduce the pressure on the brain and spinal cord, restore the normal flow of cerebrospinal fluid and resolve Syringomyelia.

Draining the syrinx: The doctor will surgically insert a drainage system called a shunt and drain the syrinx. It consists of a tube with a valve that is flexible from the syrinx flowing in the desired direction. One end of the tube is placed in the syrinx and the other is placed in another area of the body such as the abdomen.

Removing the obstruction: In case a tumor or a bony growth is hindering the normal flow in cerebrospinal fluid, surgically removing the obstruction may restore the normal flow and allow fluid to drain from the syrinx.

Correcting the abnormality: In case a spinal abnormality is hindering the flow of cerebrospinal fluid, surgery to correct it, such as releasing a tethered spinal cord, may restore normal fluid flow and allow the syrinx to drain.

Recovery post surgery

This will vary from one individual to another, but will depend largely on whether there is any permanent damage from the syrinx. In some cases it may take years to get better and stronger. Even after successful surgery, the syrinx may take a year to collapse and may not go away completely. Often recovery can be a series of ups and downs, with long periods of improvements punctuated by temporary setbacks.

Post Surgical Care

Follow-up care after surgery is critical as chances are Syringomyelia may recur. Regular examinations with the doctor, including periodic MRIs to assess the outcome of surgery are necessary. The syrinx may grow over time requiring additional treatment. Even after treatment, the syrinx can cause permanent spinal cord and nerve damage.

Uroflowmetry

Urinary disorders can often indicate a lot of underlying complications. Urination and the excreted product is very significant in evaluating a person's health in associated with kidney function and prostrate health in case of men. Urination is a complex procedure, which involves the contraction of the muscles associated with the detrusor and the external bladder tissues. The cerebral cortex facilitates the initiation and emptying of the bladder during the urination process.

Urination can be affected for various reasons such as weather, emotions, and hormonal imbalance, incontinence due to anatomical disorders and also underlying inflammations or infections. The regulation of blood pressure and adrenal surge is also involved in proper generation of urine. Physicians analyze the uroflowmetry parameters in order to diagnose urinary tract infections and also to evaluate the normal flow rate of urine to determine the normal function of the urinary tract and associated muscles.

Uroflowmetry is widely recommended in many countries, as it has become the foundation for diagnosing prostrate enlargement, urethritis and obstruction. Males over 30 years are advised to undergo this test as it is necessary to detect the early signs of an underlying condition such as prostate cancer, bladder tumor or neurogenic bladder dysfunction where the cause is spinal cord injury or lesion. Typical conditions where uroflowmetry might be advised are difficulty in urinating, frequency of urination, nocturia, enuresis, Benign Prostatic Hyperplasia, urethral stenosis or incomplete bladder emptying.

Preparation and procedure

Patients undergoing uroflowmetry procedure are advised to drink plenty of water in order to fill up the bladder as it provides a comprehensive analysis of the bladder functionality. They are also asked to hold the urine for a few hours before the test. Unlike other urinary examinations, here the specimen is not collected in a cup but the patient is asked to urinate into a funnel that connects to a container underneath. Special toilets are provided in some diagnostic centers for this procedure. The funnel shaped device measures the urine flow rate and quantity and the results obtained are recorded.

The normal flow rate of the urine varies from 10 ml to 20 ml per second. The results associated may vary both in males and females. The flow rate in women is often less as it may take 15 ml to 18 ml per second. In men, urine flow declines with age. Women have lesser change with age.

14 - 45 years

The average flow rate for males is 21 ml/sec.
The average flow rate for females is 18 ml/sec.

46 - 65 years

The average flow rate for males is 12 ml/sec.
The average flow rate for females is 18 ml/sec.

66 - 80 years

The average flow rate for males is 9 ml/sec.
The average flow rate for females is 18 ml/sec.

The diagnostic evaluations based on this can indicate the strength of the bladder muscles and also other disorders. Delayed urine flow indicates obstruction and also infections that are causing tissue inflammation. Increased flow of urine also indicates weak bladder muscles and also lack of cerebral cortex control. Incontinence is widely reported in elderly groups. Neurological conditions and trauma can also affect urine flow rate.

Tags: #Spinal Cord Injury #Syringomyelia #Uroflowmetry