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.

Anterior Cord Syndrome

Anterior Cord Syndrome refers to the Anterior Spinal Artery Syndrome. The anterior spinal artery originates from the vertebral arteries and basal artery at the base of the brain. It supplies the anterior two thirds of the spinal cord to the upper thoracic, that is chest, region. Anterior cord syndrome results from injury to the motor and sensory pathways in the anterior cord. Patients suffering from Anterior Cord Syndrome may feel some crude sensations, but their movement and more detailed sensation is lost. In Anterior cord syndrome there is damage primarily in the anterior 2/3 cord. This is related to vascular insufficiency, sparing the posterior columns. Anterior cord syndrome usually results from the compression of the artery that runs in front of the spinal cord. The compression may be from bone fragments or a large disc herniation.

• In Anterior Spinal cord syndrome, there is usually complete loss of strength below the level of the injury. Anterior spinal artery syndrome produces variable loss of motor function and of sensitivity to pinprick and temperature. Thus the patient undergoes complete sensory loss. But the sensitivity to vibration (vibratory sense) and position sense (proprioception) is preserved.
  
• In Anterior Cord syndrome, the anterior section of the spinal cord is injured. This results in loss of movement and sensory perception. In anterior cord syndrome, there is complete motor paralysis.
  
• In Anterior Cord Syndrome, there is sparing of the dorsal column. The patient therefore exhibits greater motor loss in the legs than arms.
  
• It is interesting to note 80% of spinal cord injuries occur in males. Children suffer spinal cord injuries due to sports activities. Adult suffer spinal cord injuries that are work related.

MRI is a most accurate imaging test for spinal disorders. This is because in MRI the spinal cord parenchyma, soft tissue lesions like hematomas, tumors and interverterbral disks, bony lesions like erosion, hypertrophic changes, collapse, fracture and subluxation are revealed. Myelography with a radiopaque agent is used less often. Physicians normally use CT scans to demonstrate bony fragments compressing the anterior spinal cord. X rays may help to detect bony lesions.

Anterior cord syndrome is said to have the worst prognosis of all cord syndromes. The prognosis is usually good if the recovery is evident and progressive in the patient during first 24 hours. However, if there are no signs of sacral sensibility to pinprick or temperature are present after 24 hours, then the prognosis for functional recovery can be said to be poor. There is no standard course of treatment or cure for anterior cord syndrome. Physicians adopt drug therapies and surgery as part of the treatment program. There have been some exceptional cases where sensations that travel along pathways are still intact after the injury. Normally, it is observed that only 10 to 15% of anterior cord syndrome sufferers demonstrate any improvement in functions over a period of time.