What Is It?
The spinal cord carries nerve signals from the brain to the rest of the body. Trauma to the spinal cord can result from a number of injuries: about half occur after motor vehicle accidents; followed by falls; gunshot wounds or other violence; and sports-related injuries. The average age at injury is 42 years, and approximately 80% of those affected are male. Up to one-quarter of cases occur after significant alcohol ingestion. Pre-existing disease in the spine can make spinal cord trauma more likely. For example, complications of rheumatoid arthritis or osteoporosis may lead to spinal cord damage.
Most spinal cord injuries occur in the area of the neck called the cervical region. Trauma can result from bruising to the spinal cord itself, loss of blood flow to the cord or cuts in the cord. Spinal cord injuries are serious and can cause diminished strength, coordination and sensation as well as other functions, such as bladder control.
The symptoms of spinal cord trauma vary and depend on the location and severity of the injury. Complete spinal cord trauma -- an injury that results in a total loss of sensation or the ability to move -- occurs at about the same level as the injury. For example, a person injured in the middle of the neck will lack feeling and be unable to move below the middle of the neck. Almost one-half of all spinal cord injuries are complete. Complete injuries that take place in the upper neck can compromise breathing ability and require the person to use a mechanical ventilator. Injuries to the spinal cord in the neck or upper back may cause abnormalities in blood pressure, sweating and in regulating body temperature. In addition, loss of bladder and bowel control and increased muscle tone in the extremities (spasticity) may accompany spinal cord injury. Some of these symptoms may not be apparent immediately after the injury.
Injuries to a specific side of the spinal cord or its center will produce characteristic patterns of symptoms, such as weakness or paralysis of arms or legs, or one side of the body. In an injured person who is unconscious, the degree of neurological injury may be hard to assess, so doctors must have a high degree of suspicion that a spinal cord injury has taken place and take steps to protect the spinal cord. This usually is done by using a cervical collar to immobilize the neck or by strapping the person to a stiff backboard for transport.
The possibility of spinal cord trauma should be considered in anyone who has been in a severe automobile accident or who has experienced significant injury to the head or neck.
If you are conscious, you will be asked about neck pain and whether you can feel and move your arms and legs. Significant pain, bruising and swelling of the skin and tissues over the neck or back may raise the suspicion of a spinal cord injury. A physical examination may reveal loss of sensation, weakness, and abnormal reflexes.
You also will be assessed for whether you have other injuries that may be diverting attention from a neck injury, and for the presence of other signs of spinal cord injury. X-rays, computed tomography (CT) scans and magnetic resonance imaging (MRI) also may be used to evaluate your spine and the spinal cord.
A cervical collar to keep your neck immobilized often will be left in place until the results of tests are available. If a spinal cord injury is suspected, the collar may be left in place for at least several days, even if tests are negative, in case an injury does exist but hasn't been detected because of swelling or muscle spasm.
Complete spinal cord injuries are diagnosed when total loss of sensation and control occurs. Incomplete injuries cause variable amounts of sensory loss, weakness or paralysis, depending on the site of the injury.
How long the symptoms of spinal cord injury last depends on the nature and extent of the injury. Minor bruising may go away over time, although full recovery sometimes takes weeks or months. More serious injuries often will result in permanent loss of function. Strategies for helping nerve cells (neurons) recover after injury is an area of active research.
Preventing spinal cord injury requires preventing traumatic injury to the spinal column, especially the neck. The leading causes of spinal cord injury include automobile accidents, falls, sports, diving accidents and firearms. To prevent spinal cord injury:
- Always wear your seat belt.
- Don't drink and drive.
- Dive only in water at least 9 to 12 feet deep, with your arms in front of you. Never dive into water if you don't know its depth.
- Wear protective equipment when playing sports or engaging in any dangerous activity.
- Protect yourself against falls.
Emergency care, surgery (when necessary), rehabilitation and supportive care, including use of respirators, can help people with spinal cord injuries survive and make the most of their remaining neurologic function.
In the past, corticosteroids were often given just after the injury to reduce swelling around the injured spinal cord. While corticosteroid therapy remains an option, a number of guidelines have removed this treatment as a standard recommendation due to a lack of convincing evidence supporting its effectiveness and its potential to cause side effects.
Most treatment of spinal cord injuries involves a "wait and see" approach. If the injury is minor, only time will reveal the extent of recovery. For those with major injuries, a complete recovery is highly unlikely, and treatment consists of providing supportive care, teaching new skills and developing coping strategies.
Surgery sometimes is required to stabilize a damaged spine, to remove fragments of injured bone, discs, or foreign objects (such as bullets), to drain fluid or a blood clot that is pressing on the spinal cord.
Active areas of research include:
- cooling of the body temperature or cooling of the tissues near the spinal cord
- nerve-cell transplant
- hormones and growth factors that encourage nerve cell regeneration
- electrical stimulation
Some believe that stem cells hold promise in helping people with spinal cord trauma regenerate damaged nerve cells so that neurologic function can be regained.
When To Call a Professional
All cases of actual or possible spinal cord trauma should be evaluated by a doctor immediately.
Spinal cord trauma may heal over time without further problems, or it may result in permanent deficits, depending on the location and severity of the injury. Early recovery of at least some movement or sensation suggests that additional recovery is possible. Lost sensation or function lasting more than 6 months is unlikely to improve.
Christopher Reeve Paralysis Foundation
United Spinal Association
Think First National Injury Prevention Foundation
Ni Nini? Upasuaji wa uti wa mgongo ni njia ya kusafirisha ishara za neva kutoka kwenye ubongo hadi kwenye sehemu nyingine za mwili. Ugonjwa wa uti wa mgongo unaweza kutokea kutokana na majeraha kadhaa: karibu nusu hutokea baada ya ajali za magari; ikifuatiwa na kuanguka; majeraha ya risasi au vurugu nyingine; na majeraha yanayohusiana na michezo. Kiwango cha wastani cha umri wa kuumia ni miaka 42, na karibu 80% ya wale walioathiriwa ni wanaume. Hadi robo ya visa hutokea baada ya kunywa kileo kingi. Ugonjwa uliopo tayari katika uti wa mgongo waweza kufanya uwezekano wa kuumia kwa uti wa mgongo uwe mkubwa zaidi. Kwa mfano, matatizo ya ugonjwa wa viungo vya mgongo au ugonjwa wa mifupa yanaweza kusababisha uharibifu wa uti wa mgongo. Majeraha mengi ya uti wa mgongo hutokea katika eneo la shingo linaloitwa eneo la shingo ya tumbo la uzazi. Matatizo ya kibofu yanaweza kutokea kutokana na kuharibiwa kwa uti wa mgongo wenyewe, kupoteza mtiririko wa damu kwenye uti wa mgongo au kukatwa katika uti wa mgongo. Majeraha ya uti wa mgongo ni makubwa na yanaweza kusababisha kupungua kwa nguvu, uratibu na hisia, pamoja na kazi nyingine, kama vile udhibiti wa kibofu cha mkojo. Dalili za majeraha ya uti wa mgongo hutofautiana na hutegemea mahali na uzito wa jeraha hilo. Uharibifu wa mshipa wa uti wa mgongo - uharibifu ambao unasababisha kupoteza kabisa hisia au uwezo wa kusonga - hutokea karibu katika kiwango sawa na uharibifu. Kwa mfano, mtu aliyeumia katikati ya shingo hatakuwa na hisia na hawezi kusonga chini ya katikati ya shingo. Karibu nusu ya majeraha yote ya uti wa mgongo yamekamilika. Majeraha ya jumla ya shingo ya juu yanaweza kuathiri uwezo wa kupumua na kuhitaji mtu kutumia kifaa cha kupumua. Uharibifu wa uti wa mgongo wa shingo au mgongo wa juu unaweza kusababisha kasoro katika shinikizo la damu, jasho na katika kudhibiti joto la mwili. Kwa kuongezea, kupoteza udhibiti wa kibofu cha mkojo na matumbo na kuongezeka kwa misuli ya viungo (spasticity) kunaweza kuambatana na jeraha la uti wa mgongo. Huenda baadhi ya dalili hizo zisiwe dhahiri mara tu baada ya jeraha hilo. Majeraha ya upande fulani wa uti wa mgongo au sehemu ya katikati ya uti wa mgongo yatatokeza dalili kama vile udhaifu au kupooza kwa mikono au miguu, au upande mmoja wa mwili. Katika mtu aliyejeruhiwa ambaye hana fahamu, kiwango cha uharibifu wa neva inaweza kuwa vigumu kutathmini, hivyo madaktari lazima kuwa na kiwango cha juu cha shaka kwamba uharibifu wa uti wa mgongo umetokea na kuchukua hatua za kulinda uti wa mgongo. Kwa kawaida, hilo hufanywa kwa kutumia kola ya shingo ili kuzuia shingo isiweze kusonga au kwa kumfunga mtu huyo kwenye ubao mgumu wa nyuma ili amsafirishe. Uwezekano wa kuumia kwa uti wa mgongo unapaswa kuzingatiwa kwa mtu yeyote ambaye amekuwa katika ajali kubwa ya gari au ambaye amepata jeraha kubwa kwa kichwa au shingo. Ikiwa unafahamu, utaulizwa juu ya maumivu ya shingo na ikiwa unaweza kuhisi na kusonga mikono na miguu yako. Maumivu makubwa, majeraha na uvimbe wa ngozi na tishu juu ya shingo au nyuma inaweza kuongeza tuhuma ya jeraha la uti wa mgongo. Uchunguzi wa kimwili waweza kufunua kupoteza hisia, udhaifu, na mwitikio usio wa kawaida. Pia utachunguzwa ikiwa una majeraha mengine ambayo yanaweza kugeuza umakini kutoka kwa jeraha la shingo, na ikiwa kuna dalili zingine za jeraha la uti wa mgongo. X-ray, CT, na MRI pia zinaweza kutumika kutathmini uti wako wa mgongo na uti wa mgongo. Mara nyingi, mkufu wa shingo ya tumbo la uzazi utawekwa mahali pake hadi matokeo ya uchunguzi yatakapopatikana. Ikiwa kuna shaka ya jeraha la uti wa mgongo, kola inaweza kuachwa mahali kwa angalau siku kadhaa, hata ikiwa vipimo ni hasi, ikiwa jeraha lipo lakini halijagunduliwa kwa sababu ya uvimbe au spasm ya misuli. Majeraha kamili ya uti wa mgongo hugunduliwa wakati hasara kamili ya hisia na udhibiti inatokea. Majeraha yasiyo kamili husababisha kiasi tofauti cha kupoteza hisia, udhaifu au kupooza, kulingana na eneo la jeraha. Muda unaodumu wa dalili za jeraha la uti wa mgongo unategemea aina na kiwango cha jeraha hilo. Majeraha madogo-madogo yaweza kutoweka baada ya muda, ingawa nyakati nyingine uponyaji kamili huchukua majuma au miezi. Mara nyingi majeraha mazito zaidi husababisha kupoteza kazi kwa njia ya kudumu. Mbinu za kusaidia chembe za neva (neuroni) kupona baada ya kujeruhiwa ni eneo la utafiti wenye bidii. Kuzuia jeraha la uti wa mgongo huhitaji kuzuia jeraha la kiharusi kwenye uti wa mgongo, hasa shingo. Sababu kuu za majeraha ya uti wa mgongo ni pamoja na ajali za magari, kuanguka, michezo, ajali za kupiga mbizi na silaha za moto. Ili kuzuia jeraha la uti wa mgongo: - Sikuzote vaa mkanda wako wa usalama. - Usinywe na kuendesha gari. - Piga mbizi katika maji yenye kina cha angalau mita 9 hadi 12, na mikono yako mbele yako. Kamwe usizamishe ndani ya maji ikiwa hujui kina chake. - Vaa vifaa vya kujilinda unapocheza michezo au kufanya shughuli yoyote hatari. - Jilinde dhidi ya kuanguka. Matibabu ya dharura, upasuaji (wakati inahitajika), ukarabati na huduma ya kusaidia, ikiwa ni pamoja na matumizi ya respirators, inaweza kusaidia watu wenye majeraha ya uti wa mgongo kuishi na kufanya zaidi ya kazi yao iliyobaki ya neva. Zamani, mara nyingi corticosteroids zilitolewa baada tu ya jeraha ili kupunguza uvimbe kuzunguka uti wa mgongo uliovunjika. Ingawa matibabu ya corticosteroid bado ni chaguo, miongozo kadhaa imeondoa matibabu haya kama mapendekezo ya kawaida kwa sababu ya ukosefu wa ushahidi wa kushawishi unaounga mkono ufanisi wake na uwezekano wake wa kusababisha athari za upande. Matibabu mengi ya majeraha ya uti wa mgongo huhusisha mbinu ya "kusubiri na kuona". Ikiwa jeraha hilo ni dogo, ni wakati tu utakaofunua kadiri ya kupona. Kwa wale walio na majeraha makubwa, uponyaji kamili ni uwezekano mdogo sana, na matibabu ni kutoa huduma ya kusaidia, kufundisha ujuzi mpya na kuendeleza mikakati ya kukabiliana. Wakati mwingine upasuaji huhitajiwa ili kuimarisha uti wa mgongo ulioharibiwa, kuondoa vipande vya mifupa iliyoathiriwa, diski, au vitu vya kigeni (kama vile risasi), kuondoa umajimaji au damu inayokusanya ambayo inasisitiza uti wa mgongo. Utafiti wa utafiti unaonyesha kwamba chembe za msingi zinaweza kusaidia watu walio na majeraha ya uti wa mgongo kurekebisha seli za neva zilizoharibiwa ili uwezo wa neva upate upya. Wakati wa Kumwita Mtaalamu Kesi zote za jeraha halisi au linalowezekana la uti wa mgongo zinapaswa kutathminiwa na daktari mara moja. Majeraha ya uti wa mgongo yanaweza kupona kwa muda bila matatizo zaidi, au yanaweza kusababisha upungufu wa kudumu, kulingana na eneo na uzito wa jeraha. Kupata mapema angalau baadhi ya harakati au hisia inaonyesha kwamba uponyaji wa ziada inawezekana. Kupoteza hisia au utendaji kwa zaidi ya miezi sita ni uwezekano mdogo wa kuboresha. Christopher Reeve Paralysis Foundation United Spinal Association Fikiria Kwanza Shirika la Kitaifa la Kuzuia Majeraha