Injury or gradual wear and tear that affects your spinal cord or its nerve roots can have serious or even permanent consequences if they are not addressed. Director Todd Gravori, MD and his team of spine and neurosurgeons are experts at treating spine conditions and offer a variety of treatments to alleviate pain and improve mobility.
Please do not hesitate to contact our offices in Beverly Hills, Encino, and Valencia. The bundle of nerves that run from the base of the skull to the low back and tail bone are protected by sturdy bones called the vertebrae that also help support the body and skeleton. However, the spine is also flexible and can wear down over time, become weakened by disease, or suffer injury in an accident. Common causes of damage to the spinal cord and nerve roots that branch out from the spine include:.
Learn more about the causes of nerve and spinal cord damage by visiting Mayo Clinic. This would be one of the first recorded industrial accidents. Pictorial evidence of urinary catheterization has been recorded by these early historians.
It seems that spinal cord injury and other paralysis have been with us since the dawn of mankind. In some of the remains of the Native American culture in the United States, vertebrae bones with arrows going through them have been found. One arrow pierced vertebra can be seen at Cahokia Mounds in Southern Illinois. This exhibited specimen is of a human vertebra with the arrow and tip through the bone.
The human tissue is long gone but the injury that would have been sustained would clearly have been a traumatic spinal cord injury. War and trauma were the common sources of SCI for years mostly because people did not live long enough to see much effect of SCI from disease. Because of the large numbers of injured soldiers from each battle, techniques to save lives were developed over time.
The more soldiers that could be saved would mean more soldiers that could return to the battlefield. One of the first rehabilitation nurses was Florence Nightingale who suggested novel treatments such as hand washing, cleanliness in providing care and pressure release treatments.
Florence thought patients should be turned to avoid pressure injury about every two hours-sound familiar? We still aim for the two hour turn in hospitals today, even though scientific evidence indicates that pressure releases should be accomplished as frequently as every 10 minutes. Fast forward to World War II. The intervention of antibiotics and field hospitals with quick treatments resulted in a significant survival of wounded soldiers.
Regenerative techniques were developed to improve vascular function and spare nerve damage. Medical doctors and surgeons continued with development of treatments after the war since many soldiers lived to return home. Today, military and other researchers continue with advancing treatments for rehabilitation care. Paralysis treatment was extensively developed with the polio epidemic in the United States. Other countries had been conducting research for neurological conditions as well.
Some of these techniques were further developed for the treatment of polio. These included providing activity to affected parts of the body, aquatic or water therapy and ventilation with iron lungs. In polio treatment centers, those affected were provided range of motion by volunteers for hours at a time.
This constant movement provided the body with the necessary activity that was not being provided internally. Aquatic therapy, in warm water, relaxed muscles and provided the buoyancy to help support limbs. Moving a body part on your own might be too difficult due to gravity but the added buoyancy of the water reduced the difficulty of overcoming gravity with movement.
Another essential element for treatment was ensuring oxygenation for those who had difficulty breathing.
This allowed individuals a chance to survive until enough strength was regained to participate in additional therapies. There were other treatments as well, but these were the mainstays of the program. Whole communities would take part in providing this time intensive therapeutic treatment. One famous spa is in Warm Springs, Georgia. This was developed by President Franklin D.
He continued with this therapy throughout his life. Another proponent of therapy for polio was Sister Kenny who created a novel treatment. The Sister designation was from her origin of Australia, although she did not have formal training as a nurse. Her treatment consisted of reducing spasms, so limbs could be put through range of motion.
At the time, this practice was controversial as it was not the state of the art. However, her unusual thinking changed the way treatments were conducted. A new idea was conceived: hope.
There was a wave of movement that it would be possible for individuals with spinal cord injury to improve. It was due to several discoveries such as nervous system plasticity where it is acknowledged that the nervous system can adapt to injury and reroute itself. Previously, the nervous system was thought that only one particular nerve could connect to another particular nerve. If you think of a ponytail hair do, it was thought that if the ponytail was cut, each single hair would have to be reattached to its original hair.
This was the same thinking that spinal cord injury could be repaired, each nerve reattaching to its original nerve. The concept of plasticity changed this idea. The body can adapt and adjust to injury.
There were several other major discoveries about the nervous system which when combined created a new vision of recovery from spinal cord injury.
The major proponent of these discoveries was Christopher Reeve who developed what is now called the Christopher and Dana Reeve Paralysis Foundation to expand and develop these new ideas about the nervous system. His motto, Forward, indicates the need to look toward these new ideas of hope and recovery rather than to cling to old ideas that we now know did not encompass spinal cord injury recovery. Many researchers and health care professionals have embraced the new concept of recovery for spinal cord injury.
Similar therapies like those instituted for the treatment of polio have been adapted and revised for the current use. The explosion in the development of technology has been utilized to develop equipment that can replace the large numbers of people needed to deliver the therapies as well as to deliver treatments in less time allowing the recipient to have time for other pursuits in life.
As time moves on, these therapies have been refined and tested with positive results. Knowing which therapy to be provided for the best results and the length and number of treatments is being considered.
Further advances in technology have allowed some of the external cumbersome equipment to be reduced to microscopic size which can actually be transplanted into the body. This is beneficial and convenient for the person with spinal cord injury. Future research will make these technologies more encompassing and available for everyone with spinal cord injury. One of the prime features is that these technologies will benefit individuals with new spinal cord injuries and those that have injuries from years ago.
If you are looking for more information about spinal cord injury or have a specific question, our Information Specialists are available business weekdays, Monday through Friday, toll-free at from am to pm ET. Additionally, the Reeve Foundation maintains a spinal cord injury fact sheet with additional resources from trusted sources. Check out our repository of fact sheets on hundreds of topics ranging from state resources to secondary complications of paralysis.
We encourage you to reach out to organizations and associations which feature news, research support, and resources, national network of support groups, clinics, and specialty hospitals.
Spinal Cord Injury Zone. Agency for Healthcare Research and Quality. SCI Info Pages. American Association of Neurological Surgeons. Montalbano MJ et al. Innervation of the blood vessels of the spinal cord: a comprehensive review.
Neurosurg Rev. Update on traumatic acute spinal cord injury. Part 1. Med Intensiva. Part 2. Weidauer S et al. Spinal cord ischemia: aetiology, clinical syndromes and imaging features.
Greene, N. Inositol for the prevention of neurol tube defects: A pilot randomized controlled trial. Br J Nutr. Ikeda K et al. The respiratory control mechanisms in the brainstem and spinal cord: integrative views of the neuroanatomy and neurophysiology. J Physiol Sci. Zaninovich OA et al. The role of diffusion tensor imaging in the diagnosis, prognosis, and assessment of recovery and treatment of spinal cord injury: a systematic review.
Neurosurg Focus. Implementing a self-management mobile app for spinal cord injury during inpatient rehabilitation and following community discharge: A feasibility study. J Spinal Cord Med. Mil Med. Wang Z et al. Neurosci Lett. A preliminary investigation of mechanisms by which short-term resistance training increases strength of partially paralysed muscles in people with spinal cord injury. Spinal Cord. A systematic review of the content and quality of clinical practice guidelines for management of the neurogenic bladder following spinal cord injury.
J Adv Nurs. Epub Aug Global and domain-specific life satisfaction among older adults with long-term spinal cord injury.
Crowe, Maria J. Nature Medicine, vol. Behrman AL et al. J Neurol Phys Ther. Quel de Oliveira C et al. J Neurotrauma. Jones ML et al. Activity-based therapy for recovery of walking in individuals with chronic spinal cord injury: results from a randomized clinical trial. Arch Phys Med Rehabil. Khan S et al. Curr Stem Cell Res Ther. Stenudd M et al. Role of endogenous neural stem cells in spinal cord injury and repair.
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Disabil Rehabil Assist Technol. TsNTxP, a non-toxic protein from Tityus serrulatus scorpion venom, induces antinociceptive effects by suppressing glutamate release in mice. Eur J Pharmacol. MicroRNAp attenuates motor deficit following spinal cord injury via targeting paired box gene 2.
J Integr Neurosci. Holtz KA et al. Spinal Cord Injury Facts and Figures. Plast Reconstr Surg. Effect of biceps-to-triceps transfer on rotator cuff stress during upper limb weight-bearing lift in tetraplegia: A modeling and simulation analysis. J Biomech. Rapid and robust restoration of breathing long after spinal cord injury. Nat Commun. Phrenic motoneuron structural plasticity across models of diaphragm muscle paralysis.
J Comp Neurol. Epub Nov 8. Reeve Foundation. Causes of a Spinal Cord Injury Spinal cord injury occurs when something interferes with the function or structure of the cord. Other Types of Spinal Cord Injury There are other less common types of spinal cord injury that affect specific areas of the spinal cord.
Cervical Spinal Cord Section The nerves exiting the vertebrae in the neck area or cervical segments are referred to as C1 through C8. An injury above the C3 level may require a ventilator for breathing. Thoracic Spinal Cord Section Nerves in the thoracic or rib cage area T1 through T 12 relay signals to the torso and some parts of the arms. Lumbar and Sacral Sections Nerves in the lumbar and sacral levels of the spinal cord affect the legs, bowel, bladder and sexual function.
Individuals with injuries in the lumbar or mid-back area just below the ribs L1-L5 affect messages to and from the brain to the hips and part of the legs. A person with an L4 injury can often extend their knees. The sacral sections S1 through S5 lie just below the lumbar segments in the mid-back and control signals to the groin, toes, and some parts of the legs. Bowel, bladder and sexual function is affected. The spinal cord is numbered by the boney vertebrae that houses it.
You will notice that the bones that surround the spinal cord are not stacked directly on top of each other but have some gentle curves to allow movement in the back and torso. The nerves of the cervical C spinal cord are numbered from C1 is located in the skull, C2-C8 are located in the neck. Thoracic T vertebrae are the back bones that have ribs attached. Thoracic vertebrae are numbered T1-T Lumbar L spinal cord segments are at the small of the back and number L1-L5.
Sacral nerves are S1-S5. There is one coccygeal segment. The spinal cord consists of a bundle of nerves that travel down the back from the brain through the back bones or vertebrae.
The nerves of the spinal cord and the bones that protect the spinal cord have the same section cervical, thoracic, lumbar, sacral and number notation. Each vertebra has two nerves that exit from either side that control a segment of the body called a dermatome. Each nerve controls the function, sensation and autonomic nerves of that part of the body.
The nerves that exit the spinal cord are specific to each area of the body. This is how you and your healthcare providers will communicate function and sensation. Key levels include C3 and above which, if injured, will require mechanical ventilation for breathing.
In the cervical levels, your function and sensation are tetraplegic the same as quadriplegic or involving all four limbs. Paraplegia is diagnosed at T1, which means arm and hand function is intact, but trunk and legs have limitations. Individuals who have sacral level injury will be able to walk with assistive devices but will have limitations in bowel, bladder and sexual function. It is a bit difficult to locate some levels of the spinal cord on the body especially in the trunk where there are no particular differentiation points.
T4 is at the nipple line. T10 is at the umbilicus or belly button. If you start at T4 and count down by two finger widths you will be at T5, two more consecutive finger widths downward is T6. Keep going and you will end up at the umbilicus or belly button which is T Cells that Control Spinal Cord Function Several types of cells carry out spinal cord functions, including: Long axons that control skeletal muscles in the neck, torso, and limbs are called large motor neurons.
Sensory neurons called dorsal root ganglion cells, or afferents, carry information from the body into the spinal cord and are found immediately outside the spinal cord. Cells that help integrate sensory information and generate coordinated signals that control muscles are called spinal interneurons.
These cells lie completely within the spinal cord. Supporting cells called glia , far outnumber neurons in the brain and spinal cord and perform many essential functions. Glial cells produce substances that support neuron survival and influence axon growth. However, these cells may also impede recovery following injury; some glial cells become reactive and thereby contribute to formation of growth-blocking scar tissue after injury.
Creating the myelin sheaths that insulate axons and improve the speed and reliability of nerve signal transmission is a specific type of glial cell called the oligodendrocyte. Large star-shaped glial cells regulate the composition of the fluids that surround nerve cells. Some of these cells named Astrocytes, also form scar tissue after injury.
Smaller cells become activated in response to injury and help clean up waste products. These cells are called microglia. You might hear these words discussed, especially if you are having or had surgery to the area around the injury of your spinal cord: Pia mater: inner most layer Arachnoid: delicate middle layer Dura mater: tougher outer layer Diagnosing Spinal Cord Injury Imaging using MRI or CT scans will provide information about a spinal cord injury including the type and level where the trauma occurred.
Motor incomplete. Motor function is present to the end of the spinal cord. Muscle function below level of injury is against gravity. No residual affects assessed. Treatment for Spinal Cord Injury Immediately after a spinal cord injury, the individual is placed on a back board with a neck brace to help stabilize the spine. Recovery from Spinal Cord Injury Recovery from spinal cord injury can be a slow process.
Secondary Conditions Due to Spinal Cord Injury Besides a loss of sensation or motor function, injury to the spinal cord leads to other changes in the body.
Body System Secondary Complication Paralysis Effects Suggestions for Treatment Musculoskeletal Calcium loss Calcium loss from lack of movement through long bones of the legs, fractures Keep track of bone density though regular bone density testing and treat as recommended by your healthcare professional.
Use of a standing frame with gliders if able to use to put movement through the legs. Heterotrophic Ossification H. Overgrowth of bone into soft tissue muscle Perform range of motion exercise to joint to keep them pliable. Medication: etidronate disodium Didronel to reduce bone growth.
Surgical removal. Loss of muscle tissue Replacement of muscle with fat, stomach pouch, scoliosis, skin breakdown Exercise as able. Move all body joints several times a day. Use resistance bands if possible Some drugs can decrease muscle tone but have significant side effects, discuss with healthcare professional when appropriate. Upper extremity pain Shoulder pain from propelling wheelchair, rotator cuff injury, bursitis, capsulitis Work with therapist to learn techniques for strengthening.
Add power assist to your wheels Poor muscle tone Scoliosis or curvature of the back Strengthening exercises for the back. Sit up, use excellent posture. Utilize positioning equipment when sitting or lying. Monitor equipment for wear and damage. Tone spasticity Spasms of muscles of the extremities and inside the body in individuals with cervical and thoracic injuries. Move and stretch muscles frequently during the day. Fatiguing the muscle can reduce tone.
Use medication as needed to reduce tone and pain, if necessary. Some tone can be effective for assisting with transfers. Use advanced therapies to exercise muscles to reduce tone. Flaccidity Lack of muscle tone in the lower extremities and the body in lumbar and sacral injuries. Provide manual movement to the lower extremities to keep muscles pliable. Nervous Slowing rate of information processing Complicated by injury to the brain Exercise your brain as well as your body. Engage in conversation and socialization.
Decreased balance and coordination Spasticity Stretching for all parts of your body on a regular basis. Muscular pain and Neuropathic pain Nerve pain from inefficient nerve transmissions Discuss option with your healthcare specialists for non-narcotic treatment options.
Exercise and stretch muscles which fatigues them making spasms less frequent and less severe. Become active in the SCI community to exchange ideas and opportunities. Cardiovascular Autonomic Dysreflexia A. Misinterpretation of nerve impulses Know the warning signs and treatments. Use elastic blood return flow garments especially full leg and abdomen. Wear prevention elastic stocking on legs or arms. Use blood thinning medication, only if prescribed.
DVT wallet card Edema Poor return of fluid from the legs and arms Elevate affected body part higher than the heart. Use elastic blood return flow garments. Diuretic medication if indicated. Exercise intolerance Ineffective distribution of oxygen in the blood If unable to perform the exercise routine that you did earlier, modify but stick with a plan. Increased cardiac risk Develops over time. Control factors such as diet, exercise, weight gain, cholesterol, blood pressure Respiratory Decreased lung capacity Restriction of breathing, poor posture Breathe in deeply and exhale completely at regular intervals throughout the day.
Strengthen chest muscles with therapy. You also may expect to undergo intense rehabilitation treatment for your spinal cord injury. Follow these hacks each day to improve, protect, and straighten your spine. Autonomic dysreflexia AD , also known as autonomic hyperreflexia, is a condition in which your involuntary nervous system overreacts to stimuli. Paralysis is a loss of muscle function in part of your body.
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