Spinal Cord Injury: Treatments and Rehabilitation (cont.)

The outcome of any injury to the spinal cord depends upon the number of axons that survive: the higher the number of normally functioning axons, the less the amount of disability. Consequently, the most important consideration when moving people to a hospital or trauma center is preventing further injury to the spine and spinal cord.

Spinal cord injury isn't always obvious. Any injury that involves the head (especially with trauma to the front of the face), pelvic fractures, penetrating injuries in the area of the spine, or injuries that result from falling from heights should be suspect for spinal cord damage.

Until imaging of the spine is done at an emergency or trauma center, people who might have spinal cord injury should be cared for as if any significant movement of the spine could cause further damage. They are usually transported in a recumbent (lying down) position, with a rigid collar and backboard immobilizing the spine.

Respiratory complications are often an indication of the severity of spinal cord injury. About one third of those with injury to the neck area will need help with breathing and require respiratory support via intubation, which involves inserting a tube connected to an oxygen tank through the nose or throat and into the airway.

Methylprednisolone, a steroid drug, became standard treatment for acute spinal cord injury in 1990 when a large-scale clinical trial supported by the National Institute of Neurological Disorders and Stroke showed significantly better recovery in patients who were given the drug within the first 8 hours after their injury. Methylprednisolone appears to reduce the damage to nerve cells and decreases inflammation near the injury site by suppressing activities of immune cells.

Realignment of the spine using a rigid brace or axial traction is usually done as soon as possible to stabilize the spine and prevent additional damage.

On about the third day after the injury, doctors give patients a complete neurological examination to diagnose the severity of the injury and predict the likely extent of recovery. The ASIA Impairment Scale is the standard diagnostic tool used by doctors. X-rays, MRIs, or more advanced imaging techniques are also used to visualize the entire length of the spine.

ASIA (American Spinal Injury Association) Impairment Scale*

Classification	Description
A	Complete: no motor or sensory function is preserved below the level of injury, including the sacral segments S4-S5
B	Incomplete: sensory, but not motor, function is preserved below the neurologic level and some sensation in the sacral segments S4-S5
C	Incomplete: motor function is preserved below the neurologic level, however, more than half of key muscles below the neurologic level have a muscle grade less than 3 (i.e., not strong enough to move against gravity)
D	Incomplete: motor function is preserved below the neurologic level, and at least half of key muscles below the neurologic level have a muscle grade of 3 or more (i.e., joints can be moved against gravity)
E	Normal: motor and sensory functions are normal

 * Used with permission of the American Spinal Injury Association.

Spinal cord injuries are classified as either complete or incomplete, depending on how much cord width is injured. An incomplete injury means that the ability of the spinal cord to convey messages to or from the brain is not completely lost. People with incomplete injuries retain some motor or sensory function below the injury.

A complete injury is indicated by a total lack of sensory and motor function below the level of injury.

Source: MedicineNet.com
http://www.medicinenet.com/spinal_cord_injury_treatments_and_rehabilitation/article.htm