A spinal cord injury (SCI) develops when the spinal cord is damaged by preventing signals from being sent among the brain and the other parts of the body. Damage of this kind can cause loss of feeling and movement and in extreme situations it might cause paralysis. 

There are two main categories of injuries to the spinal cord: 

Traumatic SCI occurs by a sudden impact on the cervical spine such as a vehicle accident or act of violence. The spinal cord may be harmed by the force of impact by fracturing or dislocating the vertebrae. 

Non-traumatic SCI frequently caused degenerative disorders of joints, cancer and inflammation. 

The incidence rate of spinal cord injury in the US is around 40% incidences/million people or 12,000 new cases each year. Based on statistics from 1990s to 2010 approximately 265,000 individuals were with SCI. In 2005 66.5% White, 26.8% Black, 8.3% Hispanic and 2.0% Asian people are the SCI sufferers. 

80.7% of reported injuries in men are four times more likely than women to suffer these types of injuries. 

Type and Incidence of SCI: There are around 12,000 new instances of SCI yearly in the United States which are said to be affecting approximately 40 persons per million. After an accident, the level of the damage may change; it usually gets worse in a few days. Vasogenic edema, free radicals and changed blood flow are examples of pathophysiologic processes. SCI is frequently caused by ischemia, direct trauma and compression. 

Total cases of SCI majority are because of a motor vehicle accident (40. 4%). Fall rates are higher in > 45 years with an average of 27. 9 %. It was clearly established that women are more likely to have osteoporosis and are more likely to develop spinal fractures. 

15% of cases comprise interpersonal violence, bullet shots are the common cause of spinal cord injuries in different regions like several metropolitan areas. Stab and gunshot injuries to spinal cord are usually associated with neurological damage that can be worsen than tissue damage. 

Sports Injuries 8. 0% are possible cause in diving and explained by 21 of the participants. 

• Level of Injury:  Distinction depends on whether the injury is lumbar, cervical or thoracic in nature as it affects the degree of disability. Severe cases of injuries like tetraplegia cause loss of function. 
• Degree of Neurological Impairment:  Probability for recovery is closely related to the initial severity of neurological deficit assessed by standardized instruments. 
• Rehabilitation Start Date: Early mobilization and rehabilitation enable the affected persons to achieve optimum functional levels which helps to prevent complications and assists in reintegration to life with paralysis. 
• Injury-Incident Age: This is because the older patient’s brain has reduced plasticity and therefore, any potential regeneration where young people are likely to recover more. 

Young children may experience trauma from non-accidental injuries, sports-related accidents or falls and they may show symptoms of spinal cord dysfunction and motor deficiencies. Recreational activities such as sports injuries and car accidents are common causes. It is possible for adolescents to sustain compression injuries, dislocations or fractures. Middle-aged people may experience degenerative spine illnesses due to work-related injuries and auto accidents. Osteoporosis raises the risk of fractures and degenerative spinal disorders such spinal stenosis which make falls more common among older persons. 

Neurological examination 

Sensory examination 

Autonomic function assessment 

Trauma & Critical Care for Spinal Cord Injury 

• Stabilization: ABCDE approach suits the stabilization of patient wellness.
• Immobilization: Reduce the patient mobility and maintain spinal cord stability due to further traumas. 

Diagnostic Imaging: 

• X-rays, CT scans, or MRI:  The level and severity of injury to the spinal cord can be determined with imaging and scanning techniques. 

Medical Management: 

• Steroids:  It should be given within 8 hours of injury to minimize inflammation and other possible complications. 

Respiratory Support:  

• Self-care may be an issue and needs the use of assistive devices or ventilatory support. 

Surgical Interventions: 

• Decompression Surgery:  It is used to reduce the size of bone fragments, foreign bodies, or decompression of spinal cord. 
• Stabilization: Instrumentation can be employed to manage spinal instability. 

Rehabilitation: 

• Early Rehabilitation: It comprises physical therapy, occupational therapy and other related practice. 
• Adaptive Devices: Improves the ability to move around and be as self-sufficient as possible. 

Psychiatry/Mental Health

• Cognitive-Behavioral Therapy: Emotional and psychological difficulties are backed up psychologically. Arranging the appointments of the people with the support groups or counseling services. 
• Nutritional Support: Having close coordination with dietitians to maintain a proper eating regimen. 
• Speech therapy: Caring for individuals with cervical SCI presenting with dysphagia and speech dysfunction. 

Methylprednisolone Protocol:  A continuous infusion of methylprednisolone is administered after a high dosage “loading” of the drug. Usually given eight hours after the injury, the loading dosage consists of 15 minutes of 30 mg/kg of methylprednisolone, followed by a 23-hour maintenance infusion of 5.4 mg/kg/hour. 

Neurology

Pregabalin: The voltage-gated calcium channel alpha2-delta subunit is bound by it. It is comparable to GABA; however it doesn’t work with GABA receptors directly. The FDA has authorized pregabalin for the treatment of neuropathic pain brought on by spinal cord injuries. It works well to lessen neuronal hyperexcitability and lessen the symptoms of neuropathic pain. 

Orthopaedic Surgery

• Epidural Steroid Injections (ESIs): Inject corticosteroids into epidural space around spinal cord to reduce inflammation and alleviate pain. 
• Facet Joint Injections: Inject local anesthetics and corticosteroids into facet joints to relieve pain and inflammation caused by facet joint dysfunction. 
• Nerve Blocks: Inject local anesthetics or medications near specific nerves to block pain signals. 
• Spinal Cord Stimulation (SCS): Neuromodulation technique involving electrode implantation to interfere with pain signals. 

Neurosurgery

Phases of Spinal Cord Injury Management 

Acute Phase: 

• Provide Emergency Medical Care: Address critical issues which realigns the spine and halts the further deterioration. 
• Surgery: May be required for decompression of the spinal cord in case of fractures or any other emergencies. 
• Medical Management: Drugs to address pain and inflammation that may lead to complications. 

• Early Rehabilitation: Transfers to a facility with a prevention focus by  enhancing their physical and mental status and starting the process of correcting the person. 
• Multidisciplinary Care: Describes an idea for a medical team regarding patients with dysfunctional needs wishing to become independent and have a better quality of life. 
• Assistive Technology and adaptable EquipmAent: Education information about AT to people they must meet in order to use it. 
• Psychosocial Support: Provides support and coordinates therapy services to address psychological and emotional consequences.