It is important to realise that every person with SCI is different. While there are some general management options that are likely to be followed, everyone will be treated slightly differently to accommodate their unique combination of needs.
At the scene
Many people with traumatic injury to the spinal cord receive other injuries at the same time. The top priority at any accident scene is always preservation of life. Establishing an open airway, ensuring that the person is breathing and that his/her heart is still beating takes priority over suspected spinal injury. Once these assessments are completed, the possibility of spinal cord injury will then be considered, to avoid worsening any existing damage.
If spinal cord damage is suspected, the person will be immobilised – the spine temporarily held in place to protect the cord from further damage – and transferred to the nearest Accident and Emergency (A&E) department.
A&E
On arrival at an A&E unit, a second range of checks will be carried out immediately:
- Taking a medical history: the exact circumstances of the accident, injury or assault.
- Vital signs: pulse, temperature, blood pressure, breathing rate.
- Physical examination: overall examination and examination of spinal break/injury/wound site.
- Neurological examination: state of consciousness, and brain and spinal cord function. Since nerves branching from different levels of the cord control different muscles and receive sensory information from different parts of the skin, specific testing of muscle function and skin sensitivity can help to determine the level of injury to the spinal cord.
- Radiological examination: X-rays to detect any broken bones or damage to vital organs.
- Other diagnostic tests: Other tests, such as MRI and CT scans may also be carried out, according to the injuries involved.
The way an individual will be managed and treated from this point onwards is determined by the results of their assessment.
Hospital management
Once the patient’s life is no longer at risk, correcting any problems with the spinal column (e.g. breaks or misalignment) becomes a priority. Initial, usually temporary, procedures are carried out in A&E. Longer-term procedures are likely to be carried out when more specialised facilities are available, after the person with SCI has moved to a general ward or a spinal injuries unit.
Most breaks to the spine will heal spontaneously after traction and a suitable period of bed-rest. (Traction involves putting a steady pulling force on the spinal column, in order to stabilise or correct the position of damaged parts of the spine.) A range of traction appliances may be used, as well as devices such as braces and splints that hold the spine in place while the bones heal.
Surgery may be another option, depending on the extent of the damage to the spinal column. The main reason for early surgery are to:
- remove any blood clots that are pressing on the spinal cord, since these could cause further damage.
- realign the spinal column - when non-surgical methods are not possible or have not been successful.
- stabilise the spinal column if a fracture has made it unstable. Devices such as rods and plates will be fixed to the spine to hold it in place.
Although surgery may realign the spinal column, the damaged bone still has to heal, and rigid immobilisation to hold the spine in place may be needed. Other surgical procedures may be carried out later, when the person has stabilised and all the necessary medical professionals, facilities and equipment are available.
Possible early complications
There are many potential complications associated with spinal cord injury. The types of complications and the time that they occur after the injury vary from one person to the next. There is a risk of some complications right from the time that the injury is sustained, such as:
- pressure sores (damaged skin as a result of continuous pressure)
- blood clots, e.g., deep vein thrombosis, pulmonary embolism
- respiratory complications, e.g., breathing difficulties, chest infections.
Nursing and medical staff are aware of these sorts of risks. They will take preventative measures where appropriate, and will look out for the symptoms of such complications, allowing their early treatment.
Intermediate and longer-term management
Once the immediate needs of the person with an SCI have been met, usually in an A&E department, the next stage of management begins. Initially, this may be in a general ward or intensive care unit (ICU) if the person has other injuries. In the UK, most people with SCI are transferred to a spinal injuries unit (SIU) within a few hours/days of injury, but other injuries or medical complications may delay this.
The aims of this intermediate period are to maintain the functioning of the body as much as possible. Early mobilisation from bed-rest, and ensuring that the individual is eating and drinking enough, will help to maintain this functioning. However, the physical effects of an SCI are wide-ranging, with all of the important body systems being affected in some way. Examples include impaired functioning of the bladder and bowel, various effects on the heart and circulation, and skin-related problems associated with loss of sensation and immobility. (The effects that SCI has on specific body systems and how they are dealt with are explained in detail in the Medical section of this website.)
In addition, the spinal injury will have a huge psychological effect on the person with SCI and those close to them. Counselling and psychological treatment will help them to come to terms with these new circumstances.
Rehabilitation – the process where the person with SCI adapts to the injury and learns how to regain maximum independence – also begins from this point onwards, and will continue for many months.
Medical management and rehabilitation of the individual involves dealing with complications associated with all of the body systems affected at the same time, so a team of healthcare professionals with a range of skills will be involved to help the person with SCI to receive the best care possible.
Click here for more information
 |
/SN_SPINALNET_LOGO_COLOURS_WWW/$File/SpinalNet_colours.gif){kind=logo}
/COLO-LOGO---HOSTED-NEW/$File/Colo_logo_hosted_200505.gif){kind=logo}
/PRINTER/$File/Printer_icon.gif "For printer friendly version of this page, click on the icon"){kind=icon}
/ENVELOPE-/$File/Envelope_icon.gif "Click on the icon, if you wish to send this page to a friend"){kind=icon}
/ADD-TO-FAVORITES/$File/ikon_small_favorits.gif "Please click on the icon if you wish to add this website to your favorites")