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Treatment of Spinal Cord Injury

Treatment begins with the emergency medical personnel who make an initial evaluation and immobilise the patient for transport. Immediate medical care within the first 8 hours following injury is critical to the patient's recovery. Nowadays there is much greater knowledge about the moving and handling of spinal injury patients.  Incorrect techniques used at this stage could worsen the injuries considerably.

When injury occurs and for a period of time thereafter, the spinal cord responds by swelling. Treatment starts with steroid drugs, these can be administered at the scene by an air ambulance Doctor or trained paramedic. These drugs reduce inflammation in the injured area and help to prevent further damage to cellular membranes that can cause nerve death. Sparing nerves from further damage and death is crucial.

Each patient's injury is unique. Some patients require surgery to stabilise the spine, correct a gross misalignment, or to remove tissue causing cord or nerve compression. Spinal stabilisation often helps to prevent further damage.  Some patients may be placed in traction and the spine allowed to heal naturally.  Every injury is unique as is the course of post injury treatment that follows.

Spinal Cord Shock
When a spinal cord injury is caused due to trauma, the body goes into a state known as spinal shock. While spinal shock begins within a few minutes of the injury, it make take several hours before the full effects occur. During spinal shock the nervous system is unable to transmit signals, some of which may return once spinal shock has subsided, the time spinal shock lasts for is approximately 4-6 weeks following the injury. In some rare cases spinal cord shock can last for several more months.  The loss of these signals will effect the persons movement, sensation and how well the body’s systems function. Often the persons loss of movement and sensation below the level of the spinal cord injury may appear complete soon after the injury. This may mask the real extent of the damage. Usually, over the first few weeks the some of body systems adjust to the effects of the injury and their function improves. Therefore, during this time and the early stage of ANY new injury it is unlikely that an accurate prediction of any recovery or permanent paralysis can be made.

Surgery
Depending on the circumstances, when surgery is required, it may be performed within 8 hours following injury. Surgery may be considered if the spinal cord is compressed and when the spine requires stabilization. The surgeon decides the procedure that will provide the greatest benefit for the patient.

Different tissue and bony structures including vertebrae misaligned from the force of injury, a herniated disc, or a haematoma can cause spinal cord compression. An unstable spine may require spinal instrumentation and fusion to build in support.

Spinal instrumentation and fusion can be used to provide permanent stability to the spinal column. These procedures correct, join, and solidify the level where a spinal element has been damaged or removed (e.g. herniated disc)

Instrumentation uses medically designed hardware such as rods, bars, wires and screws. Instrumentation is combined with fusion (bone grafts) to permanently join two or more vertebrae.

Healing Broken Bones Without Surgery
Surgery isn't the only way to repair broken bones in the neck and back a more conservative and less invasive approach is to allow the bones to heal naturally with the help of halo traction where needed.  This approach may mean up to two months complete bed rest.
 
Recovery
Once the patient is stabilised, care and treatment focuses on supportive care and rehabilitation. Family members, nurses, or specially trained carers give supportive care. This care might include helping the patient bathe, dress, change positions to prevent bedsores, and other assistance.

Rehabilitation often includes physical therapy, occupational therapy, and counselling for emotional support. Each program is designed to meet the patient's unique needs.

The services may be initially provided while the patient is hospitalised or on a specialist spinal injuries unit. Following hospitalisation, some patient's are admitted to a rehabilitation facility. Other patients can continue rehabilitation on an outpatient basis and/or at home.

A physiotherapy (PT) program can facilitate the restoration of muscle strength, flexibility, improve mobility, coordination, and maintain body functions through exercise. Massage, hydrotherapy, and other treatments can help to relieve pain.

Gait training may be taught to patients with difficulty walking, which could include teaching the patient how to use assistive devices (e.g., walker, crutches or a cane). physiotherapy benefits the patient be preventing complications from surgery or illness.

Occupational therapy (OT) teaches the patient how to cope with everyday life. OT encourages independence by helping the patient with daily tasks such as dressing, bathing, food preparation, going to the toilet, and other activities of daily living.

Speech and language therapy may be included. These skills cross over to the workplace, helping the patient develop their full potential. This might include teaching the patient how to use different muscles to complete tasks such as writing.

Sometimes more than the support from family and friends is needed to cope with spinal cord injury. Many types of counselling are available including psychiatrists, psychologists, and group therapy.

see also:-

Complications - Rehabilitation - Rehabilitation Functional Goals - Spinal Injury


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