Knowing rules to protect your spinal cord

Dr. Muhammad Raji Mahmud, Associate Professor/chief consultant neurosurgeon at the National Hospital, Abuja spoke on causes of spinal injuries, treatment and how to nourish the spine. GERALDINE AKUTU reports .

What is the spinal cord?
The spinal cord is part of the central nervous system that functions as a channel for outgoing (efferent) neural motor transmission, and incoming (afferent) sensory information. It also serves as the site of neural reflex circuits and central pattern generators. It is shaped as a long tubular structure, beginning at the level of the occipital bone and extending down to the space between the first and second lumbar vertebrae in adult humans.

The spinal cord is encased in protective layers of spinal meninges, outer dura mater, middle arachnoid mater and the innermost pia mater. The spinal cord is also protected by a layer of cerebrospinal fluid in the subarachnoid space. The entire spinal cord and its protective layers are encased in the bony vertebral column.

How does spinal cord injury occur?
Spinal cord injury (SCI) costs some societies excess of $7bn annually, and is responsible for the greater cost of human suffering related to impairment of ambulation and of sexual and sphincter functions (loss of control of urine and faeces). A critical advance in our understanding of SCI has been the recognition that injury to the spinal cord leads to a protracted period of tissue damage.

Tissue damage, following SCI has thus been divided into primary and secondary phases of injury. Primary injury is damage that occurs at the time of initial trauma, which causes immediate severing of axons and death of spinal cord cells. Secondary injury refers to delayed and progressive damage that continues after cessation of primary injury, which can last for weeks or even years.

What causes Spinal cord injuries?
Common causes of SCI are motor vehicle accidents (50 percent), falls and work-related injuries (30 percent), violent crimes (11 percent), and sports-related injuries (nine percent).

There are also non-trauma illnesses to the spinal cord. These could be broadly divided into congenital (from inside the womb) and acquired (after birth) causes of spinal cord disorders/illnesses.

The principal congenital problems manifesting in adulthood include, congenital kyphosis, scoliosis, lordosis, and closed or occult spinal dysraphism. Also included in the congenital list are various forms of spinal cord neural tube defects manifesting at birth. Acquired spinal cord disorders include degenerative spine diseases (cervical and lumbar spondylosis), infections (Pott’s disease, Tuberculoma, Spinal meningitis) and spinal cord tumours (mainly metastatic spinal lesions).

Unfortunately, the most debilitating and costly spinal cord injuries are the most common. This is the cervical spine (neck area). This is because the mobility of the cervical spine comes at the cost of stability, leaving it relatively vulnerable to injury. Approximately 60 to 75 percent of acute SCI involve the cervical spine, 15 percent involve the thoracic spine, and 10 percent involve the lumbosacral spine. SCI most commonly affects young, otherwise healthy and productive individuals. Males are more commonly affected— the male-to-female ratio is about 4:1. This may be related to sociocultural and also lifestyle factors.

Who are most at risk of spinal cord injury?
While spinal cord injuries can happen to anyone, certain populations may be more prone to them. According to the Mayo Clinic, 80 percent of spinal cord injuries in the United States occur in men. Age is another risk factor. People aged 18 to 35 are more likely to sustain spinal cord injuries from car or motorcycle accidents, and the elderly are more likely to become injured in falls. Athletes, particularly gymnasts, skiers, hockey players, divers, and surfers are at increased risk. Patients with diseases that affect the bones and joints are also more susceptible to spinal cord injuries.

How is spinal cord injury treated?
Treatment of SCI begins before the patient is admitted to the hospital. Paramedics or other emergency medical services personnel carefully immobilise the entire spine at the scene of the accident. In the emergency department, this immobilisation is continued, while more immediate life-threatening problems are identified and addressed. If the patient must undergo emergency surgery because of trauma to the abdomen, chest or another area, immobilisation and alignment of the spine are maintained during the operation.

Other forms of treatment would depend on the type, severity, location and extent of the SCI. Patient with high cervical spine injury may require admission into Intensive Care Unit (ICU) for airways management and haemodynamic (physiologic systems) monitoring.

What treatment options are available?
Following initial stabilisation, surgical decompression can be considered with goals of restoring biomechanical stability to the spinal column and optimising neurological outcomes by decompressing the spinal cord and neural elements. A combination of factors should be taken into consideration, when making the decision to operate, including presence of neurological deficit, mechanism of injury, biomechanical stability, osteoligamentous (bone and soft tissue) integrity, and fracture morphology. Surgeries may involve inserting some metals (implants) to stabilise the spine.

What are the preventive measures to avoid spinal cord injury?
While recent advances in emergency care and rehabilitation allow many SCI patients to survive, methods for reducing the extent of injury and for restoring function are still limited. Currently, there is no cure for SCI. However, SCI prevention is crucial to decreasing the impact of these injuries on individual patients and on society.

Motor vehicle safety measures include, always wearing a safety belt and making sure all passengers are wearing safety belts, ensuring that infants, toddlers and young children are properly restrained in an approved child safety seat that is installed correctly in the back seat. Ensuring that all children that are12 years and younger ride in the back seat, properly restrained, ensuring that all children that have outgrown child safety seats are properly restrained in booster seats until they are eight years old or over 4’9” tall. Obey speed limits and follow traffic rules at all times. Never drive under influence of drugs or alcohol or ride as a passenger in a vehicle with a driver under the influence.