Treatment:

A spinal cord trauma is a medical emergency requiring immediate treatment to reduce the long-term effects. The time between the injury and treatment is a critical factor affecting the eventual outcome.

Corticosteroids, such as dexamethasone or methylprednisolone, are used to reduce swelling that may damage the spinal cord. If spinal cord compression is caused by a mass (such as a hematoma or bony fragment) that can be removed or brought down before there is total destruction of the nerves of the spine, paralysis may in some cases be reduced or relieved. Ideally, corticosteroids should begin as soon as possible after the injury.

Surgery may be necessary. This may include surgery to remove fluid or tissue that presses on the spinal cord (decompression laminectomy). Surgery may be needed to remove bone fragments, disk fragments, or foreign objects or to stabilize fractured vertebrae (by fusion of the bones or insertion of hardware).

Bedrest may be needed to allow the bones of the spine, which bears most of the weight of the body, to heal.

Anatomic realignment is important. Spinal traction may reduce dislocation and/or may be used to immobilize the spine. The skull may be immobilized with tongs (metal braces placed in the skull and attached to traction weights or to a harness on the body).

Treatment will address muscle spasms, care of the skin, and bowel and bladder dysfunction.

Extensive physical therapy, occupational therapy, and other rehabilitation interventions are often required after the acute injury has healed. Rehabilitation assists the person in coping with disability that results from spinal cord trauma.

Spasticity can be reduced by many oral medications, medications that are injected into the spinal canal, or injections of botulinum toxins into the muscles. It is important to treat pain with analgesics, muscle relaxants, or physical therapy modalities.

Support Groups:

For organizations that provide support and additional information, see spinal injury resources.

Expectations (prognosis):

Paralysis and loss of sensation of part of the body are common. This includes total paralysis or numbness and varying degrees of movement or sensation loss. Death is possible, particularly if there is paralysis of the breathing muscles.

How well a person does depends on the level of injury. Injuries near the top of the spine result in more extensive disability than do injuries low in the spine.

Recovery of some movement or sensation within 1 week usually means the person has a good chance of recovering more function, although this may take 6 months or more. Losses that remain after 6 months are more likely to be permanent.

Routine bowel care frequently takes one hour or more on a daily basis.

A majority of people with spinal cord injury must perform bladder catheterization from time to time.

Modifications of the person's living environment are usually required.

Most people with spinal cord injury are wheelchair- or bed-bound, or have impaired mobility requiring a variety of assistive devices.

Complications:

The following are possible complications of a spinal cord injury:

• Blood pressure changes - can be extreme (autonomic hyperreflexia)
• Complications of immobility:
  • Deep vein thrombosis
  • Pulmonary infections
  • Skin breakdown
  • Contractures
• Increased risk of injury to numb areas of the body
• Increased risk of kidney damage
• Increased risk of urinary tract infections
• Loss of bladder control
• Loss of bowel control
• Loss of sensation
• Loss of sexual functioning (male impotence)
• Muscle spasticity
• Pain
• Paralysis of breathing muscles
• Paralysis (paraplegia, quadriplegia)
• Shock

People living at home with spinal cord injury should do the following to prevent complications:

• Daily pulmonary care, for those who need it.
• Follow all instructions regarding bladder care to avoid infections and damage to the kidneys.
• Follow all instructions regarding routine wound care to avoid pressure sores.
• Keep immunizations up to date.
• Maintain routine health visits with their doctor.

Calling your health care provider:

Call your health care provider if injury to the back or neck occurs. Call 911 if there is any loss of movement or sensation. This is a medical emergency!

Management of spinal cord injury begins at the site of an accident with paramedics trained in immobilizing the injured spine to prevent further damage to the nervous system.

Someone suspected of having a spinal cord injury should NOT be moved without immobilization unless there is an immediate threat.