Spinal cord injuries (SCI) are like people; no two are exactly alike. Because there are so many different types and gradations, there is no one-size-fits-all answer to the types of treatments available. However, spinal cord injuries can be divided into a few major categories. Here, we’ll lay out those major categories and describe just what to expect from available treatments.
First and foremost, spinal cord injuries are discussed in terms of levels of injury; the level refers to the highest vertebrae affected by the injury. Because motor function and sensation are perceived by the brain, anything above the level (or vertebrae) of injury is unaffected while everything below that level can be affected. Next, SCIs are generally divided into two categories: complete and incomplete. A complete SCI causes a total loss of all function below the level of the injury, while an incomplete SCI retains some function below the level of the injury.
Is a spinal cord injury permanent?
In a nutshell, yes. The spinal cord is, by any other name, a bundle of nerves. There is no method known to science that can reverse nerve damage. To be as clear as possible, complete spinal cord injuries refer to complete nerve damage in that no signals are sent or received. Incomplete spinal cord injuries refer to partial nerve damage where some signals are sent and/or received, but not all. However, the effects of an incomplete SCI may be reduced or fully eliminated in certain cases with therapy and medication.
So far, we’ve established that just about the only thing that’s certain about any given SCI is that complete injuries are permanent below the level of injury. The level of injury tells us what parts of the body are affected by an SCI while complete vs incomplete informs the severity of the damage. Without going too in depth, SCIs are further identified by a common grading scale. The American Association of Neurological Surgeons (AANS) explains that:
SCIs are graded according to the American Spinal Injury Association (ASIA) grading scale, which describes the severity of the injury. The scale is graded with letters:
ASIA A: injury is complete spinal cord injury with no sensory or motor function preserved.
ASIA B: a sensory incomplete injury with complete motor function loss.
ASIA C: a motor incomplete injury, where there is some movement, but less than half the muscle groups are anti-gravity (can lift up against the force of gravity with a full range of motion).
ASIA D: a motor incomplete injury with more than half of the muscle groups are anti-gravity.
ASIA E: normal.
The more severe the injury, the less likely a recovery will occur.
How are spinal cord injuries treated?
Per the Mayo Clinic, “researchers are continually working on new treatments, including prostheses and medications that may promote nerve cell regeneration or improve the function of the nerves that remain after a spinal cord injury.” Currently, however, there is no real “treatment” for SCI that we know for sure will lead to a permanent fix.
Interestingly, the National Institutes of Health notes that when the steroid methylprednisolone is administered within 8 hours of a SCI, “some patients experience improvement. It appears to work by reducing damage to nerve cells and decreasing inflammation near the site of injury.” However, the Mayo Clinic claims otherwise; “…recent research has shown that the potential side effects, such as blood clots and pneumonia, from using this medication outweigh the benefits.”
Healthcare professionals have a duty of care to evaluate the risks and benefits of any treatment. That said, there is effectively no other treatment that carries even the hope of reducing trauma to the spinal cord. Instead, the current state of treatment for SCIs involves acute care to minimize further damage, then evaluation and rehabilitation (if possible), and lastly continuing therapy to maintain a victim’s new quality of life.
Acute care for spinal cord injuries
Acute care for spinal cord injuries begins at the scene of the accident. Once trauma to the spinal cord has occurred, there is absolutely no way to undo the damage. However, there is a great deal that can be done to minimize further damage. Typically, first responders begin with immobilization. This keeps the spinal cord stable and prevents additional damage in the event that the nerve is pinched or crushed.
Next, health care providers use every weapon in their arsenal to stabilize the spine and reduce inflammation. Every effort is taken to protect the spinal cord from the effects of any force at all; doctors may perform surgery to remove fluid or bone, fuse vertebrae or place braces on the spine. Extreme care is taken to properly align the spine and give the spinal cord the best possible environment to heal if possible. Drugs, ice packs and other methods may be used to control swelling, bruising and inflammation.
Evaluation and rehabilitation
Once the injury has stabilized, healthcare professionals evaluate the severity of the injury and grade it according to the ASIA scale above. There is no real treatment plan to be had, but once the extent of the impairment is determined, survivors may benefit from exercise, healthy diets, and different types of physical therapies to adjust to their new world. Assistive devices like wheelchairs or walkers may help with mobility, while adaptive devices may help with communication problems.
Unfortunately, all of these measures are in response to the injury and can only help victims of SCIs learn to live with their new limitations. The article The Role of a Physical Therapist in Spinal Cord Injury Rehabilitation from SpinalCord.com offers tepid support for SCI therapy, citing a 2018 report from the US Department of Health and Human Services; “The report states: ‘Moderate evidence indicates that physical activity improves walking function, muscular strength, and upper extremity function for persons with spinal cord injury.’ Other studies also have shown positive effects from physical therapy interventions.”
Spinal cord injuries are devastating in every sense of the word. One bad accident and an SCI changes a life forever. If you or your loved one sustained a spinal cord injury in a car crash, you may be entitled to compensation for medical bills, lost wages, and continuing care. The Nashville personal injury attorneys at Rocky McElhaney Law Firm can be there for you and yours every step of the way. To learn more about how we represent our clients, call us today at 615-425-2500 or fill out our contact form. We have offices in Nashville, Hendersonville, and Clarksville.