Treatments

Acute Spinal Cord Injury Treatments

Management of a spinal cord injury begins at the site of an accident with paramedics trained in immobilizing the injured spine to prevent further damage to your nervous system. If a spinal cord injury is suspected, you should NOT be moved without immobilization, unless there is an immediate threat to your safety.

Corticosteroids such as dexamethasone or methylprednisolone are used to reduce swelling that may damage your spinal cord. Ideally, administration of corticosteroids should begin as soon as possible after your injury.

Surgery

If spinal cord compression is caused by a mass, such as a hematoma that can be dissolved or a bony fragment that can be removed before the nerves of your spine are permanently damaged, paralysis may in some cases be reduced or relieved.

Surgery may be necessary for a variety of reasons:

• Remove fluid or tissue that presses on your spinal cord (decompression laminectomy)
• Remove bone fragments
• Remove disk fragments
• Remove foreign objects
• Stabilize fractured vertebrae (by fusion of the bones or insertion of hardware)

Recovery

Bedrest may be needed to allow the bones of your spine to heal, since they bear most of the weight of your body. Proper realignment of your spine is important. Traction may be used to reduce dislocation or immobilize your spine. Your skull may be immobilized with tongs, which are metal braces placed in the skull and attached to traction weights or to a harness on your body.

Your care team will work with you to address muscle spasms, skin care, and bowel and bladder dysfunction. Spasticity can be reduced by oral medications, medications that are injected into your spinal canal or injections of botulinum toxins into your muscles. It is important to treat pain with analgesics, muscle relaxants or physical therapy modalities.

You may require extensive physical therapy, occupational therapy and other rehabilitation interventions after the SCI has healed. Rehabilitation assists you in coping with disability resulting from your spinal cord trauma.

Expectations and prognosis

How well you do depends on the level of your injury. Injuries near the top of your spine result in more extensive disability than do injuries lower on the spine. Recovery of some movement or sensation within one week usually means you have a good chance of recovering more function, although this may take six months or more. Losses that remain after six months are more likely to be permanent.

Paralysis and loss of sensation are common, ranging from varying degrees of movement or sensation loss to total paralysis. Paralysis of the breathing muscles can be fatal.

Modifications of your living environment are usually required. Most people with a spinal cord injury are wheelchair–or bed-bound, or have impaired mobility requiring a variety of assistive devices. A majority of people with SCI must perform bladder catheterization, and routine bowel care frequently takes one hour or more daily.

If you are living at home with a SCI, you should do the following to prevent complications:

• Daily pulmonary care, if you need it
• Follow all instructions regarding bladder care to avoid infections and damage to your kidneys
• Follow all instructions regarding routine wound care to avoid pressure sores
• Keep immunizations up to date
• Maintain routine health visits with your physician
• Call your physician if you have an injury to your back or neck
• Call 911 if there is any loss of movement or sensation. This is a medical emergency.