Spinal cord injury

Spinal cord injury

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■ Outline:

Along with the development of scientific civilization by humans, the frequency of various accidents is increasing, and the incidence of spinal cord injury is also increasing.

Spinal cord injuries are mainly caused by traffic accidents or crashes, and the destruction of structures that act as bridges in the connection between the brain and the body, resulting in limb paralysis or non-limbic pain, which results in permanent disability.

Many cases of spinal cord injury occur in young men in their 20s and 30s who need to work in the middle of the day. Spinal cord injury causes not only mental and economic damage to the patient, but also causes disability problems Also, they can not ignore the economic costs of rehabilitation.

■ Synonyms:

Spinal cord injury, paraplegia, limb paralysis

■ Definitions:

From the neck to the waist, there is a vertebral bone, which has a nerve (spinal cord). If there is a fracture in the vertebra bone or a deviation in the bone for some reason, the spinal cord is damaged. Of course, there is no abnormality in the bones and the spinal cord may be damaged.

When the spinal cord is damaged, the lower part of the damage is paralyzed. Thus, the spinal nerve passing through the vertebrae of the spinal cord is damaged by trauma, such as when the nervous symptoms occur, is called 'spinal cord injury'.

■ Symptom:

paralysis

Depending on the degree of paralysis, it is classified as complete paralysis and incomplete paralysis.

Paralysis

Complete loss of motion and sensory function in the lower part of the damaged area is called complete paralysis. Once complete paralysis occurs, it is difficult to expect an improvement and thus the prognosis is very poor.

Incomplete paralysis

An incomplete paralysis is a state in which a small amount of movement and sensory function remains in the lower part of the damaged area. Incomplete paralysis can be significantly improved with proper treatment.

Exercise paralysis

Limb paralysis: Both arms and legs move weakly or not at all. Therefore, it is impossible to walk, and in severe cases, the arm can not move and the patient can not ride the wheelchair himself.

Paraplegia: It is impossible to walk because both legs move weakly or not at all. However, it is possible for the arm to move, so the patient can ride a wheelchair himself.

Numbness

There is no sense below the damaged area. I do not know the pain when I pinch or pinch. In these patients, physiotherapy is performed. When you apply hot poultice, you have to be careful because the patient feels burned and burns.

Large · urinary disorders

In spinal cord injury, paralysis of the vagina and urine may occur as well as paralysis of the motor and sensory nerves. During the acute phase of spinal cord injury, the urine should be inserted to artificially urinate, and regular enema is needed.

Respiratory paralysis

Respiratory paralysis may occur when the spinal cord injury site is high (cervical vertebra). In order for our people to breathe, the respiratory muscles must contract, and when these respiratory muscles are paralyzed, they can not breathe. In this case, artificial respiration is necessary, and when it is prolonged, airway incision is sometimes necessary.

■ Causes / Pathophysiology:

cause

Traffic accidents and crashes are the most common. At the time of the accident, the neck or vertebra is excessively bent forward, backward, or twisted, or rotated, resulting in damage to the spinal bones and damage to the spinal cord.

In addition to traffic accidents and crashes, direct damage, diving damage, and gunshot wounds can cause spinal cord injury.

Pathophysiology

Mechanical shock: Damage caused by force applied directly to the spinal cord at the time of the accident, which occurs in proportion to the degree of the accident. Of course, even minor damage, if degenerative lesions already exist in the spine of the patient, can lead to spinal cord injury.

Biochemical changes: There is a secondary injury caused by a biochemical change in the spinal cord following a mechanical shock at the time of the accident.

Mechanical damage is determined by the extent of the accident and the degree of physical force, and secondary damage occurs over time after the primary physical injury and biochemical changes occur within the damaged spinal nerve.

Much research has been done to reduce these secondary injuries.

■ Diagnosis:

History: It is important to know how the force of the trauma affected the injury.

Neurological examination: The initial neurological examination is an important indicator of whether future spinal cord function is restored or worsened. (It is important to observe the degree and location of motor paralysis, sensory paralysis, and compare whether this progresses further or improves.)

Simple spinal X-ray examination: This is the simplest and most commonly used test method. Fractures of the vertebrae, dislocation, etc. can be observed. However, it is not possible to determine whether the spinal nerve is compressed or damaged, and other precautions are required.

Spine CT: This is the most commonly used test.

It is helpful to set the treatment method and to set the surgical method because it shows the lesion of the vertebra bone and knows the degree of compression of the spinal cord nerve.

Spine MRI: This is the most accurate diagnostic method. Especially, it is the most important test to show the abnormality of the spinal nerve and it is necessary to establish the surgical plan by showing the degree of spinal cord injury with various images.

■ Progress / Prognosis:

The prognosis of spinal cord injury is very poor.

Of course, there may be differences depending on the degree of spinal cord injury, and if a complete limb paralysis or non-paralysis occurs at the time of the accident, the patient is more likely to be a handicapped person with a lifetime of paralysis.

Fortunately, if the paralysis at the time of the accident was an incomplete paralysis and some exercise or sensory function remained, some treatment could be expected with proper treatment.

Most patients will be admitted to the neurosurgery immediately after injury and will undergo spinal cord injury testing, treatment, and, if necessary, surgery. In addition to the stabilization of the patient's spine, rehabilitation therapy is helpful in the recovery of the patient.

■ Complications:

As mentioned earlier, the complication of spinal cord injury is paralysis. During the lifetime of the limb paralysis (or paralysis), large and urinary disturbances persist, and there are terrible complications that must be handicapped.

In addition to paralysis, there are complications such as pressure ulcers, urinary tract infections, and pneumonia, which can eventually lead to complications such as kidney failure.

■ Treatment:

Most important in the treatment of spinal cord injury is the establishment of an organic cooperation system among the medical staff involved in the treatment and transportation of patients, the operation, rehabilitation, and nursing in the place of accident.

This can be called "treatment by team approach" and I will describe the treatment by looking at the members of the team.

A. First Aid

Emergency personnel are the first to move to the place of the accident. In the past, when there was an accident, the people around him unconditionally carried the patient back to the hospital and ran to the hospital. At this time, if the patient had a vertebral fracture and had an incomplete paralysis, this patient may be exacerbated by an irreversible complete paralysis. Therefore, the most important thing in the place of the accident is the fixation of the patient's spine. Even if there is no equipment, it is most important to fix the patient's spine using a splint or simply to transport the patient to the hospital.

Recently, as the activities of 119 rescue teams in Korea have become active, the treatment of patients has been relatively well treated from the place of accident.

B. Hospital

Your spine doctor will diagnose the vertebral fracture through a patient's degree of paralysis and simple radiology, and then perform professional fixation and traction, or surgery. Apart from fixing the patient's vertebrae and surgery, several treatments are needed. This should be understood and enforced by not only medical staff but also patients and caregivers.

Skin care

Patient's position change should be regular. The position should be changed at least once every 2 hours, and if it is neglected, a pressure ulcer occurs immediately.

Although it is easy to develop a pressure ulcer, once it occurs, it takes a long time for the treatment. The most difficult thing in treating a spinal cord injury patient is the treatment of a pressure ulcer, which is the biggest factor that hinders the patient's rehabilitation training.

Bladder treatment

Initially, the tube is inserted into the bladder to urinate. Then, after a certain period of stabilization, the patient inserts a thin tube regularly to urinate. If this is done and the bladder adapts, the patient may urinate himself.

Colonic treatment

Initially, paralytic ileus can occur, and regular bowel movements should be done.

Rehabilitation treatment

People with spinal cord injuries usually begin rehabilitation immediately after admission.

Simply starting with physical therapy, joint training, occupational therapy, etc. Once the spine is fixed and the patient becomes able to move, specialized spinal rehabilitation training is essential.

Nutrition management

Psychotherapy

Social welfare services

In this way, it is important that all medical teams such as doctors, nurses, physiotherapists, occupational therapists, social workers, nutritionists, psychologists,

■ Prevention:

It is most important to be careful not to get accidents.

■ To the doctor:

If you suspect spinal cord injury, do not hesitate to visit the patient at the nearest hospital, get first aid, and get a spine specialist.

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