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#15-03 Mt. Elizabeth Medical Centre
3 Mt. Elizabeth, Singapore 228510

30+ YEARS OF SPECIALIST EXPERIENCE -
USA, CANADA, UK, SINGAPORE

AWARD WINNING SPECIALIST

BACK PAIN DIAGNOSIS AND BACK PAIN RELIEF EXPERT
LESS INVASIVE AND NO SURGERY SPINE SPECIALIST


Spinal Cord Injury (SCI): An Overview

Dr Prem Pillay, Senior Neurosurgeon and Spinal Cord Injury Expert, Singapore

Causes of Spinal Cord Injury

 

 

 

 

 

Spinal cord injuries (SCIs) can result from both traumatic and non-traumatic events. Traumatic SCIs are most commonly caused by:

  1. Motor vehicle accidents: These are the leading cause, accounting for nearly half of new SCIs each year[6].
  2. Falls: Particularly prevalent in individuals over 65 years old[6], but it can also be a cause in young adults.
  3. Acts of violence: Including gunshot and knife wounds[6].
  4. Sports and recreation injuries: Football, diving, motorsports, skiing, bicycling/motorcycling, mountaineering and other high-impact sports are notable contributors[2].

Non-traumatic causes include infections, tumors, degenerative diseases, ischemia-reperfusion injuries, and congenital conditions[5]. The spinal cord, a critical conduit for nerve signals between the brain and the rest of the body, when damaged, can lead to significant loss of function and mobility[4].

Diagnosis and Classification

Diagnosis of SCI typically involves:

  1. Physical Examination : To assess motor and sensory function.
  2. Imaging Studies: X-Rays of the Spine, MRI and  CT scans are used to visualize the extent of damage. MRI is particularly useful for detecting lesions, ischemia, and hemorrhage[7].

Classification of SCIs is based on:

  1. Level of Injury: Cervical, thoracic, lumbar, or sacral, which determines the extent of paralysis or loss of sensation.
  2. Completeness: Complete injuries (Tetraplegia, Paraplegia )result in total loss of function below the injury site, while incomplete injuries (Tetraparesis, Paraparesis) allow some function to remain[2].

Treatment Options

Immediate Care and Surgery

Spine Surgery

Including Minimally Invasive Surgery and Microsurgery is often necessary to remove bone fragments, foreign objects, or to stabilize the spine. Procedures like spinal fusion, laminectomy, or decompression aim to prevent further injury and stabilize the spine[4][8]. Unstable Spine Fractures need surgery with implants to fix the Spine and prevent further Spine Nerve / Cord damage and to allow healing and a better chance of recovery explains Dr Prem Pillay, a Neurosurgeon and Spine Injury Expert.

Spine and Spinal Cord (Nerve) Rehabilitation

Physical Therapy: Focuses on improving motor function, preventing contractures, and enhancing overall mobility[2].

Occupational Therapy: Helps in adapting to daily activities with assistive devices[1].

Speech Therapy: For those with cervical injuries affecting speech or swallowing.

Medications

Used to manage symptoms like pain, spasticity, and autonomic dysreflexia[4].

Adaptive Equipment

Wheelchairs, braces,  communication devices, Functional Neurological Electrical Stimulation and now Robotics are crucial for increasing independence[4].

Complications of SCI

SCIs can lead to numerous complications:

  1. Chronic Pain: Often in areas with sensory loss[4].
  2. Respiratory Issues: Particularly with thoracic injuries affecting breathing muscles[4].
  3. Spasticity: Increased muscle tone causing stiffness[4].
  4. Autonomic Dysreflexia: A life-threatening condition in injuries above T6[4].
  5. Cardiovascular Issues: Including high blood pressure and poor circulation[4].
  6. Bladder and Bowel Dysfunction: Common due to loss of control over these functions[4].

Syrinx Detection and Treatment

Post-Traumatic Syringomyelia (PTS): A delayed complication where a syrinx (fluid-filled cavity) forms within the spinal cord. Detection involves MRI, often with dynamic imaging to observe CSF flow[1].

Treatment: Conservative management for stable cases, surgical decompression for symptomatic progression, including shunting to drain the syrinx[1] where indicated (Syringo-Subarachnoid Shunt, Syringo-Peritoneal Shunt).

Latest Advances in SPINAL CORD INJURY (SCI) Treatment

Robotics: Robotic exoskeletons are being developed to assist with walking and rehabilitation, enhancing mobility and reducing complications like pressure ulcers[3].

Spinal Cord Stimulation: Techniques like epidural stimulation have shown promise in restoring some motor function by activating neural circuits below the injury site[3].

Stem Cell Therapy: Research into stem cells aims at promoting regeneration and repair of damaged spinal cord tissue. Early trials have shown potential in reducing syrinx size and improving clinical symptoms[1].

Neuroprotective Strategies : Advances in understanding the secondary injury mechanisms have led to treatments aimed at reducing cell death, controlling inflammation, and promoting regeneration[3].

Precision Medicine: Utilizing biomarkers and advanced imaging to tailor treatments to individual patients, potentially improving outcomes[3].

Conclusion

Spinal cord injuries pose significant challenges due to their complexity and the profound impact on an individual’s life. While the prognosis for regaining lost function remains guarded, advancements in surgical techniques, rehabilitation strategies, and emerging therapies like robotics, and Spinal Cord Stimulation treatments offer hope for better management and potential recovery. Continuous research and clinical trials are essential to further understand and treat this debilitating condition, aiming to enhance the quality of life for those affected by SCI.

With many years of experience in treating Spinal Cord Injury and access to the latest technological advancements, Dr Prem Pillay offers patients the highest standard of care. From accurate diagnosis to tailored treatment plans, our approach aims for the best possible outcomes for individuals affected by this challenging condition.

If you or a loved one has been diagnosed with a Spinal Cord Injury, we welcome you to seek consultation with our specialized team. Together, we can develop a comprehensive evidence based and personalized treatment strategy that addresses your unique needs and provides the best chance for a positive outcome.

References and Citations:

[1] https://now.aapmr.org/post-traumatic-syringomyelia/

[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC4303793/

[3] https://pmc.ncbi.nlm.nih.gov/articles/PMC11278467/

[4] https://www.novahospital.co.in/overview-of-spinal-cord-injury/

[5] https://www.nature.com/articles/s41392-023-01477-6

[6] https://www.mayoclinic.org/diseases-conditions/spinal-cord-injury/symptoms-causes/syc-20377890