Permit me a space in your weekly dedicated health column to ask about spinal cord injury. My mother had a car accident few months ago and was flown abroad for treatment. Wishing you a happy 2019.
Thanks Zahra for your question and best wishes for New Year. According to World Health Organization the term ‘spinal cord injury’ refers to “damage to the spinal cord resulting from trauma (e.g. a car crash) or from disease or degeneration (e.g. cancer). Symptoms of spinal cord injury depend on the severity of injury and its location on the spinal cord.”
Symptoms may include partial or complete loss of sensory function or motor control of arms, legs and/or body.
The most severe spinal cord injury affects the systems that regulate bowel or bladder control, breathing, heart rate and blood pressure. Most people with spinal cord injury experience chronic pain.
Transfer method to hospital after injury and time to hospital admission are important factors. Preventable secondary conditions (e.g. infections from untreated pressure ulcers) are no longer among the leading causes of death of people with spinal cord injury in high-income countries, but these conditions remain the main causes of death of people with spinal cord injury in low-income countries.
Spinal cord injury is associated with a risk of developing secondary conditions that can be debilitating and even life-threatening e.g. deep vein thrombosis, urinary tract infections, muscle spasms, osteoporosis (degeneration of bone), pressure ulcers, chronic pain, and respiratory complications.
Acute care, rehabilitation services and ongoing health maintenance are essential for prevention and management of these conditions.
The leading causes of spinal cord injury are road traffic crashes, falls and violence (including attempted suicide). A significant proportion of traumatic spinal cord injury is due to work or sports-related injuries. Effective interventions are available to prevent several of the main causes of spinal cord injury, including improvements in roads, vehicles and people’s behaviour on the roads to avoid road traffic crashes, window guards to prevent falls, and policies to thwart the harmful use of alcohol and access to firearms to reduce violence.
How to improving care
Many of the consequences associated with spinal cord injury do not result from the condition itself, but from inadequate medical care and rehabilitation services, and from barriers in the physical, social and policy environments.
Essential measures for improving the survival, health and participation of people with spinal cord injury include the following.
Timely, appropriate pre-hospital management: quick recognition of suspected spinal cord injury, rapid evaluation and initiation of injury management, including immobilization of the spine.
Acute care (including surgical intervention) appropriate to the type and severity of injury, degree of instability, presence of neural compression, and in accordance with the wishes of the patient and their family.
Access to ongoing health care, health education and products (e.g. catheters) to reduce risk of secondary conditions and improve quality of life.
Access to skilled rehabilitation and mental health services to maximize functioning, independence, overall wellbeing and community integration. Management of bladder and bowel function is of primary importance.
Access to appropriate assistive devices that can enable people to perform everyday activities they would not otherwise be able to undertake, reducing functional limitations and dependency.
Specialized knowledge and skills among providers of medical care and rehabilitation services are needed to attend to someone with the injury.