Spinal cord injury treatment
There are a variety of treatment and surgery options for spinal cord injury, depending on the affected area. Spinal cord injury is the result of traumatic damage such as a bruise or contusion, a partial tear or a complete tear in the spinal cord. It also can result indirectly from damage to surrounding bones, tissues or blood vessels.
Spinal cord injuries are very serious. If you are suffering from any symptoms of spinal cord injury, it is very important to seek immediate medical attention. To diagnose your condition, your doctor will perform both a physical and neurological exam. If the location of the injury is not known, one of more of these tests will help locate the exact point of injury:
- CT scan or MRI – Shows the location and extent of the damage. These scans also can reveal internal problems such as hematomas or blood clots.
- Spine X-rays – Show damage or fractures to the bones in the spine
- Myelogram – Dye is injected into the fluid-filled space between the bones in your spine. The dye is able to move through the space to allow the spinal cord and nerve roots to be seen more clearly. This is used in rare cases to find the source of a problem that was not detected by other tests.
- Somatosensory evoked potential (SSEP) – A test which evokes response from the nervous system through magnetic stimulation. It can show if nerve signals are able to pass through the spinal cord, or if an injury is blocking the transmission.
Since spinal cord injury is such a serious and time-sensitive condition, it is critical to seek treatment as soon as possible. Time between injury and treatment will have a huge impact on the outcome. Some nonsurgical treatment options for spinal cord injury include:
- Methylprednisolone – Steroid medication used to decrease inflammation at the site of the injury and reduce damage to nerve cells. If given within eight hours of injury, it will produce mild improvement.
- Immobilization – This is done to stabilize and/or realign your spine after injury. Immobilization is accomplished by using metal braces and a body harness to keep your head from moving. A special bed or neck brace also can be used to secure your head and prevent movement of the spine.
- Experimental treatments – Scientists are working on methods to prevent cell death, promote nerve regeneration and control inflammation.
In many cases, spinal cord surgery is necessary to remove bone fragments, herniated discs, foreign objects, fractured vertebrae and anything that may be compressing your spine. Because there are varieties of injuries and different sections of the spine that can be injured, there are many different types of surgery:
- Lumbar discectomy – Procedure to remove all or part of a herniated or ruptured disc in the lower part of the spine
- Cervical discectomy – Surgery to remove one or more discs from the neck
- Microdiscectomy – Minimally invasive surgery on a ruptured disc in the neck or back. This procedure aims at removing a small part of the ruptured disc to alleviate pain while avoiding any possible instability in the spine.
- Spinal fusion – Surgical procedure for fusing or joining two or more vertebrae. There are different types of this surgery for different areas of the spine:
- Anterior lumbar interbody fusion – In this procedure, the spine is operated on from the front. The surgeon removes a disc from the lower part of the spine and replaces it with bone graft. The desired result is for the two surrounding vertebrae to grow or fuse together into one solid bone.
- Posterior lumbar interbody fusion – This procedure is virtually the same as the anterior fusion except that the surgeon approaches the spine from the back.
- Transforaminal lumbar interbody fusion – In this procedure, the spine is approached from the side.
- Laparoscopic fusion – A minimally invasive surgical alternative to open surgery, it requires a much smaller incision in the back to gain access to the spine. Recuperation time and pain levels are significantly reduced, compared to other types of spinal fusion surgery.
- Intradiscal electrothermal therapy – Minimally invasive treatment for lower back pain. This procedure uses fluoroscopic (X-ray) guidance and an electrothermal catheter to heat up the affected lumbar disc. The goal is to destroy pain receptors in the disc.
- Surgical decompression – A small portion of the bone over the nerve root is removed to allow more space for the nerve root while helping it to heal. There are different types of surgical decompression:
- Foraminotomy – The foramen, or opening where the nerve root comes out of the spinal column, is widened by shaving away a portion of the bone.
- Laminotomy – Partial removal of the lamina, or bony arches in the canal of the spine
- Laminectomy – Complete removal of the lamina, or bony arches in the canal of the spine
- Corpectomy – The entire degenerated vertebra is removed and replaced by bone graft.
- Laminoplasty – The lamina, or bony arches in the spinal canal, is cut open on both sides to create an open flap to relieve pressure on the spinal cord. The bone flap is propped open with small wedges or pieces of bone.
- Kyphoplasty/vertebroplasty – Kyphoplasty and vertebroplasty are both minimally invasive procedures that treat pain and other symptoms caused by a spine fracture resulting from osteoporosis. Each procedure can also restore vertebral body height lost due to a compression fracture.
- Anterior cervical discectomy and fusion – Surgical procedure used to treat neck problems resulting from fractures, herniated discs and spinal instability.
- Spinal cord stimulation – This procedure uses an electrical current to treat chronic back pain by implanting a small pulse generator in the back. The pulse generator sends electrical pulses to the spine to block the nerve signals which make you feel pain.
The multidisciplinary team of spine experts at Northwell Health Orthopaedic Institute treats all types of spinal cord injury as well as a broad range of bone conditions that can occur at any stage of life.
The most important question that scientists and doctors are pondering is, “Can a damaged spine be rebuilt?” This question fuels much of the spinal cord research taking place. The underlying biomechanics of the spinal cord are being looked at closely to determine what inhibits or promotes new growth and why neurons and axons fail to regenerate after injury. Neurons are specialized cells that transmit nerve impulses. Axons are long thread-like parts of a nerve cell that conduct impulses from the neuron. By understanding the cellular and molecular mechanisms involved with spinal cord functions, it is possible to one day understand how to prevent secondary damage, encourage axons and neurons to grow despite injury and eventually reconnect vital neural circuits within the spinal cord.
The National Institute of Neurological Disorders and Stroke (NINDS) is continuously conducting research in its laboratories at the National Institutes of Health (NIH). The NINDS also supports other spinal cord research through grants for institutions across the country. This research aims at repairing injured spinal cords and is giving hope to both doctors and patients that this is indeed a reachable goal. Rehabilitation techniques are also part of the research to restore function and help patients become more mobile.
Ongoing research is extensive and many discoveries have been made, so it is important to ask your doctor about any experimental treatments or breakthroughs for spinal cord injury.