What are some of the major concerns for a patient with a spinal cord injury?
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). There is no reliable estimate of global prevalence, but estimated annual global incidence is 40 to 80 cases per million population. Up to 90% of these cases are due to traumatic causes, though the proportion of non-traumatic spinal cord injury appears to be growing.
Show
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. Demographic trendsMales are most at risk in young adulthood (20-29 years) and older age (70+). Females are most at risk in adolescence (15-19) and older age (60+). Studies report male-to-female ratios of at least 2:1 among adults, sometimes much higher. MortalityMortality risk is highest in the first year after injury and remains high compared to the general population. People with spinal cord injury are 2 to 5 times more likely to die prematurely than people without SCI. Mortality risk increases with injury level and severity and is strongly influenced by availability of timely, quality medical care. 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. Health, economic and social consequencesSpinal 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, pressure ulcers, chronic pain, and respiratory complications. Acute care, rehabilitation services and ongoing health maintenance are essential for prevention and management of these conditions. Spinal cord injury may render a person dependent on caregivers. Assistive technology is often required to facilitate mobility, communication, self-care or domestic activities. An estimated 20-30% of people with spinal cord injury show clinically significant signs of depression, which in turn has a negative impact on improvements in functioning and overall health. Misconceptions, negative attitudes and physical barriers to basic mobility result in the exclusion of many people from full participation in society. Children with spinal cord injury are less likely than their peers to start school, and once enrolled, less likely to advance. Adults with spinal cord injury face similar barriers to economic participation, with a global unemployment rate of more than 60%. Existing data do not allow for global cost estimates of spinal cord injury, but they do offer a general picture.
PreventionThe 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. Improving care and overcoming barriersMany 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. Implementation of the UN Convention on the Rights of Persons with Disabilities (CRPD) requires action to address these gaps and barriers. Essential measures for improving the survival, health and participation of people with spinal cord injury include the following.
Essential measures to secure the right to education and economic participation include legislation, policy and programmes that promote the following:
WHO responseWHO works across the spectrum from primary prevention of traumatic and non-traumatic causes of spinal cord injury, improvements in trauma care, strengthening health and rehabilitation services, and support for inclusion of people with spinal cord injuries. WHO: What is the most common complication of spinal cord injury?A spinal cord injury can cause circulatory problems ranging from low blood pressure when you rise (orthostatic hypotension) to swelling of your extremities. These circulation changes can also increase your risk of developing blood clots, such as deep vein thrombosis or a pulmonary embolus.
What is the greatest risk when dealing with a spinal injury?The greatest risk of someone who has a spinal injury is that their spinal cord will be either temporarily or permanently damaged. If this happens, they may lose sensation or power below the injured area.
What are some difficulties a person with spinal cord injury may face?A spinal cord injury can cause one or more symptoms including: Numbness, tingling, or a loss of or changes in sensation in the hands and feet. Paralysis that may happen immediately or develop over time as swelling and bleeding affects the spinal cord. Pain or pressure in head, neck, or back.
What is the immediate concern with the patient who has suffered a spinal cord injury at C3?Breathing Challenges
A C3 spinal cord injury can affect the muscles involved with breathing which, without immediate medical attention, can be fatal. This is because the primary muscle involved in respiration, called the diaphragm, is controlled by the C3-C5 spinal nerves.
|