Spinal Cord Injury

Cervical Spinal Cord Injury

UNDERSTANDING YOUR INJURY

Your spinal cord is a tubular extension of your brain that runs downward through a canal in your vertebrae carrying messages between the brain and the rest of your body for movement and sensation.

There are three major areas of your spine: cervical, thoracic and lumbar. The cervical spine refers to the seven bones of the neck. The thoracic region refers to the twelve bones of the back - all the bones that have ribs attached to them. Finally, the lumbar is what we refer to as the “low back” – located below the rib bones.

The spinal cord starts at the base of the brain and usually ends between the lowest portion of the thoracic spine or the highest portion of the lumbar spine. At each level the spinal cord gives off spinal nerves. After the spinal cord ends, those spinal nerves become much longer and drape down into the lumbar spine and continue to exit at each level. These draping nerves resemble a horses tail and are thus referred to as the cauda equina.

The cervical spinal cord is the part of the spinal cord that conveys the function to the shoulders, arms and hands. The brain communicates via its “upper motor neuron” through the spinal cord and then connects to a “lower motor neuron” within the spinal cord. This neuron extends its axon out into peripheral nerves which connect to muscles and skin to allow the body to move and feel.

When a patient has an injury to their cervical spine (injuring their spinal cord on the inside of it), they will often lose some muscle function based on the level at which the injury occurs. Everything above the injury should work well, but everything below the injury will be impaired or sometimes won’t function at all causing paralysis.

Classifying Your Cervical Spinal Cord Injury
The American Spinal Injury Association created a grading scale of spinal cord injuries. This is the typical grading system used by physicians to talk about the severity of a spinal cord injury. The letters in this system refer to how much control remains below the level of injury.

In the ASIA scale, an “A” means that there is no motor or sensory function below the level of the spinal cord injuries. This is when a patient can’t feel anything and can’t move anything.

“B” is when a patient can feel some sensation but there’s no movement.

“C” is when a patient has some movement but it’s not very functional.

“D” is an injury which a patient can stand and take steps.

“E” refers to normal function – no impairment to sensation or movement.

In addition to the grading scale physicians also reference the vertebrae – for example cervical, is C and then a number. In this scale, the lowest level of good function determines “your level”: C5 – elbow flexion C6 – wrist extension C7 – elbow extension C8 – Finger flexion T1 – finger spreading.

What Causes A Cervical Spinal Cord Injury?

When a patient has a spinal cord injury, it usually is the result of a severe trauma – most commonly from motor vehicle accidents. At the Paralysis Center, we see a lot of patients who have suffered a high impact trauma such as a diving accident, falling from a tree, or crashing their motor bikes. The neck is much more mobile than the back and is particularly susceptible to injury, crushing the spinal cord that’s runs within the bony canal of the vertebrae. When the spinal cord is injured, it’s no longer able to convey the information as it did before to all nerve branches and muscles below it.

If a patient, for example, has a C5 spinal cord injury, they typically have control of their shoulders and can typically flex the elbow with their biceps, but limited motor function below that.

Diagnosis And Treatment

Recovering even partial arm and hand function after a spinal cord injury can have an enormous impact on the independence and quality of life for a patient. Our methodology is the most cutting edge, and proven in helping a patient get movement back.

Some of the most common treatments we used at the Paralysis Center for spinal cord injury are:

1. Nerve transfer: Nerves with the best control are transferred to the most important muscle groups to provide control to formerly paralyzed muscles. This is a newer procedure to be offered in spinal cord injury and has many benefits in recovery of function. We have been leaders in this field and have taught our techniques all over the world.

2. Tendon transfer: This is the more traditional procedure for restoring function for a spinal cord injury patient and remains an important part of the treatment options. One end of a muscle is moved from its original attachment to an new one to produce a new function. Tendon transfers offer functional gains for an estimated 70 percent of tetraplegic patients.

3. Muscle transplant: In some patients in which the damage to the spinal cord results in a large segment of lower motor neuron loss and resultant muscular atrophy, if a local tendon transfer is not available, a muscle can be transplanted from a leg to achieve a critical function in the arm or hand.

4. Selective peripheral neurotomy: Nerves are trimmed to reduce spasticity but maintain function. This is often helpful for improving walking or allowing hands to open that are clenched, for example.

5. Phrenic nerve stimulator: Patients dependent on a ventilator have the option of a surgically implanted phrenic nerve stimulator, which will cause their breathing to function by contraction of the diaphragm – a more normal method. This can often free them from being dependent upon a ventilator.

6. Spinal cord stimulation: Electrodes placed in the space outside of the thick membrane that surrounds the spinal cord (the dura) to reduce spasticity and to recover lost movement.

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Tips to help you get the most from a visit to the Paralysis Center

• Before your visit, write down questions you want answered.

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• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

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