Spinal cord injuries (SCI) cause significant physical, emotional, and mental challenges. It is crucial to understand the impact. An SCI damages the spinal cord and causes loss of function, mobility, and sensation. The causes of SCI are traumatic or non-traumatic. Traumatic SCI occurs when there is physical trauma to the spinal cord, such as a car accident, fall, or sports injury. Non-traumatic SCI can result from diseases such as multiple sclerosis or cancer.
What are the main parts of the spine?
There are four significant regions of the spinal cord:
- Cervical (neck)
- Thoracic (upper back)
- Lumbar (lower back)
- Sacral (pelvis)
Each region has a specific number of vertebrae designated by a letter and number.
Common levels of spinal cord injuries
SCI are categorized as complete or incomplete injuries. Complete injuries cause total loss of function below the level of injury, while incomplete injuries allow for some degree of function below that level. The injury’s location determines the level of SCI along the spinal cord, and each group has specific implications for function and mobility.
The most common levels of SCI are cervical (C), which affects the neck and upper body, and thoracic (T), which involves the chest and abdomen. Lumbar (L) and sacral (S) injuries are less common.
Different injuries impact different body functions. The following are the typical levels of injury for SCI:
- C1-C8. The higher the level of injury, the greater the impact on mobility and function.
- C1-C4 injuries can result in quadriplegia (paralysis of all four limbs). For example, C2 injuries are potentially life-threatening, resulting in paralysis of the diaphragm, which interferes with breathing.
- C5-C8 injuries can result in varying degrees of upper body impairment. For example, C5 injuries affect the shoulders and upper arms, C7 injuries affect the triceps and wrist flexors, and C6 injuries affect the wrist extensors and hand muscles.
- T1-T12. Thoracic injuries can affect the chest, abdomen, and lower body.
- T1-T8 injuries can result in paraplegia (paralysis of the lower body)
- T9-T12 injuries can result in varying degrees of lower body impairment.
- L1-L5. Lumbar injuries can affect the hips, legs, and feet.
- L1-L2 injuries can result in varying degrees of lower body impairment
- L3-L5 injuries typically result in less severe impairment
- S1-S5. Sacral injuries can affect the hips, legs, and feet.
- S1-S2 injuries can result in varying degrees of lower body impairment
- S3-S5 injuries typically result in less severe impairment
Overall, the level of SCI has substantial implications for mobility and function. Understanding the level of injury is crucial for developing an appropriate treatment plan and managing the long-term effects of SCI.
Medical attention at the scene of the Incident
When a spinal cord injury is suspected, quick medical attention is crucial to minimize the long-term effects of the trauma. Emergency personnel will immobilize the head, neck, and spine with a brace as gently and quickly as possible and transfer the patient to promote immobilization on a carrying board1. EMS also focuses on maintaining the patient’s airway and stabilizing the patient for safe transport.
Treatment and management of SCI
The long-term treatment of SCI involves a multidisciplinary approach. Following an SCI, the multidisciplinary team works to create a comprehensive plan that addresses the patient’s physical, emotional, and social needs. Management includes surgery, medications, and rehabilitation2. Early intervention is crucial in promoting the best possible outcomes.
Medications
Potential medications for SCI include those that reduce inflammation and swelling, manage pain, prevent or treat infections, and address other related complications, such as blood clots or muscle spasticity.
Some of these medications include:
- Anti-inflammatory and anti-swelling drugs reduce inflammation and swelling in the spinal cord after injury. These medications include corticosteroids like methylprednisolone.
- Pain management drugs are crucial to the common occurrence of pain in SCI. Medications include nonsteroidal anti-inflammatory drugs (NSAIDs), anticonvulsants, and opioids (in limited amounts for a limited time).
- Antibiotics are used to prevent and treat infections in individuals with SCI.
- Blood clot prevention drugs address the serious complication associated with SCI. Mediations include heparin or warfarin.
- Muscle spasticity drugs are used to treat muscle spasms associated with SCI. Drugs include baclofen or tizanidine.
Surgery
Some spinal injuries require surgery to stabilize the spine, remove bone fragments or foreign objects, or decompress the spinal cord. Surgery also may address secondary complications like pressure injuries or urinary tract infections (UTIs) that can arise from having an SCI.
Rehabilitation
The goal of rehabilitation is to increase independence, improve function, and enhance the individual’s quality of life. Other rehabilitation interventions include physical therapy (PT), occupational therapy (OT), speech therapy (ST), and assistive technology like wheelchairs or braces.
Psychological care
There are strategies to manage the physical and emotional effects of SCI. Long-term planning includes emotional support and psychotherapeutic techniques to cope with SCI’s emotional or mental effects. Psychologists and other mental health professionals can provide therapy and support to individuals with SCI and their families. Psychiatrists, psychiatric physician assistants, and psychiatric-mental health nurse practitioners.
Evidence-based psychotherapeutic techniques include cognitive behavioral therapy (CBT) and eye movement desensitization (EMDR), which can assist in managing SCI’s emotional and psychological impact.
Support groups and peer counseling may benefit those with SCI and their families. Developing a community is crucial; it can be beneficial to have shared experiences.
Research and development
The research and development of new therapies and technologies to prevent and treat SCI improve outcomes and quality of life for individuals with SCI2. The research addresses medications to provide neuroprotection and cell-based therapies that replace damaged cells with other cell types like stem cells. There is ongoing research into neural regeneration, neuroplasticity, and imaging.
In some cases, researchers are exploring the use of advanced rehabilitation techniques through technology like virtual reality, electrical stimulation, or robotics. New treatments for secondary complications such as infections, pressure injuries, and spasticity are being developed. New prostheses are being created all the time. Ultimately, the research promises to improve the quality of life and outcomes for those with SCI.
Advocacy for patients with SCI
Advocate for patients with SCI to ensure they have access to appropriate health care, emotional support, and valuable resources. Advocating at the legislative level for policies and funding to support SCI research, accessibility and accommodations to those affected by SCI, and ensuring individuals with SCI are involved in decision-making processes as crucial stakeholders.
Raising awareness about the impact of SCI is beneficial, but advocating for increased support and resources for those with SCI will provide long-lasting changes.
Important ICD-10 codes for SCI
There are some essential ICD-10 codes for SCI. The standard and broad ICD-10 codes for SCI are as follows3:
- Cervical SCI: S14.0 Injury of nerves and spinal cord at neck level
- Thoracic SCI: S24 Injury of nerves and spinal cord at thorax level
- Lumbar SCI: S34 Injury of lumbar and sacral spinal cord and nerves at abdomen, lower back, and pelvis level
- G95.9 Disease of spinal cord, unspecified
It is crucial to realize that each ICD-10 category has multiple specific diagnoses underneath the same umbrella (i.e., S34.1) that will more clearly describe the situation. By being as precise as possible, you can save your team and patients plenty of time and hassle.
Patient education about SCI
The most crucial component of patient education about SCI is understanding the anatomy and function of the spinal cord, the medical management, and the related impact of the SCI. Patient education following SCI is vital and should cover various aspects of care and management, including sexual counseling and bowel and bladder management. It is also crucial for patients and family members to learn how to prevent pressure injuries.
Vocational training may sometimes be appropriate and necessary as patients choose to return to work or find a new career. Social workers can provide significant resources like health insurance coverage, disability benefits, and local resources.
SCI may significantly impact healthy sexual function and relationships. Patients should receive appropriate education about all aspects of health. Some individuals with SCI experience changes in sexual desire, sensation, and function. Couples counseling or sexual counseling can help individuals with SCI and their partners navigate these changes to maintain fulfilling sexual relationships.
Conclusion
This article covered the typical levels of SCI, treatment and management, prevention techniques, and required patient education. It is crucial to both be aware and advocate for SCI prevention, management, and support.
Works cited
- National Institution for Child Health and Development. Updated January 25, 2022. Accessed April 9, 2023. What are the treatments for spinal cord injury? https://www.nichd.nih.gov/health/topics/spinalinjury/conditioninfo/treatments
- National Institute of Neurologic Disorders and Stroke. Spinal cord injury: Hope Through Research updated February 16, 2023. Accessed April 9, 2023. https://www.ninds.nih.gov/archived/health-information/patient-caregiver-education/hope-through-research/spinal-cord-injury-hope-through-research
- Centers for Medicare and Medicaid Services. ICD code lists. Updated September 28, 2022. Accessed April 9, 2023. https://www.cms.gov/medicare/coordination-benefits-recovery/overview/icd-code-lists