Surgical Stabilization after SCI: Short and Long Term

Surgical Stabilization after SCI: Short and Long Term

Posted by AskNurseLinda on Jan 15, 2018 9:58 am

To those with spinal cord injury from disease, it seems that a lot emphasis is placed on those with SCI from trauma. This is understandable because the start point for trauma is clear. When trauma occurs, you know exactly when the insult to the spine occurred. With disease, it is much more difficult to establish the exact onset. Because of this reason, research and study of SCI from disease is more complicated. The important issue is to know that the research into treatment benefits everyone with paralysis regardless of the reason for a change in function.

The topic for the blog today is to understand surgery for spinal cord injury. This is more common in those with trauma. Individuals with injury from disease may or may not require stabilization of the spine surgery but it remains a potential issue. Regardless of the cause or source of injury, healthcare professionals refer to spinal cord injury as both, trauma and disease, and do not differentiate between the two unless there is a physiological reason to do so.

When a person is involved in an accident that may or may not have a spinal cord injury component to it, emergency services are called. The individual will have a brace or collar placed on their neck and spinal precautions will be used. The person is moved so the spine does not become disturbed and placed on a backboard so their spine remains stable during transportation.

In the pediatric population, there is a difference in field stabilization in that the body, starting from the shoulders, is placed on a pad or blanket to elevate the body from the neck down. This is because infants and small children have heads that are not in the same proportions as adults. Their heads are bigger than the body so this extra lift is needed to keep the spine in alignment. The physiology is not the same in adults so padding under the adult’s body disrupts spinal alignment.

The individual is then transported to the emergency room where they will be examined and evaluated for spinal cord injury. This examination should include the entire spine as sometimes there is an injury to the cervical spine which can mask an injury to the thoracic, lumbar and sacral spine. If the cervical spine is damaged, the injury to the lower spine will be hidden as the physical exam will indicate the cervical injury covering any other injury below.  This is important information for the individual with spinal cord injury from disease. If you have disease in several locations in the spine, a higher level injury can hide an injury at a lower level. 

If you are at a trauma center, you may be examined by a trauma surgeon. These specially trained surgeons are particularly adept at diagnosing SCI. All emergency room physicians will conduct a physical exam and usually a CT scan right in the ER or even an MRI so the spine can be inspected for trauma. In the ER, medication may be given to reduce swelling which will avoid further trauma to the spine from the body attempting to protect itself.

None of the protective gear provided by the EMT or paramedic will be removed until the spine is ‘cleared’, meaning no trauma, nor will precautions for stabilizing your spine be stopped. These precautions include moving your head and body in alignment so you will not have any further trauma to a possible damage site.

Typically, if a spinal cord injury is present, neurosurgery will be conducted as soon as possible. Sometimes, there is an injury to the vertebrae or bones that encase the spinal cord but does not disturb the cord. This type of orthopedic injury may or may not require surgery and may be repaired by an orthopedic surgeon.

The reason for early surgery is to stabilize the area and remove any bone fragments that might be pinching the spinal cord. The vertebrae will be placed back into alignment to avoid further damage to that delicate spinal cord. Injury to the spinal cord can come from over stretching the cord, bones displaced and pinching it or even blood accumulation such a hematoma or an internal bruise. Any movement that can disturb or re-disturb the spinal cord can lead to further injury. Correction to the disruption should be made early and by a highly qualified surgeon.

The spinal cord is cushioned in cerebral spinal fluid which is the same fluid that cushions your brain. The cord is contained in the vertebra for extra protection. From all of this natural protection around the cord, you can see that it does not tolerate disruption! Organs that are inside our bodies do not like to be touched or manipulated which is why our bodies are so protected.

Many people ask why their surgery is done the way it is. Sometimes, it takes two days to complete the surgical process. If in the lower back, the surgery is usually performed from the back, with the patient laying on their stomach, and then the patient is turned so the surgeon can enter through the abdomen which allows stabilizations from both sides.

In the neck, most often the surgery is performed from the front. It would seem logical to perform the surgery on the back of the neck however, this approach is rarely used for cervical injury. This is because the vertebrae are tiny and close together with projections from the back of the bones to further protect the vulnerable neck area.  All surgery leads to some swelling and scarring so approaching from the back can lead to swelling and scarring around the brainstem which controls breathing. Therefore, the front approach is used. It may seem like this is the long way to reach the area that needs correction, but it is actually the safest.

Sometimes, there can be complications after spinal surgery. As with any type of surgery, infection can occur. Surgery is performed within the most sterile of processes. Infection can result from the trauma if it was a dirty injury or from the stress of the event leaving the individual unable to respond to the bacteria. Fortunately, there are a variety of antibiotics that can be used to treat infection. Mostly, these rare infections will be on the surface of the skin or right at the incision site. They usually are treated without much complication. There are serious infections that enter the nervous system that require major treatment with antibiotics. Infections in the nervous system can lead to seizures and even death.

As mentioned, the spine is cushioned in cerebral spinal fluid. Sometimes, a leak of this fluid can occur after surgery. It can drain out of the tiniest opening which has been sutured closed but still fluid can sometimes get through. Leaks might be able to be closed with treatment but sometimes surgery to repair the leak needs to be completed. If a leak gets out, infection can get in so these must be carefully treated.

Electrolyte imbalances can result from any surgery or major illness or disease. Not being able to take in enough fluid or food can upset the balance of electrolytes in the body. Excessive output such as urine or blood can also affect this balance. Post operatively, you are carefully monitored and provided fluid with electrolytes.

If you are in an outlying area, most likely, you will have your spine stabilized before being able to be transferred to a major medical center or rehabilitation hospital.  It is very dangerous to move someone with an unstable spine as the chance of further damage is so high. Occasionally, a second surgery might be necessary or, very rarely, even a surgery much later to remove some of the scar tissue or to make adjustments in alignment.

Overtime, there is a very rare situation that can occur which is syringomyelia. Many people become concerned with this but it is truly a rare incident. Syringomyelia is a condition where the small hole in the center of the spinal cord which results from spinal cord injury, not surgery, starts to enlarge. The symptom of syringomyelia is noted by the individual is a loss of function, even just slightly. Treatment is challenging as the syringomyelia requires draining which is another neurosurgical procedure. The drain has to travel through spinal cord nerves which can lead to additional damage. If this procedure is required, you want to be sure to have an experienced surgeon.

Since the surgery is in the nervous system, caution is always taken as with all surgeries. It is important to have a stable spine to protect from further injury and so you can move forward with your rehabilitation. If you have spinal cord injury from disease, the decision for when surgery should be undertaken will be made with you and your surgeon.

Some individuals with spinal cord injury from disease do not require surgery but manage with orthotic devices. It is not an option if surgery is recommended but I wanted to mention this as some particular injuries can be managed in this way. It is best to follow the recommendations of your healthcare professional. Ask questions so you understand what is happening to your body.

Nurse LindaI'm online in this community every Wednesday from 8-9 PM ET to answer your SCI and paralysis related questions.

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