A traumatic spinal cord injury occurs when an external force strikes the spinal column. It fractures or shifts the vertebrae, causing compression of the spinal cord.
This article will explain what happens after a traumatic spinal cord injury and how to approach recovery.
Primary Traumatic Spinal Cord Injury
Damage to the spinal cord consists of 2 phases: primary and secondary injury.
Primary traumatic spinal cord injury is the initial blow to the spinal cord. The most common causes of primary SCI damage are car crashes, falls, violence, and sports accidents.
Direct outcomes of primary damage include:
- cell damage and death
- blood vessel damage
- misalignment of the spine
- strained nerves
- reduced blood supply
Secondary Traumatic Spinal Cord Injury
The secondary stage of traumatic spinal cord injury is a result of changes your spinal cord undergoes in the hours to weeks following the initial injury.
The body goes into defense mode and activates the release of inflammatory chemicals in hopes of stabilizing the spinal cord.
Unfortunately, these processes can also cause a lot of harm and amplify spinal cord damage by reducing blood flow, increasing inflammation, overexciting the neurons, and inhibiting axon regrowth.
Reduced Blood Flow
Damaged blood vessels can lead to reduced blood supply and, worst case scenario, hemorrhaging.
When your blood pressure drops, your cells don’t get enough oxygen and nutrients, causing them to die. This can cause swelling of the spinal cord, which can cut off blood flow and lead to spinal shock.
Spinal shock is a temporary loss of feeling, movement, and reflexes below your level of injury. It can last anywhere from a few days to several weeks.
As swelling starts to die down, these functions can gradually return. It isn’t until spinal shock goes away that patients develop a better understanding of what functions have been affected or spared by traumatic spinal cord injury.
Normally, your blood-brain barrier helps decide what crosses over into the spinal cord.
In the case of a traumatic spinal cord injury, the barrier gets disrupted and immune cells invade the spinal cord. These cells activate an inflammatory response that creates more damage and cell death.
Another harmful outcome of inflammation is the production of free radicals. Free radicals are highly reactive molecules that cause cell damage through a process called oxidative stress.
In small quantities, they are not harmful. However, after a traumatic spinal cord injury, they are produced in large amounts which destroys the interior lining of your blood vessels and cell tissues.
Excessive Release of Neurotransmitters
Another source of damage comes from the excessive release of neurotransmitters (the chemicals that allow neurons to communicate with each other).
When too many neurotransmitters are released, the neurons in your spinal cord become overstimulated and potentially damaged in a process called excitotoxicity.
Cystic Cavities and Glial Scarring
From: Obermair et al. (2008). Copyright © and courtesy of the American Physiological Society (2008).
So why can’t the spinal cord regenerate as easily as other parts of the body?
Cystic cavities form at the site of injury in response to the large amounts of cell deaths. Unfortunately, these cavities don’t serve any meaningful purpose and are voids that take up space and prevent the growth of axons.
Additionally, glial scars form around the cyst. They create a barrier that separates the injured area from the rest of the spinal cord to prevent further damage.
However, glial scars aren’t penetrable, so they also prevent neural regeneration.
Traumatic Spinal Cord Injury Treatment
As you’ve just learned, a traumatic spinal cord injury can drastically progress if not properly treated.
Therefore, immediate medical attention is necessary to stabilize the spinal cord and minimize secondary damage.
Early treatment goals for traumatic spinal cord injury include:
- decreasing inflammation
- increasing blood flow
- preventing glial scar/ cystic cavity formation
- decelerating cell deaths.
After stabilizing the injury, treatment goals focus more on rehabilitating movement and sensation.
Rehabilitation After Traumatic SCI
Recovery outlook following spinal cord injury primarily depends on the severity of damage and how intensely you pursue rehabilitation therapies.
The less severe your spinal cord lesion, the more spared neural pathways exist. Spared neural pathways connect the brain to areas below your level of injury.
Neuroplasticity is the spinal cord’s ability to rewire itself and recover functions damaged by SCI. The more spared neural pathways you have, the more neuroplasticity can work, and the greater the potential for recovery.
The best way to promote neuroplasticity is through massed practice. When you repeat a function, you’re stimulating and reinforcing its neural circuitry. Stronger neural pathways lead to the development of more natural movements.
Hopefully, this article helped you better understand the importance of timing after traumatic spinal cord injury. The goal is to stabilize the spinal cord as soon as possible to minimize secondary damage and promote rehabilitation.
Featured image: ©iStock.com/demaerre