Of all the catastrophic injuries, spinal cord injury is the most complex. Spinal cord injury is an uncommon condition that has significant impact on the injured person’s Functional, medical, psychological and economic well being. Every year in this country alone, 8,000 to 12,000 people have a non-fatal spinal cord injury (SCI) and there are currently more than 200,000 Americans with SCI. The average age at the time of injury is 15 to 35 years old, with a male to female ratio of approximately 2:1. Spinal cord injuries most frequently occur on weekends, specifically between Friday night from 6:00 p.m. to Sunday morning at 6:00 a.m. The peak season of the year for spinal cord injury is in the summer. The most common causes are Motor vehicle accidents, followed by falls, sports injuries and violence. Injury prevention remains the most effective method of decreasing the incidence of spinal cord injuries.
Spinal cord injury Rehabilitation requires comprehensive medical and therapeutic patient management. It is a multi-step process that starts immediately after the accident and continues for the remainder of the patient’s life. Rehabilitation intervention commences at the time of injury with management of the acute trauma. This is the most critical time as the patient is at highest risk for SCI complications, including death. Acute rehabilitation follows with interdisciplinary intervention from physicians, rehabilitation nurses, physical, occupational and respiratory therapists, speech pathologists, case managers, psychologists, social workers and therapeutic recreation therapists.
Anatomically, the spine, or vertebral column, is comprised of vertebral bodies separated by intervertebral discs and supported by many ligaments. The vertebral column is divided into Cervical, Thoracic, Lumbar, Sacral and coccygeal regions. There are seven cervical, twelve thoracic, five lumbar, five fused sacral and four fused coccygeal Vertebrae. Structurally, a typical vertebra is comprised of an Anterior portion called the vertebral body and a Posterior portion called the neural arch. The neural arch consists of a pair of anterolateral pedicles, a pair of posterolateral laminae, four articular processes, two transverse processes and one spinous process. The bony portion of the spine provides structural integrity to the entire vertebral column.
The spinal cord is encased in supporting structures that protect its fragile, gelatinous nature. These supporting structures include bone and ligaments. Although there are eight ligaments that help to maintain spinal stability, the most important supporting structures are the anterior longitudinal ligament, the posterior longitudinal ligament and the intervertebral discs. When there are insignificant or no bony fractures in a spinal injury, the stability of the vertebral column lies with the integrity of the ligaments.
The bony vertebral column and the supporting ligaments determine the amount of motion that is possible in the spine. In the cervical spine, there is greater range of lateral Flexion and rotation than in any other portion of the spinal column. Maximum bending in flexion and Extension occurs between C4 and C6. The thoracic region is less flexible but more stable than the cervical region because of the limitations provided by the rib cage. The lower thoracic and lumbar spine has the capability to resist an imposed load (stiffness) secondary to the design of the facet joints in these areas.