spinal cord injury

Monday, October 31, 2011

As he led his Rutgers onto the field, Eric Legrand’s presence was an inspiration but also a reminder of the consequences of trauma to the head and neck. A year ago, trying to make a tackle, he sustained a spinal cord injury and was paralyzed from the neck down, but after months of rehabilitation, he rode his motorized wheelchair onto the field in front of the cheering crowd with his teammates by his side. His is the reminder that while most players strapped onto a stretcher do well, the worry always is what might be.

There is always fear in caring for trauma victims that an unrecognized spinal cord injury will cause a lifetime of debilitation. This is especially true if a patient cannot complain of neck pain because other are unconscious or are confused because of head injury, intoxication or other underlying medical conditions. An awake person can cooperate to complain of neck pain, weakness of numbness but how does one assess a patient who can’t complain?

A broken neck refers to fractures of one of the seven vertebrae that make up the cervical spine. If the bones and ligaments maintain the alignment of the spine, the spinal cord may not be injured. However, some fractures are unstable and an initial normal physical exam may deteriorate if the bones shift and the spinal cord kinks. For that reason, trauma victims, from athletes on the football field to people who fall down steps to car wreck victims are treated with kid gloves. Their necks are immobilized in collars and they are strapped to a board so that inadvertent movements will be prevented and a potential catastrophe averted. Sometimes, these precautions seem to be overkill and patients complain, but until he decision is made that the neck and spinal cord is normal, that concern is appropriate.

X-rays aren’t always needed to “clear” a neck from fracture. If the patient is fully awake, has no major injury about the collarbones and does not have a painful injury that might distract from a potential neck injury, a careful physical examination may be enough to reassure that no neck problem exists.

Sometimes x-rays aren’t enough. The body sometimes doesn’t read the textbook and tries to hide its injuries. SCIWORA can rear its ugly head and neck precautions may be maintained for days in certain trauma situations. Spinal cord injury without radiologic abnormality occurs when there is significant flexion or extension of the neck but the bones don’t break. Parts of the spinal cord can stop working and it may take repeated questions and examinations to uncover the damage. MRI might be needed to demonstrate the damage. Sometimes, the MRI can be done immediately. Sometimes the patient may have life threatening injuries that need attending and for that reason, protection of the neck is a priority.

Routine question looking for neck injury often ask about pain in the neck, pain radiating to the shoulder or down an arm, muscle weakness or change in sensation. Other questions may seem bizarre. The spinal cord has a variety of zones that connect the brain to different parts of the body. Bowel or bladder problems like urine or stool incontinence or inability to urinate may be a clue that parts of the spinal cord is damaged.

Treatment of neck fractures is aimed at protecting the spinal cord and preventing paralysis. If paralysis is present, treatment is meant to preserve whatever function is left and prevent further potential damage. The higher the level of spinal cord damage, the more difficult it is to function. The more that can be saved, the better quality of life for the patients.

Mr. Legrand’s return to the Rutgers sideline required a year’s worth of physical rehabilitation. The inspiration to his teammates had to do no only with his physical presence but also the understanding the emotional and spiritual strength required to overcome a devastating injury. The devotion to training that made him a college football player needed to be translated to the training required to return to the classroom, to the sideline and to the rest of his life.

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