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Home » Treatment » Spinal Cord Injury-Epidural Stimulation

Spinal Cord Injury-Epidural Stimulation

The spinal cord is a tube containing a bundle of nerves that carry messages to and from the brain to the rest of the body. The spinal cord is surrounded by bony structures called vertebrae stacked on top of one another.

 

Spinal cord injury can happen directly due to the damage to the spinal cord's nerves or an indirect trauma directed through the bony structures, soft tissues, and vessels around the spinal cord.

 

A spinal cord injury can have a varied impact depending upon the nerves affected and the extent of the injury. There may be a loss of sensation, strength or balance.

 

What are the symptoms of spinal cord injury?

 

The location of the spinal injury and the intensity of damage play a role in the signs and symptoms.

 

Spinal cord injuries are classified according to the completeness of the injury:

 

Complete: If there is a complete loss of sensation and ability to control movements below the spinal cord injury, it is referred to as a complete injury.

 

Incomplete: When sensations or voluntary control of movements is intact below the level of injury, it is called an incomplete injury. This can be of various types.

 

The following signs and symptoms may also occur:

  • Disturbed sensations include the ability to distinguish between heat, cold, or touch.
  • Involuntary passage of stools or urine.
  • Twitching or spasms
  • Severe pain or tingling numbness in the arms, legs and along the spine
  • Breathing problems, hawking or coughing, and weakness of muscles.
  • Weakness or complete loss of control over muscles.
  • Pain in the back, or a pressure feeling in the head, neck or back
  • Loss of balance while walking with a tendency to fall on one side
  • Paralysis - this may be of two types.
  •  Tetraplegia: loss of function of trunk, pelvis and legs
  •  Paraplegia: spinal cord injury has affected the arms, hands, legs, trunk, and pelvis

 

The symptoms may not be evident at once after an injury. The doctor might do a comprehensive neurological examination to determine the effects of the injury.

 

Even if the symptoms do not feel severe immediately after an injury, always consult a doctor to ensure the seriousness of the case as the symptoms may appear gradually as the swelling or bleeding occurs.

 

What can be the probable causes of spinal injury?

 

  • Accidents in two-wheeler or four-wheeler vehicles. This is one of the common causes of spinal cord injuries in young adults.
  • Sudden falls, especially among older adults about 65 years of age, are frequently encountered as a cause of spinal injury in patients.
  • Diseases of the spinal cord such as cancer, arthritis, or osteoporosis may damage the spinal cord.
  • Injuries incurred during sports and recreational activities may impact the spinal cord.
  • Violent activities causing injuries, especially knife or gunshot wounds, can damage the spinal cord significantly.

 

What can be the complications of spinal cord injury?

 

  • Respiration: Due to weakness of chest & abdominal muscles, breathing must also require extra effort. If the cervical or thoracic spine injury is there, then the respiration's impact would be more than other injuries. There is a risk of lung infection, severe cough, laboured breathing, and difficulty in eliminating expectoration in such cases.
  • Circulation: A wide range of problems may occur after a spinal cord injury ranging from the sudden fluctuation of blood pressure such as orthostatic hypotension or autonomic hyperreflexia to the risk of blood clots such as deep vein formation thrombosis or pulmonary embolism.
  • Urine: The urine from kidneys will be stored in the urinary bladder, but the sensation of the passage of urine, muscle weakness or sphincter control may be lost after a spinal cord injury leading to the involuntary passage of urine.
  • Bowel control: Even with an efficient digestive system, the evacuation of bowels may also be disturbed.
  • Skin: In most cases, the skin sensation is lost below the level of spinal cord injury. Hence, even if any abrasion, injury or bed sores occur on the skin, signals might not be transmitted to the brain. This can worsen the skin condition even more.
  • Mind: The quality of life is hampered by the spinal cord injury as there may be difficulty in performing day to day activities. This can have a drastic effect on the mental plane leading to anxiety and depression.
  • Metabolism: As the activity is minimized due to muscle weakness & loss of sensation, there may be excessive weight gain coupled with wasting of the affected muscles. This simultaneous change may also predispose to metabolic diseases such as high blood pressure, diabetes, and cardiovascular disorders.
  • Pain: Pain in various muscles, joints, and back is bound to occur after a spinal cord injury as there is extensive nerve damage.
  • Sexual health: Fertility and sexual health may also be hampered after a spinal cord injury. There may be issues with erection & ejaculation in males, while in females, there may be a lack of lubrication. 

 

Diagnosis of Spinal cord injury

After the trauma, a physical examination will be conducted to assess whether there is an injury to the spinal cord by checking the power & sensation in muscles and asking about the incident that led to the damage.

 

If the patient is unconscious or not fully awake and there are associated symptoms such as difficulty breathing, pain or stiffness in the neck, the doctors might suggest an X-ray, CT scan or MRI.

 

How can a spinal cord injury be treated?

The period between the occurrence of injury and the treatment is crucial to determine the outcome of treatment.

 

Emergency treatment

Initially, emergency treatment is provided to revive the patients to:

  • Manage the effects of head & neck trauma
  • Make sure that there is no further injury to the spine, head, and neck
  • Ensure that there is breathing difficulty
  • Check bowel and bladder function
  • Minimize blood loss and prevent blood clots formation

 

Once the medical team has ascertained that you have a spinal cord injury, in that case, you may be shifted to an intensive care unit or a spine injury hospital where a team of orthopaedic surgeon, neurosurgeon, spinal cord medicine specialist, psychologist, nursing care team, along with a physical therapist, and social workers may also be consulted to devise your care plan.

 

Medications: Medicines shall be prescribed according to the symptoms to relieve pain, numbness, constipation, or other problems.

 

Immobilization: If the alignment of your spine is disturbed, traction may be required in addition to placing a neck collar for neck stabilization and support.

 

Surgery: In case of fracture of the vertebrae, incisive injury containing fragments of bones, foreign objects, or any other condition that can be rectified with surgery, it will be performed.

 

Once your condition has been stabilized, the medical team may focus on other ailments bothering you, such as bowel & bladder function, muscle weakness & contractions, and lung infections.

 

You may have to stay in the hospital till you can perform your essential functions properly and your injuries have been resolved. The duration of your hospital stay shall vary with your condition. After your discharge, the doctors shall advise you to enrol in a rehabilitation program to guide you about how to resume your normal activities again.

 

Self-care

A spinal cord injury can come as a blow to you as well as your family. Hence, a collective effort towards your recovery has to be made in coordination with your medical team.

  • You may be required to use specific equipment or machines to aid various movements and functions such as an electric wheelchair, computer adaptations or electronic aids.
  • You might feel vulnerable and depressed as you may be dependent on your loved ones even for basic activities, which may take a toll on them. It is best to make an effort to overcome your illness physically as well as mentally.
  • Try to understand the cause of your injury and the way to overcome the effects. Whenever you visit your doctor for consultation, ask as many questions as you can to understand your condition and recovery process.
  • You might feel embarrassed with a tendency to stay alone after such an incident. Talk about your difficulties, express your pain or feelings to others. Never shy away from sharing your feelings, and be clear if you require something so that your family & friends can help you better.

 

 

 

What is Epidural Electrical Stimulation and It workings

This technique to treat medical conditions by using electrical current has been in practice tracing back to thousands of years.

Epidural stimulation for spinal cord injury works by implanting an epidural electrical stimulating electrode into the epidural space that is by the backside of the bones of your vertebral spine. This procedure means that the electrode array is inserted in the gap space on top of your dura just outside of the spinal cord.

To move the targeted groups of muscles, the electrode is used to send electrical currents to cause muscle contractions. Sometimes it happens that after a spinal cord injury, the neurons and axons throughout the body are still in good condition. However, our brain is not able to transmit signals to and from them because of the damage to the spinal cord.

Through spinal cord stimulator surgery, the implant device helps to reactivate and use remaining intact neural networks within the spinal cord. This helps to direct the movements required to stand and take steps.

What are the Complications of Epidural Stimulation for Spinal Cord Injury

Though epidural stimulation has shown great incredible promise for people with spinal cord injuries, but as it with many types of procedures, it comes with its own set of potential risks. The complications are concerning with the long term use of epidural stimulation. However, when you consider undergoing repeat back surgery, epidural stimulation is significantly less risky. The Procedure is less risky and more effective and cost-effective than chronic pain therapies.

Some of the complications arising in implanting an SCS system may include:

  • Nerve injury
  • Epidural Fibrosis
  • Epidural abscess
  • Postdural puncture headache
  • Seroma
  • Hematoma
  • Pain at generator
  • Wound infection
  • Unacceptable programming
  • Lead migration
  • Current leak
  • Generator failure

Results of Epidural Stimulation to Help Spinal Cord Injuries

As the technology is still in research phase, the medical providers say that epidural stimulation for spinal cord injury is not a “cure” for spinal cord injuries. But with recent advancements in spinal cord surgeries, researchers have taken a step forward in the evolution of understanding of what a spinal cord injury and related treatments entail.

Why Pursue Epidural Stimulation

Epidural electrical stimulation, particularly FES, has shown excellent promise in helping some patients regain some abilities. The patients who have undergone FES therapy have shown improvements in hand function, improved core control, bladder and bowel control, and even the ability to breathe without the use of a ventilator.

After surgery and during extensive rehabilitation, the spine specialists will help you regain your quality of life. With epidural stimulation, you will be able to perform functions such as standing and stepping, more muscle mass and stamina, less fatigue and pain, enhanced motor skills, and better control over bladder and bowel.

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