Spinal cord injuries (SCI) result from motor vehicle and workplace accidents, community violence, and recreational activities. In the United States, motor vehicle accidents account for 36-48%, violence for 5-29%, falls for 17-21%, and recreational activities for 7-16% of events.
Spinal cord injuries (SCI) usually have permanent impairment of motor, sensory and autonomic function. It is imperative that accident victims sustaining SCI obtain timely and competent management, otherwise permanent impairment is almost a certainty, and secondary cardiac and respiratory complications cannot be prevented.
The spinal cord is divided into 31 segments, each with a pair of anterior (motor) and dorsal (sensory) spinal nerve roots. On each side, the anterior and dorsal nerve roots combine to form the spinal nerve as it exits from the vertebral column through the neuroforamina. The spinal cord extends from the base of the skull and terminates near the lower margin of the L1 vertebral body. Thereafter, the spinal canal contains the lumbar, sacral, and coccygeal spinal nerves that comprise the cauda equina. Injuries below L1 are not considered SCIs because they involve the segmental spinal nerves and/or cauda equina. Spinal injuries proximal to L1, above the termination of the spinal cord, often involve a combination of spinal cord lesions and segmental root or spinal nerve injuries.
The initial goal of your treating physician is to classify the pattern of the neurologic deficit into one of several cord syndromes. The following cord syndromes are the most common:
- Anterior cord syndrome: variable loss of motor function and pain and/or temperature sensation, with preservation of proprioception (sensory two point discrimination).
- Brown- Séquard syndrome: greater ipsilateral loss of proprioception and motor function, with contralateral loss of pain and temperature sensation.
- Central cord syndrome: a cervical lesion, with greater motor weakness in the upper extremities than in the lower extremities.
- Conus medullaris syndrome: a sacral cord injury with or without involvement of the lumbar nerve roots. This syndrome is characterized by areflexia (lack of reflex) in the bladder, bowel, and to a lesser degree, lower limbs. Motor and sensory loss in the lower limbs is variable.
- Cauda equina syndrome: injury to the lumbosacral nerve roots characterized by an areflexic bowel and/or bladder, with variable motor and sensory loss in the lower limbs. Because this syndrome is a nerve root injury rather than a true SCI, the affected limbs are areflexic. This injury is usually caused by a large central lumbar disk herniation.
Acute SCI must be suspected whenever someone presents with a combination of autonomic (i.e. urinary retention, constipation, ileus, hypothermia, hypotension, bradycardia), motor (i.e. hemiplegia and/or hemiparesis sparing the face, paraplegia and/or paraparesis, quadraplegia and/or quadraparesis), and sensory (i.e. lack of sensation at a certain level, hemisensory loss) symptoms. Neurogenic shock occurs only in the presence of acute SCI above T6. Hypotension and/or shock with acute SCI at or below T6 is caused by hemorrhage and a source for bleeding should be vigorously pursued.
Lab studies are non-specific but should be obtained. Imaging studies are most specific and include the standard 3-view: anteroposterior, lateral, and special view (e.g. odontoid and neuroforaminal) all of which show alignment of bony structures. If cervical fracture is suspected, the T1 level should be x-rayed to observe the possibility of low cervical fractures or subluxation. Computerized tomographic (CT) imaging and magnetic resonance imaging (MRI) are the preferred methods for spinal cord imaging. CT imaging is better for bone definition and is important when radiography shows injury or when an area is poorly visualized. CT imaging can also show soft tissue changes, cord edema, demyelination, cysts, abscesses, hemorrhage, and calcifications. CT myelography is preferred for better evaluation of spinal canal abnormalities. MRI is the best method for definition of neural tissues. MRI findings correlate with neurologic status and help to establish prognosis.
The major medical-legal issue is failure to diagnosis impending spinal cord injury when the neurologic findings are subtle yet present, or if the history is commensurate with focal neurologic impairment. Other concerns involve failing to properly immobilize the spine when the mechanism of injury suggests an increased risk of SCI. Special concerns include agitated, intoxicated or unconscious patients. Other problems include misreading x-rays, inadequate imaging studies, attributing shock to hemorrhage rather than cord injury, failing to give IV steroids in a timely manner, and failing to call for neurosurgical or orthopedic back up immediately.
If you have suffered this type of injury, due to the negligence of another person or entity, you may be entitled to monetary compensation. These types of accidents require expert analysis and the resources of an experienced, board certified civil trial attorney. The Law Office of Steven S. Farbman, P.A., specializes in cases involving this type of injury and will make sure the negligent parties are held accountable for their actions. The Law Office of Steven S. Farbman, P.A. is committed to helping people who have been involved in an accident. We understand that being injured in an accident is a difficult time for you. Our office will be there for you in your time of despair. You are more than a file number at the Law Office of Steven S. Farbman, P.A.. You are family. We will protect your rights and aggressively pursue all legal remedies available to you under the law.
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