A spinal cord injury is a significant, life-altering condition, which often results in permanent paralysis. Spinal cord injury affects thousands of lives each year in the UK. Here, JMW discusses the frequency, types of injury, complications, and the role of early intervention in relation to spinal injuries.

Incidence and Prevalence

In the UK, an estimated 50,000 people are living with spinal cord injury, which is about 0.07% of the population. Statistics indicate that each year, around 2,500 individuals in the UK sustain new spinal cord injuries. This is part of the wider picture where annually, there are approximately 13,300 hospital emergency visits due to spinal injuries.

Breaking down these figures further, the UK experiences around 48 spinal cord injuries every week, which is about seven each day, or one every 3.5 hours. 

The typical profile of an injured person is shifting, with older patients becoming more common, and injuries increasingly linked to the effects of ageing. 

Of the spinal cord injuries noted, 51% result in tetraplegia, and just below half are due to trauma rather than through illness or condition. The demographic split shows a male predominance, with a two-thirds to one-third male-to-female ratio. Notably, 5% of new cases are individuals over 80, while 2% are under 14, so while unlikely, it is evidence that these injuries can happen across all age groups.

According to the World Health Organisation, young adult men (20-29 years) and those over 70 are the most susceptible to spinal injuries, while the greatest risk for women occurs in the teenage years (15-19) and after 60. The adult ratio of male-to-female spinal injury cases is consistently at least double.

Individuals with spinal cord injuries face the most significant risk of mortality within the first year after their injury, being 2 to 5 times more likely to die prematurely compared to those without such injuries

The likelihood of mortality intensifies with the level and severity of the injury and is greatly affected by the accessibility to immediate, high-calibre medical care. How quickly and by what means a patient is transported to the hospital post-injury are also critical factors.

Types of Spinal Cord Injuries

Spinal cord injuries can be categorised into two types: traumatic and non-traumatic.

Traumatic Spinal Cord Injuries

Traumatic spinal cord injuries are caused by a sudden external force that impacts the spine. Common causes include car accidents, falls and sports injuries. These incidents can fracture, dislocate or compress the vertebrae, leading to damage to the spinal cord.

Non-Traumatic Spinal Cord Injuries

nNon-traumatic spinal cord injuries result from internal factors such as ageing, inflammation or disease. Conditions like spinal tumoursor cauda equina syndrome are examples of non-traumatic spinal cord injuries. These injuries often develop gradually, often without a specific incident to trigger them.

Causes of Spinal Injuries

Spinal cord injuries can occur in a variety of ways, sometimes in high-impact accidents but also in innocuous incidents. Road traffic accidents: cars, motorcycles, bicycles, and pedestrian incidents are significant contributors to spinal injuries due to the high force of impact.

Workplace accidents: falls from height and incidents involving heavy lifting or machinery can result in serious spinal damage.

Falls: whether at work, home or elsewhere, these accidents can cause catastrophic injury, particularly to individuals with pre-existing vulnerabilities.

Sporting injuries: activities like rugby, horse riding, skiing or diving can be a cause ofspinal injuries, such as compression fractures or displaced bones in the spine.

Less Severe Incidents

Repetitive strain and mispractice: unhealthy practices like improper lifting techniques over time can lead to strains, sprains, and slipped discs.

Onset and Progression

Understanding what occurs at the onset of a spinal cord injury and how it may progress over time is crucial for both immediate treatment and long-term management.

Onset

At the onset of a traumatic spinal cord injury, the impact or force leads to immediate damage to the spinal cord. Symptoms can manifest rapidly, ranging from loss of motor function to numbness or even paralysis. In the case of non-traumatic injuries, symptoms might develop gradually and may initially be less severe, although they can become debilitating over time.

Progression

The progression of a spinal cord injury can vary widely depending on the severity of the initial injury, the speed of medical intervention, and individual health factors. While some individuals may regain partial or full function if the nerves in the spinal cord remain intact,others may experience a worsening of symptoms or the onset of secondary health issues.

It's important to note that spinal cord injuries are generally categorised based on their 'completeness'. A complete injury results in total loss of sensory and motor function below the level of the injury, whereas an incomplete injury means there is some remaining function. The level of completeness can impact the progression and potential for recovery.

Secondary Health Concerns

Spinal cord injuries often come with a range of secondary health issues that c make management more challenging. Two common secondary health concerns are urinary tract infections and untreated pressure ulcers.

Urinary Tract Infections

People with spinal cord injuries are at an increased risk of developing urinary tract infections (UTIs). Due to changes in bladder function and the frequent use of catheters, UTIs can become a recurring issue that requires vigilant management. A UTI can be debilitating for the person suffering and will usually require a course of antibiotics to clear it. 

Untreated Pressure Ulcers

Also known as bedsores, untreated pressure ulcers are another common concern. Immobility from a spinal cord injury can lead to constant pressure on certain parts of the body, cutting off circulation to the skin and creating an environment where ulcers can form. If not treated promptly, these ulcers can take weeks or even months to heal, can become infected and lead to more serious complications.

Being aware of these secondary health concerns and managing them effectively is vital for improving the quality of life for someone with a spinal cord injury. Timely treatment of these issues can prevent them from becoming more severe problems that are harder to manage.

Importance of Early Treatment

Prompt and appropriate medical intervention can significantly impact the outcome of a spinal cord injury. The time immediately following the injury is often termed the 'golden hour’, a critical period during which medical treatment can prevent further damage and improve long-term prognosis.

Medical Response

Upon the occurrence of a suspected spinal cord injury, the first step is often immobilisation to prevent further harm to the spinal cord. Emergency medical services, including swift transportation to a specialised medical facility, can make a substantial difference in the outcome.

Long-Term Management

Early treatment is not just about immediate medical intervention; it's also about setting the stage for effective long-term management. Initiating a suitable rehabilitation programme quickly can aid in the recovery of some functions and improve the quality of life for the injured person.

Coping and Support

Living with a spinal cord injury can feel overwhelming, both for the injured individual and their loved ones. However, a strong support network and access to the right resources can make a world of difference.

Emotional Support

One of the first steps in coping with a spinal cord injury is coming to terms with the emotional and psychological impact. Support from family, friends and professional counselling can be invaluable in this process. Peer support, talking to someone who has been through a similar experience, can also be a great source of comfort and insight. 

Physical Rehabilitation

Ongoing physical therapy is often a key aspect of long-term management. Working with healthcare professionals to tailor a rehabilitation programme can help improve mobility and functionality over time, helping the injured person maintain as much independence as possible.