SPINAL CORD ANATOMY IN BRIEF IN RELATION TO INJURY
• The spinal cord is about 18 inches long and covered by the vertebral bones that protect it from injury
• It extends from the base of the brain, down the middle of the back, to the waist level.
• The spinal cord is actually a bunch of nerve fibers arranged in the form of tracts. There are ascending and descending tracts and their function is to carry impulses from the body to the brain (ascending tracts) and from the brain down to the body (descending tracts) resp.
• The spinal cord contains nerves that control sensory and motor function of the body as well as another diffuse system of nerves, the sympathetic and parasympathetic nervous systems that regulate involuntary functions such as blood pressure and temperature regulation.
• Spinal cord injuries are common in the neck (cervical) and the back of the chest (thoracic) parts of the spinal cord.
• Generally, the higher in the spinal column the injury occurs, the more loss of function and disability a person will experience
• Cervical cord injuries usually cause loss of function in the both arms and legs, referred to as quadriplegia (paralysis of all four limbs).
• Injuries in the thoracic portion usually affect the chest and the legs, causing paraplegia.

SPINAL CORD INJURY (SCI) – OVERVIEW
• Spinal cord injury refers to damage to the spinal cord caused by trauma (e.g. fall from a height, car crash) or even infections or cancer.
• Exact figures of global prevalence are unclear but the annual global incidence is believed to be 40 to 80 cases per million population.
• Nearly 90% of these cases are due to trauma, although the incidence of non-traumatic spinal cord injury appears to be rising.
• Symptoms of spinal cord injury depend on the severity of injury and the level of injury in the spinal cord. Symptoms comprise partial or complete loss of sensory function or motor control of arms, legs and/or body below the level of injury.
• The most severe spinal cord injury involve bowel or bladder control, vital functions such as breathing, heart rate and blood pressure.
• Most people with spinal cord injury suffer from chronic pain

IMPORTANT STATISTICS OF SCI ACCORDING TO WHO
• Annually, between 250 000 and 500 000 people are estimated to suffer a spinal cord injury (SCI) across the world.
• The majority of spinal cord injuries are due to preventable causes such as falls, road traffic crashes or violence
• Males are at increased during young adulthood (20-29 years) and older age group (60-70)
• Females have highest risk in adolescence (15-19) and older age (60+). Male-to-female ratios of SCI are reported to be at least 2:1 among adults
• People with a spinal cord injury are 2-5 times more likely to die prematurely than people without a spinal cord injury, and mortality rates are higher in low- and middle-income countries
• Mortality risk increases proportionately to severity and level of injury and is affected by availability of timely and proper medical care. Time of admission to hospital and method of transfer are key factors that influence patient outcome.

TYPES OF SPINAL CORD INJURY
Spinal cord injuries can be complete or incomplete

COMPLETE SCI
• Produces complete loss of all sensory and motor function below the level of injury.
• Nearly half of all SCIs are complete.
• Both sides of the body are affected equally
• Even with a complete SCI, the spinal cord is rarely transected.
• Most often, loss of function is caused by a bruise to the spinal cord or due to reduced blood flow to the injured part of the spinal cord.

INCOMPLETE SCI
• Some amount of sensory/motor function is preserved below the primary level of the injury.
• A person with an incomplete injury may have more movement or sensation in one arm or leg than the other

GRADING OF SPINAL CORD INJURY
SCIs are graded according to the severity of injury by American Spinal Injury Association (ASIA) grading scale. In general, the more severe the grade, the less likely are the chances of recovery

• ASIA A: Complete spinal cord injury with complete loss of sensory and motor function
• ASIA B: Incomplete injury with complete motor function loss and preservation of sensation
• ASIA C: Incomplete injury, with some motor function loss, i.e. less than half the muscle groups can lift up against the force of gravity with a full range of movement
• ASIA D: Incomplete injury with more than half of the muscle groups able to lift up against the force of gravity with a full range of movement
• ASIA E: normal.

EFFECTS OF SCI ACCORDING TO LEVEL
Cervical (neck) injuries usually result in quadriplegia. Injuries above the C-4 level necessitates use of ventilator for the person to breathe. C-5 injuries often show preservation of shoulder and biceps control, but no control at the wrist or hand. C-6 injuries generally have wrist control, but no hand function.
Thoracic SCI results in paraplegia while arm and hand function are preserved
T-1 through T-5 nerves affect muscles of upper chest, mid-back and abdominal muscles that control the rib cage, lungs, diaphragm and muscles that help respiration
T-6 through T-12 nerves affect abdominal and back muscles important for balance and posture, and they help coughing and removal of foreign matter from the airway
People with lumbar SCI have little or no voluntary control of their bowel or bladder, but can mobilize on their own with special equipment depending on the degree of loss of function in the hips and legs
People with sacral SCI have some loss of function in the hips and legs, little or no voluntary control of bowel or bladder organs, but people with this injury can mobilize independently with special equipment

FIRST AID FOR SCI
If you believe someone else has a spinal cord injury follow these measures
• Call for medical help immediately. The sooner medical help arrives, the better.
• Don’t change the position unless it’s absolutely necessary, for example, repositioning the person’s head or trying to remove a helmet
• Don’t attempt to give water or liquid to the patient
• Perform CPR if the person isn’t breathing. Don’t tilt the head back, instead move the jaw forward.