Spinal cord transection is a condition in which the nerves which run inside the vertebral column are damaged, usually as the result of an accident. Depending on the exact location of the damage, paralysis occurs which may affect all of the limbs or only the legs. Motor vehicle accidents are the most common cause of this condition. Management of the disorder involves stabilizing the spine and treating any associated conditions. Although medical advances have led to increased survival of patients, their life expectancy remains lower than normal.
Any accidental injuries which lead to broken or dislocated vertebrae can cause spinal cord transection. In violent incidents, weapons such as knives and bullets may penetrate the spinal cord. Tumors may grow and compress the cord, and inflammatory diseases, infections and hemorrhages may also cause damage.
When spinal cord transection occurs suddenly, for example as the result of a fall from a horse, the initial phase is known as spinal shock. A number of symptoms occur, including loss of sensation and movement of parts of the body supplied by nerves below the injury. When the site of the transection is the neck, the respiratory muscles and all of the limbs become paralyzed. Below the level of the neck the body becomes numb, reflexes disappear and body temperature and blood pressure fall. The bladder and bowel muscles lose function and the abdomen becomes swollen.
Spinal shock may last for up to six weeks, which can lead to complications such as bed sores. Following this phase, the reflexes return and become exaggerated, so that a slight touch causes limb spasms. The spasms may be associated with sweating, emptying of the bowel and bladder, flushing and raised blood pressure. This phase can last for up to 12 months, after which the heightened reflexes fade.
Initially, management of spinal cord transection consists of immobilizing the spine to avoid further injury to the cord. Oxygen may be given, and it may be necessary to insert a tube into the airway to ventilate the patient artificially. In some cases, surgery may be carried out to remove structures which are pressing on the spinal cord. Operations may be performed by different specialist surgeons according to the nature of the problem. The outlook for someone with complete spinal cord transection is limited because the cord does not regenerate, so treatment is focused on providing support and preventing complications.
