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Spinal cord injury: Diseases and Conditions
Published  06/12/2005 | Information | Unrated

 Screening and diagnosis

Paramedics and emergency workers are trained to treat people who have suffered a traumatic head or neck injury as if they have a spinal cord injury or an unstable spinal column, until a thorough screening and diagnosis can be completed. A key step in the initial treatment is immobilizing the spine.

Immobilizing the spine can prevent injury to the spine or prevent worsening of any injury that is already present. For this reason, emergency personnel receive training in handling an injured person without moving the neck and back. They use rigid collars around the injured person's neck and place the injured person on a rigid board, until a complete evaluation can take place.

In the emergency room, a doctor may be able to rule out spinal cord injury by carefully inspecting an injured person, testing for sensory function and movement, and asking some questions about the accident. But if the injured person complains of neck pain, isn't fully awake, or has obvious signs of weakness or neurologic injury, emergency diagnostic tests may be needed.

These tests may include:

  • X-rays. Medical personnel typically order these tests on all trauma victims suspected of having a spinal cord injury. X-rays can reveal Vertebrae problems, tumors, fractures or degenerative changes in your spine.
  • Computerized tomography (CT) scan. A CT Scan may provide a better look at abnormalities seen on an X-ray. This scan uses computers to form a series of cross-sectional images that can define bone, disk and other problems.
  • Magnetic resonance imaging (MRI). MRI uses a strong magnetic force and radio waves to produce computer-generated images. This test is extremely helpful for looking at the spinal cord and identifying herniated disks, blood clots or other masses that may be compressing the spinal cord. But MRI can't be used on people with pacemakers or on trauma victims who need certain life-support machines or Cervical traction devices.
  • Myelography. Myelography allows your doctor to visualize your Spinal nerves more clearly. After a special dye is injected into your spinal canal, X-rays or CT scans of your vertebrae can suggest a herniated disk or other lesions. This test is used when MRI isn't possible or when it may yield important additional information that isn't provided by other tests.

If your doctor suspects a spinal cord injury, he or she may prescribe traction to immobilize your spine, as well as high doses of the corticosteroid drug methylprednisolone (Medrol). This drug significantly improves neurologic functioning by reducing nerve damage and decreasing inflammation — if given within eight hours of injury.

Diagnosis doesn't stop there, though. About three days after the injury, your doctor will conduct a neurologic exam to determine the severity of the injury and predict the likely extent of recovery. This may involve more X-rays, MRIs or more advanced imaging techniques.

It's often impossible for your doctor to make a precise prognosis right away. Recovery typically starts between a week and six months after injury if it occurs, with the majority of recovery taking place within one year. Doctors generally regard any Impairment remaining after 12 to 24 months as likely to be permanent.

However, some people experience small improvements for up to two years or longer. At one point, Christopher Reeve made national headlines when he regained the ability to move his fingers and wrists and feel sensations more than five years after he was paralyzed in a horse accident. But many not-so-famous folks with a spinal cord injury have made similar strides away from the media spotlight. And doctors are rigorously researching ways to improve late recovery.

  • X-ray
  • Computerized tomography
  • MRI
  • Spinal tap (lumbar puncture)

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