A spinal cord injury, depending on its location and severity, may result in a partial or total loss of movement, sensation, and organ function. There is a range of severity in spinal cord injuries. A mild contusion of the spinal cord may cause the loss of only some function below the site of the injury. A complete transection, or severing of the spinal cord, is a total and permanent loss of sensation and movement below the site of the transection. Patients with spinal trauma also are likely to develop infections of the bladder, lungs, and skin.

Causes

The primary causes of spinal cord injury are motor vehicle accidents (44 percent of cases), violence (24 percent), falls (22 percent), and sports (eight percent).

Symptoms

The initial symptom of spinal cord injury often is spinal shock, which can cause a loss of feeling and movement below the site of the injury. Lasting from a few hours to a few weeks, spinal shock may subside over time to reveal the true extent of the injury. Other immediate symptoms may include muscle spasticity, difficulty breathing, heart rate and blood pressure problems, and loss of bladder and bowel function.

Long-term effects of spinal trauma vary depending on the location and severity of the injury. The body below the site of the injury is affected, so the higher the injury occurs in the spinal column, the more severe the symptoms usually are. For example, an injury in the cervical spine will affect all of the limbs, as well as the muscles that control breathing and other essential functions. An injury in the lumbar spine, however, will affect the lower extremities and bowel and bladder function, but usually will not damage other organs or systems.

Complete injuries high in the neck and trauma complicated by other serious injuries may result in death or require total care for the rest of the patient’s life.

Diagnosis

Diagnosis and management of spinal trauma can be difficult and a missed injury can cause serious complications. In the cases of accidents in which a spinal injury is suspected, it must be assumed until proven otherwise. The spine must be protected and immobilized at all times during assessment and diagnosis. Initial assessment includes a clinical exam and also may include imaging tests, including x-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans. The tests should include the entire spine, not just the region where the injury is suspected. The choice of diagnostic techniques varies based on the state of the patient consciousness and the presence of other injuries.

The condition of a patient immediately after a spinal trauma may not necessarily indicate the long-term effects of the injury, so an ongoing series of comprehensive medical evaluations and imaging tests are necessary to understand the extent of the injury.

Treatment

Spinal trauma requires immediate treatment, usually at the site of the injury, to prevent additional injury to the spinal cord. Initial intervention includes immobilization of the head, neck, and back, and steroid medications to control swelling. Sometimes immediate surgery is necessary to evaluate the state of the spinal cord, stabilize fractured vertebrae, release pressure from the injured area, and treat injuries to other parts of the body. There is no way to regenerate nerve tissue that has been damaged, but ongoing treatment may allow some people with spinal trauma to regain some feeling and function. Physical, occupational, and speech therapy and rehabilitation are important parts of the long-term recovery process. Rehabilitation focuses on preventing muscle wasting and contracture, helps patients learn to retrain some of their muscles for mobility to make up for the loss of others, and can improve communication in a patient who has lost some of the ability to speak and gesture.

Depending on the severity of the injury, long-term intervention may be necessary to maintain everyday function. This may include mechanical ventilation to assist in breathing, a catheter to drain the bladder, or a feeding tube to provide extra nutrition and calories.

There are many types of birth related injuries that lead to involvement of a neurosurgeon. Luckily most are fairly benign and do not require surgical treatment. Common problems are bleeding under the scalp or membranes of the skull bone and small fractures. These are best left alone and will heal spontaneously. Rarely there may be bleeding inside the head. This may cause seizures or irritability or some change in the baby’s activity. Often the bleeding is trivial and will go away on its own. Very rarely does a surgeon need to operate to remove a blood clot from the brain. These babies will then usually be followed by both a neurologist and a neurosurgeon. The outlook for most children is excellent.

Another type of injury to the nervous system at birth is injury to the brachial plexus. These are nerves that arise from the spinal cord in the neck to supply strength and sensation to the arms. This injury arises from the stretching of the nerves as the baby is being delivered. The injury may range from subtle weakness to complete loss of use of the arm. The great majority improve spontaneously. Under rare circumstances surgery may be required if the arm function does not return.

The second category of injury are those that occur in infancy. By and large these are due to freak accidents or moments of distraction when a parent will turn their back for a second and somehow the baby will topple over or off of something like a kitchen counter or changing table. The types of injuries that babies get are primarily bruises and only rarely do fractures or bleeding occur. It is difficult to say when a physician should be notified but in the absence of obvious trauma to the head then you must use your best judgment. If the baby quickly returns to their normal activity then usually things are okay. If the child becomes irritable or unusually sleepy or starts to vomit or have seizures then certainly they must be evaluated promptly.

It is difficult to say how far a child must fall to injure themselves, but a general guideline is that falls of about four feet or less are tolerated well. Of course what is also important is the type of floor they hit and which part of the head that hits it. However, it is certainly possible to fall shorter distances and get bad injuries under unusual circumstances.

In addition to these accidental causes, a small number of injuries are due to child abuse. These injuries are often far more serious than the accidental injuries. When the nature of the injury seems inconsistent with the findings, than a concern for child abuse is raised. Child abuse is seen in all socioeconomic classes and needs to be identified as soon as possible to prevent further injury or death. Often parents are outraged that they are suspected of abusing their child; however, it must be understood that the health care system is the advocate of the baby and must do everything possible to prevent a tragedy. It is not the role of the child protective agencies to remove children from their homes, but rather to see that they are being well cared for.

One type of child abuse that is often spoken of but misunderstood by the public is “shaken baby syndrome”. This usually serious injury to the brain cannot be caused by the typical bouncing of a baby on the knee or gently shaking. It is most often seen with a very violent and vigorous shaking which is concluded with throwing of the baby down onto a hard surface. Most children with this syndrome as with most child abuse are less then two to three years of age.

As children start to venture out into the world and start to ride bikes and play on swings and gym sets, the types of injuries they get are more like those of adults. These include skull fractures and bleeding into or around the brain. Some require surgery and others can be followed without any need for an operation. The best advice for parents is to minimize the risk for these injuries. This includes bike helmets, seat belts, supervised play and good judgment. Still, kids are kids and accidents will happen. Warning signs of an injury are similar to infants: worsening headaches, vomiting, seizures, lethargy, or confusion. After a concussion it is not uncommon for children to have a period of around 24 hours with vomiting and irritability. While it looks frightening it usually goes away on its own and the children make good recoveries.

In children, head trauma annually results in approximately 600,000 emergency department visits and 95,000 hospital admissions, and is the leading cause of traumatic death in children. One study of children with intracranial hemorrhages found that many children with serious injuries may have only mild symptoms and that those diagnosed early have a better outcome. Follow-up studies have confirmed these findings and have been directed at identifying the signs and symptoms of children who have more serious injuries to enable us to diagnose them as early as possible while avoiding unnecessary tests.

Dr. D’Ambrosio’s practice is devoted to brain tumors, skull base tumors, meningiomas, acoustic neuromas, pituitary tumors, microvascular decompression for trigeminal neuralgia and hemifacial spasm, cerebral aneurysm treatment, degenerative spine disease, and intervertebral disc disease.

He uses state-of-the-art technology such as frameless image guidance systems, awake craniotomy, and stereotactic radiosurgery (i.e. GammaKnife, BrainLab, Tomotherapy) for the treatment of primary and metastatic brain tumors.  He has particular expertise in the use of endoscopic techniques to remove complex intracranial tumors at the base of the brain.

Dr. D’Ambrosio directs our Northern New Jersey practice based in Ridgewood, NJ.  He is the Director of Neuro-Oncology – Disease Management Team at the Luckow Cancer Center of The Valley Hospital in Ridgewood, NJ.  Dr. D’Ambrosio is also the Director of Neurosciences for the St. Joseph’s Healthcare System in Paterson and Wayne, NJ.  He sees patients at The Valley Hospital, St. Joseph’s Regional Medical Center, St. Joseph’s Wayne Hospital, Chilton Memorial Hospital, and Mountainside Hospital.  With his main office in Ridgewood, New Jersey, Dr. D’Ambrosio has helped to establish a center of excellence for Columbia Neurosurgery in the communities of Bergen, Passiac and Essex counties.