Technological and other advances are making a difference
As in most areas of medical science and other industries, improving technology is making a difference for consumers. Of course, when talking about medicine, these changes can have truly life-altering effects—for the better. This is particularly true for conditions such as spinal cord injuries.
Spinal cord injuries (SCIs) have another common thread with most other medical prognoses—the importance of early intervention. One of the main determining factors to an individual’s ultimate outcome is the efficiency with which they receive early intervention following the initial injury. The sooner the individual begins working to strengthen the muscles below the injury site to reduce damage, the better the likely outcome for the patient.
There are other factors to consider, such as the level or degree of injury:
- A complete spinal cord injury is one in which all communication between the brain and spinal cord have been destroyed by the severance, meaning a loss of most if not all function below the injury site.
- An incomplete spinal cord injury occurs when the signals between brain and spinal cord are still present to some degree, resulting in a partial loss of function, or perhaps more optimistically, the retention of a level of function below the site of the injury.
While prevention of such injuries is the obvious goal, the role of medicine and technology is somewhat limited in that capacity. But according to the National Spinal Cord Injury Statistical Center, about 17,000 new instances occur each year. Once such injuries do occur, however, improvements in these areas can turn what would once have been complete SCIs into incomplete SCIs.
There is a good news/bad news scenario in play: due to the relatively new technology available, there tends to be a great deal of uncertainty at the time of a SCI as to what degree it will affect a patient. Indeed, the stories of the doctor dramatically telling a patient “I’m sorry… you’ll never walk again” are becoming less and less common.
While this is obviously good news, most professionals are equally wary of offering an individual false hope for recovery. This is why it’s so important to give an accurate initial prognosis and a clear understanding of the road that lies ahead.
MRI and CT scans are the most commonly utilized tools in that crucial early stage. Detailed, three-dimensional images of the body’s vital organs, tissues, and bones can highlight damage to the spinal cord and brain, while also identifying any inflammation that may affect healing or injuries to ligaments supporting the cervical spine.
The old-fashioned x-ray can offer further insight via display of the chest, skull, and other critical areas. Any misalignment of fracture of the vertebrae can be relatively easily identified.
Once the injury is identified, intervention and treatment become paramount. A very general rule is thumb is that the majority of improvements or recovery will occur in the first six months following injury, and that after one full year, remaining effects are more likely to become permanent. In many cases, the extent and severity of injury are determining factors in the level of drastic measures a patient may be willing to take. Someone with ‘nothing to lose’ may be more open to trying experimental treatments, while a person who retains a considerable level of function may focus on maintaining or improving his ability.
Last month, JAMA Neurology published a study of a man from British Columbia, Canada who sustained a spinal cord injury six years ago in a diving accident. Aside from the injury itself, the gentleman was left with side effects of dizziness, drastic fluctuations in blood pressure, and impaired bladder and bowel function. After going through rounds of ‘traditional’ therapy, the patient—identified as Isaac Darrel— made the decision to have electrodes surgically implanted over his spinal cord—an experimental treatment known as epidural stimulation—in hopes of relieving some side effects.
“Mobility issues or paralysis are the most visible consequences of a spinal cord injury but as a clinician, I know that many of my patients suffer from other invisible consequences,” said Dr. Andrei Krassioukov, principal investigator of the study. Dr. Krassioukov worked with Darrel over several years before the release of his study.
Once the electrodes are implanted, nerve cells are stimulated via electrical current. The treatment has been studied and documented in the treatment of chronic lower back pain, but the idea of using it to treat people with spinal cord injuries is a relatively new one.
Using a remote control, the patient utilized the electrical stimulation method for about 45 minutes daily. Different routines were programmed into the device to mimic the signals his brain would otherwise send to the spinal cord. Initially, the intent was to improve various motor functions, but Darrel reported such improvements as an ability to control his blood pressure to an extent that he would no longer experience drastic changes when going from his bed to his wheelchair.
The idea of managing expectations is highlighted by the following improvement—Darrel can now tolerate up to eight consecutive hours of sitting in his wheelchair, a huge increase over the two hours he reported prior to the implant.
Dr. Krassioukov intends to embark upon a larger, more comprehensive study on the effects of epidural stimulation with U.S. colleagues. The “good news/bad news” scenario comes into a play again—there is hope, but it’s very difficult to pin down the degree of improvement to be expected.
“We see very interesting and exciting results,” he admitted, “but as a clinician-scientist, I need more robust data before I would recommend this procedure.”
SOURCES: National Spinal Cord Injury Statistical Center.
University of British Columbia. (2018, February 19). Electrical implant reduces ‘invisible’ symptoms of man’s spinal cord injury. ScienceDaily. Retrieved March 19, 2018 from www.sciencedaily.com/releases/2018/02/180219115250.htm