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Treatments and drugs
By Mayo Clinic staffUnfortunately, there's no way to reverse damage to the spinal cord. But, researchers are continually working on new treatments, including innovative treatments, prostheses and medications that may promote nerve cell regeneration or improve the function of the nerves that remain after a spinal cord injury.
In the meantime, spinal cord injury treatment focuses on preventing further injury and empowering people with a spinal cord injury to return to an active and productive life.
Emergency actions
Urgent medical attention is critical to minimizing the effects of any head or neck trauma. So treatment for a spinal cord injury often begins at the scene of the accident.
Emergency personnel typically immobilize the spine as gently and quickly as possible using a rigid neck collar and a rigid carrying board, which they'll use to transport you to the hospital.
Early (acute) stages of treatment
In the emergency room, doctors focus on:
- Maintaining your ability to breathe
- Preventing shock
- Immobilizing your neck to prevent further spinal cord damage
- Avoiding possible complications, such as stool or urine retention, respiratory or cardiovascular difficulty, and formation of deep vein blood clots in the extremities
You may be sedated so that you don't move and sustain more damage while undergoing diagnostic tests for spinal cord injury.
If you do have a spinal cord injury, you'll usually be admitted to the intensive care unit for treatment. You may even be transferred to a regional spine injury center that has a team of neurosurgeons, orthopedic surgeons, spinal cord medicine specialists, psychologists, nurses, therapists and social workers with expertise in spinal cord injury.
- Medications. Methylprednisolone (Medrol) is a treatment option for an acute spinal cord injury. If methylprednisolone is given within eight hours of injury, some people experience mild improvement from their spinal cord injury. It appears to work by reducing damage to nerve cells and decreasing inflammation near the site of injury. However, this is not a cure for a spinal cord injury.
- Immobilization. You may need traction to stabilize your spine, to bring the spine into proper alignment or both. Sometimes, traction is accomplished by securing metal braces, attached to weights or a body harness, to your skull to keep your head from moving. In some cases, a rigid neck collar also may work. A special bed also may help immobilize your body.
- Surgery. Often, surgery is necessary to remove fragments of bones, foreign objects, herniated disks or fractured vertebrae that appear to be compressing the spine. Surgery may also be needed to stabilize the spine to prevent future pain or deformity.
- Experimental treatments. Scientists are trying to figure out ways to stop cell death, control inflammation and promote nerve regeneration. Ask your doctor about the availability of such treatments.
Ongoing care
After the initial injury or disease stabilizes, doctors turn their attention to preventing secondary problems that may arise, such as deconditioning, muscle contractures, pressure ulcers, bowel and bladder issues, respiratory infections and blood clots.
The length of your hospitalization depends on your individual condition and what medical issues you're facing. Once you're well enough to participate in therapies and treatment, you may transfer to a rehabilitation facility.
Rehabilitation. Rehabilitation team members may begin to work with you while you're in the early stages of recovery. Your team may include a physical therapist, occupational therapist, rehabilitation nurse, rehabilitation psychologist, social worker, dietitian, recreation therapist and a doctor who specializes in physical medicine (physiatrist) or spinal cord injuries.
During the initial stages of rehabilitation, therapists usually emphasize maintenance and strengthening of existing muscle function, redeveloping fine motor skills and learning adaptive techniques to accomplish day-to-day tasks. You'll be educated on the effects of a spinal cord injury and how to prevent complications, as well as be given advice on rebuilding your life and increasing your quality of life. You'll be taught many new skills, and will use equipment and technology that can help you live on your own as much as possible. You'll be encouraged to resume your favorite hobbies, participate in social and fitness activities, and return to school or the workplace.
Medications. Medications may be used to manage some of the effects of spinal cord injury. These include medications to control pain and muscle spasticity, as well as medications that can improve bladder control, bowel control and sexual functioning.
New technologies. Inventive medical devices can help people with a spinal cord injury become more independent and more mobile. Some devices may also restore function. These include:
- Modern wheelchairs. Improved, lighter weight wheelchairs are making people with a spinal cord injury more mobile and more comfortable. For some, an electric wheelchair may be needed. Some wheelchairs can even climb stairs, travel over rough terrain and elevate a seated passenger to eye level to reach high places without help.
- Computer adaptations. For someone that has limited hand function, computers can be very powerful tools, but they're difficult to operate. Some examples of computer adaptations range from simple to complex, such as key guards or voice recognition.
- Electronic aids to daily living. Essentially any device that uses electricity can be controlled with an electronic aid to daily living (EADL). Devices can be turned on or off by switch or voice-controlled and computer-based remotes.
- Electrical stimulation devices. These sophisticated devices use electrical stimulation to produce actions. They're often called functional electrical stimulation (FES) systems, and they use electrical stimulators to control arm and leg muscles to allow people with a spinal cord injury to stand, walk, reach and grip.
Prognosis and recovery
It's often impossible for your doctor to make a precise prognosis right away. Recovery, if it occurs, typically starts between a week and six months after an injury. However, some people experience small improvements for up to one year or longer.
- Spinal cord injury: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/sci/detail_sci.htm. Accessed July 2, 2009.
- Spinal trauma. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/print/sec21/ch311/ch311a.html. Accessed June 17, 2009.
- Spinal cord injury FAQ. American Association of Neurological Surgeons. http://www.neurosurgerytoday.org/media/fact/spinal.asp. Accessed July 2, 2009.
- Hansebout RR. Acute traumatic spinal cord injury. http://www.uptodate.com/home/index.html. Accessed June 16, 2009.
- Mayer RS. Rehabilitation of individuals with cancer. In: Abeloff MD, et al. Abeloff's Clinical Oncology. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2008. http://www.mdconsult.com/das/book/body/147442859-5/0/1709/1.html?tocnode=55014515&fromURL=1.html#4-u1.0-B978-0-443-06694-8..X5001-5--TOP_1. Accessed July 2, 2009.
- Spinal cord injury (SCI): Prevention tips. Centers for Disease Control and Prevention. http://www.cdc.gov/ncipc/factsheets/sciprevention.htm. Accessed July 2, 2009.
- Chiodo AE, et al. Spinal cord injury medicine: Long-term medical issues and health maintenance. Archives of Physical Medicine Rehabilitation. 2007;88:S76.
- Wuermser LA, et al. Spinal cord injury medicine: Acute care management of traumatic and nontraumatic injury. Archives of Physical Medicine Rehabilitation. 2007;88:S55.
- Beck LA (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 21, 2009.
- Facts and figures at a glance. National Spinal Cord Injury Statistical Center. http://www.spinalcord.uab.edu/show.asp?durki=119513&site=4716&return=19775. Accessed Aug. 25, 2009.
