The spinal cord is a collection of nerves that travels from the bottom of the brain down to your back. There are 31 pairs of spinal nerves that starts from the spinal cord and reaches your arms, legs, chest and abdomen. These nerves allow the brain to give commands to your muscles and cause movements of your arms and legs. However, the spinal cord is very sensitive to injury. Unlike other parts of your body, the spinal cord does not have the ability to repair itself if it is damaged. A spinal cord injury occurs when there is damage to the spinal cord either from trauma, loss of its normal blood supply, or compression from tumour or infection. Injuries to the spinal cord are either complete in which there is full loss of sensation or incomplete in which there is some function still remains below the level of injury.
Typically, spinal cord injury is considered as a medical emergency and requires immediate surgical intervention if neurological dysfunction worsens. Basically there are two surgical ways to treat spinal cord injury: decompressing the spine and stabilising the spine.
PREPARING FOR THE SURGERY
Since spinal cord injury is an emergency, so time plays a major role in faster recovery post-surgery. You will have to undergo various diagnostic tests like X-ray, MRI and CT scan. A detailed history and physical examination is done to see if sensation to touch is intact in the arms and legs as well as testing the muscle strength and reflexes in the arms and legs. you will be started on certain medication to control the pain and also you will have to wear cervical brace to prevent further movement of the spine before the surgery and also you may be placed in traction or a halo device around the head to try to stabilize the spine and prevent further damage. You will be under constant neuromonitoring and may be if injury is very severe you will be put on ventilator.
ON THE DAY OF THE SURGERY
After confirming the spinal cord injury, doctor will decide if you need Decompression surgery done in case of herniated disc, a collection of blood (hematoma) or fluid around the spinal cord, vertebral fracture, infection, or tumour or Stabilization surgery if the spine needs to be re-aligned or stabilized, instrumentation and fusion is necessary. The decision to operate depends on many circumstances, such as the cause and extent of injury and spinal stability issues. Spinal cord surgery is done under general anaesthesia; means you will be asleep during the procedure. Decompression surgery can be done as an open surgery with a large single incision or through minimally invasive technique using small incisions. After making an incision either space is created by separating the muscles and part of lamina is cut-away to expose the ligament that supports the spinal cord and then the compressed nerve becomes visible. At this stage surgeon with dissect disc compressing the nerves or re-align them using a bone graft, which is either taken from other part of your body or from a deceased donor. After decompressing and stabilization the incision is closed and secured with bandages.
After the surgery you will be shifted to a recovery room for observation and once your vital signs become normal and you are alert, you will be shifted to a normal hospital room. You may feel mild to moderate pain around the surgical site which can be managed through medications. Usually, you may need a hospital stay of 2-3 days. A physiotherapist will help you move and walk around a bit and also plan an exercise program for you at the time of discharge, which needs to be followed at home. Surgery may not reverse spinal cord damage. However, decompression and spinal stabilization are important to prevent pain, deformity, and progression of neurologic deficit (e.g., weakness, tingling, bowel/bladder problems).
Extensive physical therapy and rehabilitation after surgery also maximizes recovery after a spinal cord surgery. The majority of recovery occurs within the first six months after injury. Any remaining loss of function present after 12 months is much more likely to become permanent. Maintaining a positive outlook is extremely important for patients with spinal cord surgery. The use of assistive devices allows most people with even severe spinal cord injuries stay productive and go back to normal life. Since, spinal cord injuries can lead to neurological problems, you may need help of occupational therapy and psychologist consultations as well. You must have a strong social support system to help you cope with the injury and relearn how to perform daily activities.
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Q: How long can I wait before undergoing a spinal cord surgery?
A: Spinal cord injuries are considered a medical emergency and maximum 24 hours can be waited but if the neurological conditions worsen surgery is done immediately.
Q: Is the surgery only option for spinal cord injury?
A: Since spinal cord cannot heal by itself, it requires a surgical intervention to stabilize or compress the affected nerves.
Q: How long will I have to wear cervical brace or other assistive devices?
A: Braces should be worn whenever the patient is out of bed for more than 10 minutes. This brace will be worn for approximately 3 to 4 months after surgery.
Q: What is the difference between Laminectomy and Discectomy?
A: A laminectomyis the removal of the lamina or spongy tissue between the disks in the spine, to help relieve the symptoms of an injured disk. A discectomyis the removal of an injured disk.
Q: Will I be get back to normal life after spinal cord surgery?
A: Spinal cord injury may lead to severe neuromuscular problems which takes time and rehabilitation after the surgery to cure. Although proper physiotherapy, occupational therapy and psychosocial support helps you to recover faster.
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