# Talk:Spinal cord injury

To do: (meant for me, but if somebody gets really driven, I won't complain!)

Add references for statistics and try to make same internationalized
Prognoses, treatments (maybe a thing about stem cells?
ClockworkTroll 05:41, 10 Oct 2004 (UTC)

www.spinalcord.uab.edu says that the population of USA SCI is ~250,000.
Another effect of SCI is shortened lifespan.

--Cervical spinal cord injuries from motor vehicle crashes is down dramatically in the last fifteen years, owing to the broader enforcement of seatbelt/shoulder harness usage enforcement and widespread availability of airbag technology.
--The vast majority of spinal cord injury survivors are placed in some form of rehabilitation hospital after "medical stability" is reached and some form of paralysis remains to be managed.
--The substantial alteration of defecation, urination, and erectile functions is not mentioned.  These are MAJOR matters in the life of a SCI person.  (Many SCI persons have a neurogenic bladder, that is, the urinary bladder sphincter is shut permanently and and intermittent cateterization program must be performed about four times per day to remove urinary waste.)  Defecation requires an analogous intervention on a regular basis.  Loss of erectile function is often permanent and ejaculatory function is likely to be permanently absent as well.  Autonomic erections are sometimes possible, and may allow for sexual function, albeit with dramatically reduced sensation.  (These erections are neurologically identical to erections that all mammals experience with a full urinary bladder--that is, it occurs without sexual arousal.  Normal mental sexual arousal is disconnected from normal erections by the SCI.)
--Sensory loss is a major problem in that most SCI persons spend an increased percentage of their lives in a seated position.  The reduction of sensation in their legs and buttocks increases the likelihood of ischemic skin injury, that is, blood supply is compromised to the skin and surface muscles by sitting too long--pinching the blood vessels--thus denying nutrition and waste removal from the tissues.  (These are known as bedsores when developed to a more advanced stage.)  A person without SCI has the sensations and "weight shifts" to remove pressure.  SCI persons must be constantly vigilant to remember to do weight shifts and to perform visual inspections to avoid skin breakdown.
Homebuilding 207.178.98.102 (talk) 03:46, 30 November 2007 (UTC)

A major problem with commenting on recent high-profile research is many scientists are constrained in what they can say, as criticism can come back to bite you.  Most publications and grants are peer-reviewed;  speaking ones mind about the quality of work of other scientists might threaten ones own career.
Wikipedia allows anonymous posts, and could allow for frank discussion.  Moderation, to avoid slander, is obviously important.
Who'd like to start!?
Could someone with the appropriate scientific credentials summarize the results of the just-publicized Anglo-Polish therapy that has managed to regenerate a Polish man's completely severed spinal cord using cells transplanted from his olfactory nerves?  — Preceding unsigned comment added by 99.236.198.105 (talk) 22:00, 23 October 2014 (UTC) 

Buyer beware re: experimental treatments recently hyped in the media - many of us in the business are indeed reluctant to publicly speak our minds, as suggested above - privately we say "it's b.s.!!" and then, when interviewed, use terms like "premature" or "questionable" to describe our opinions. Anecdotal reports sensationalizing "improved sensation" and "sweating" without any associated visible change in movement (or wiggling a toe, and nothing else), and/or "standing for the first time" with braces are particularly suspect. Remember, those who've invested in surgery want to believe they got something for their trouble; and the media loves miracle comeback stories. Do your homework well before having the fundraiser.

Exercise is proving to be a very effective interim therapy. Many people who were told that they would be in a wheelchair for the rest of their lives are now walking because of intensive exercise programs. Exercise is obviously not the cure for everyone but for many it can mean the difference between independence and dependence. TheSnowman 21:20, 12 December 2005 (UTC)

Agreed, and we should also comment on the importance of proper rehab and what the various rehab accreditations mean. (In the US, these include CARF and being deemed a model SCI Rehabilitation Center.) What is taught at rehab in terms of ADLs and exercise are important topics, that can lead in to the overall importance of exercise.Hananekosan (talk) 00:29, 21 August 2009 (UTC)

Is itching a normal effect of spinal cord injury?  The article didn't seem to have any information about it, but it's been my experience.  -- Creidieki 4 July 2005 18:31 (UTC)
Spurious sensations of itching, soreness and heat all seem to be common.
In my experience, altered sensations are VERY common.  Persons with complete injury, that is no nerve conduction, at all, have the least sensations, of course.  Weird sensations are most common with those who have some muscle function return.  As with any pain or unusual sensation, movement and exercise are likely to "distract" and provide substitute sensations.
We really need to have a PM&R (physical medicine and rehabiliation) doctor fill in a lot of missing details, here.
Homebuilding 207.178.98.102 (talk) 03:54, 30 November 2007 (UTC)

Yes, it absolutely can. These are common with neuropathic pain, which is very common after SCI, though it doesn't always manifest in the acute phase. Agree that expansion here is needed. Hananekosan (talk) 00:29, 21 August 2009 (UTC)

O.k. not that I'm going to try this or do it but would it be possible to break someones spine from the guillitine choke hold position like in the show prison break I only wanted to know if it is possible?
76.118.107.105 (talk) 01:57, 30 January 2008 (UTC)

Where the hell are all the references?!? The bottom of the page has no citations whatsever, and any references within the body of the text are dead links that go nowhere.  Has someone made an executive decision to make this article different from all other wiki articles?? I may have to tag this article as needing references...  k1-UK-Global (talk) 11:42, 5 June 2008 (UTC)

Why is the article title hyphenated when the hyphen is not used in the text of the article? I would lean toward no hyphen, but in any case, this should be consistent.  —Preceding unsigned comment added by 163.231.6.66 (talk) 15:58, 12 June 2009 (UTC) 

We need to verify the information on methylprednisolone administration. I believe what's stated about administration beginning within 8 hours is recommended, but that there are therapeutic benefits that have been noted when initial administration has been delayed. Also, we should consider talking about the recommended dosage guidelines (initial bolus then every ?hour for a recommended period). I'm not current enough with this subject to have the information at the tip of my tongue but should brush up.Hananekosan (talk) 00:29, 21 August 2009 (UTC)

Should explain clinical difference between acute and chronic SCI.Hananekosan (talk) 00:29, 21 August 2009 (UTC)

It might be beneficial to compile a list of institutions that actively seek to repair spinal cord injuries. It´s an experimental practice and getting some overview over the major players would strengthen the research network.
For those seeking aid this would be a great help and simplify initial information gathering.
Svebo (talk) 10:43, 31 August 2009 (UTC)

Someone needs to include talk about Spinal Cord Injury Without Radiological Abnormality (SCIWORA)
--Alin0Steglinski (talk) 04:25, 31 May 2010 (UTC)

This article, like many others, does not list spinal stenosis as a cause of spinal cord injury, though spinal stenosis can potentially result in permanent spinal cord and nerve damage or even paralysis.
I was diagnosed with severe spinal stenosis in both my lumbar and cervical spines and have since had multiple vertebrae fused in both areas. But due to lack of insurance, both surgeries were performed several years later than I needed them.
By the time I got cervical fusion surgery, my spinal cord had been severely compressed for months (maybe years), and I was in imminent danger of quadroplegia. The fusion was considered emergency surgery. I was experiencing extreme, full-body pain and had virtually lost the use of my arms and hands, which sometimes were as numb as wood from the elbows to fingertips. I suffered bowel and bladder incontinence and could barely raise my legs or coordinate them for walking. I could not drive a car, use a computer, operate hand tools, or lift anything heavier than a coffee cup, and this I frequently dropped. 
By the time I underwent lumbar fusion surgery, I could only take a few steps at a time and my MRI showed compression so severe that my lumbar spinal canal looked like a series of sausage links. At L4, my spinal canal appeared virtually non-existent on the MRI.
Though I'm miraculously not paralyzed, I continue to have nerve-root pain, stiffness (spasticity), muscle spasms, occasional bladder incontinence, difficulty with hand-eye coordination, and many other problems. 
Worse yet, I think I might be experiencing many of the symptoms of autonomic dysreflexia, but I haven't yet found a doctor who could diagnose this or rule it out. As yet, I've found no information related to autonomic dysreflexia occurring in non-paralyzed people, though I've been told this is possible. I would greatly appreciate it if somebody would post information here or elsewhere about autonomic dysreflexia in non-paralyzed people. I would also like somebody to add spinal stenosis to this article, as a cause for spinal cord injury.  —Preceding unsigned comment added by Rockfish552 (talk • contribs) 13:46, 6 October 2010 (UTC) 

My background is that I'm a GP but used to work in a spinal unit when I was training in orthopaedics.
I wonder if there could be more detail on complications of SCI such as spasm, bladder and erectile dysfunction, autonomic dysreflexia etc. within the article. I see dysreflexia has it's own page, but perhaps some info on managing common problems might be helpful?
I'm not sure spinal stenosis should be included as at low lumbar levels (below the conus at L1/2) really it is a radiculopathy (damage to nerve roots) ratehr than damage to the cord itself. nerve troots are peripheral nerves and so can regenerate, they are not part of the central nervous sytem. Spinal stenosis rarely causes spinal cord syndromes and I couldn't find any cases of complete cord injury on a medline search.  it really should be viewed as a seperate problem in its own right and not included here. MazzaDB (talk) 12:42, 16 November 2010 (UTC)
This is a very late reply but I agree with you re: spinal stenosis. I could see listing it as a cause of paralysis but not as a cause of spinal cord injury. Hananekosan (talk) 01:19, 7 October 2011 (UTC)

We need to start with the best evidence and the rest will follow:

Hawryluk, GW (2008). "Protection and repair of the injured spinal cord: a review of completed, ongoing, and planned clinical trials for acute spinal cord injury". Neurosurgical focus. 25 (5): E14. PMID 18980474. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
Anderberg, L (2007). "Spinal cord injury--scientific challenges for the unknown future". Upsala journal of medical sciences. 112 (3): 259–88. PMID 18484069. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
PMID 17618980
Doc James (talk · contribs · email) 00:16, 21 February 2011 (UTC)

Could there be a history section in the article? In this link it says that "until antibiotics became widely available in the 1950s, people with spinal chord injuries would often die of septicemia caused by simple urinary tract infections or bed sores." Bib (talk) 15:09, 5 March 2011 (UTC)

1) I've been fiddling with the lead, but honestly I have some concerns about what I wrote.  The statement that SCI implies trauma is from Taber's, but can anyone actually quote exactly what it says?  I'm not sure what I put in the lead is correct.
2) Would it be reasonable to have a separate article on classification?  Most of this article is drowning in this confusing system, and I'm not even sure it's that accurate, this summary here talks about a six-point scale and the ASIA Motor Score rating, neither of which is addressed in our current article.  That might be a useful source in general for the article.
3) Would it make sense to focus more on recognizable symptoms, especially major events like paraplegia, which many readers will be familiar with, and compare and contrast that with the full spectrum of possible symptoms?  The "top to bottom" review makes sense, but it is a bit of a mess at the moment, and reads like a diagnostic and classification guide rather than an encyclopedia article.
A proposed structure for the "signs and symptoms" section would be:

General signs and symptoms
  * Pain
  * Loss of sensation
  * Loss of voluntary motor control
  * Spasticity
  * Description of incomplete injuries and "everything down"

Cervical spine issues
  * Tetraplegia
  * Respiratory issues

Thoracic spine issues
  * Paraplegia

Lumbar spine issues
  * Not sure what to put here?

Sacral spine issues
  * Bowel and bladder function
  * Sexual dysfunction

Other syndromes
  * (basically what the article has now)

I can see why this article was selected for collaboration, it's a mess.  SDY (talk) 23:34, 11 March 2011 (UTC)

To your Tabers question, yes and no. Tabers says that is is an injury to the spine but I decided to spruce it up a bit and change injury to trauma as they are the same thing. To your next question, I had issues with this too and I just end up having a stalemate in my thinking and then forgetting about it. I agree with your plan except for lumbar spinal injuries. I can try to find some more information on it but I am writing this while sleep deprived.
Also, what about the management section? The first paragraph should be expanded while the rest of it is shortened into two or three paragraphs. Just some food for through. Peter.C • talk • contribs 03:49, 12 March 2011 (UTC)

I was trying to avoid words like "trauma" in the lead since the lead should be the most accessible section as far as technical language.  Sure, most people generally know what it is, but if there's a more commonly used word, I'd like to use it.  As for the management section, one thing at a time...  SDY (talk) 12:25, 12 March 2011 (UTC)

The signs and symptoms section could still use some work, but honestly I'm no expert at this material and I'm just trying to rewrite things so that they make sense.
The next section that screams out for help is, of course, the management section, which currently reads like a how-to guide rather than an encyclopedia article.  Here's a proposed framework:
Management:

Immediate care at time of injury (rewriting to de-"how to"/de-editorialize, but not much change in material)
Stabilizing patient
Mention/wikilink backboards as an example?
Indicate focus is preventing further injury
I'm going to get rid of mention of the TSCI acronym, it's confusing.

ER/ICU care (mostly just reorganizing current material)
Life-threatening injuries first
Surgical follow-up
Anti-inflammatory drugs: methylprednisone, brilliant blue G (need some WP:MEDRS for that)
m-p is used, but evidence of benefit is weak.
potential complications to anti-inflammatory therapy
-Anyone have a sense of if this is current practice?  The article contradicts itself.
-I'm guessing NACSIS is a US study but could be UK.  Is this global practice?
Unproven treatments: therapeutic hypothermia, maintaining blood pressure
Rehabilitation (focus is on "big picture" understanding, not the current "how to" guide)
Acute recovery
psych
physical therapy
prevention of pressure sores
Acute rehabilitation
physical therapy
use of special equipment
teaching skills for activities of daily living
Transfer and mobility
Bodily functions
Community reintegration
   *living environment modifications
   *continuing support

I'd also like to keep the rehabilitation section more general.  As it is now, it's really targeted towards paraplegia: serious but workable problems, and the article is about SCI in general.  Useful advice, I guess, but Wikipedia isn't here to give professional advice.
Once that's done, I may try to condense the "causes" and "epidemiology" sections into a single thingy.  The classification section I'm going to leave for now, as I mentioned above there's content that's missing and it's hard to organize things where further changes are expected.
Is there a WP:MED template for disease articles on how they're supposed to be ordered?  I know there's one for medications.  SDY (talk) 01:23, 13 March 2011 (UTC)

Just a heads up, I am NOT going to touch management at all, not even with a 50 foot pole. With regards to the causes/epidemiology section. They should NOT be placed together as they are two similar, but distinct topics. Peter.C • talk • contribs 02:36, 13 March 2011 (UTC)
I found the disease "template" here.  I'm not sure why "Causes" and "Epidemiology" are distant from each other in the "standard" format, but I guess that's my public health bias.  According to that, there are some sections missing from this article: Pathophysiology (fairly straightforward, I guess, but again I'm more of an editor than a writer given my lack of expertise), Prognosis (information currently spread throughout the article and lacks citations), History (there are some hints in the article, but again mostly missing), Society and Culture (ugh, what a minefield, but mentioning the Reeve case isn't ridiculous), Special Populations (maybe nothing to mention here?), In Other Animals (any veterinarians in the house?).  Just some ideas if anyone's looking to add new content.  SDY (talk) 14:31, 13 March 2011 (UTC)
Causes is the of MoI's that can cause a spinal cord injury while epidemiology is the statistics of the injury. I think we might be able to do a "special populations" to point out anatomical differences in various age groups. I think we should not really bother with "in other animals" as we have a lot of other stuff to work on already. Peter.C • talk • contribs 14:41, 13 March 2011 (UTC)
They're obviously distinct definitions and concepts, but for an encyclopedia article talking about causes and epidemiology together makes a lot of sense (i.e. which causes are "significant" is based almost entirely on epi).  Anyway, I've taken a stab at what appeared to be the glaring problems with this article.  There's still a lot of work to be done, obviously, and I wouldn't consider what I've done to be stellar, but it's a start.  SDY (talk) 23:33, 14 March 2011 (UTC)

After reading this article I still do not understand why damage to the spinal cord is permanent, whereas injuries to other nerves are not. Is there anyone who knows the answer to this?  — Preceding unsigned comment added by 66.152.113.210 (talk) 19:30, 20 June 2012 (UTC)