Spinal Cord Injury
Spinal cord injury can devastate a child's life. The Keane Law Firm will provide the legal expertise to fight for the compensation and justice your child deserves. A spinal cord injury can place a family under tremendous stress - both financial stress from medical bills and emotional stress from taking care of the child 24 hours a day. Let the experts at Keane Law Firm help you and your child through this difficult time. We have the expertise and resources to advocate for your child and obtain the compensation your child deserves.
Unpaid medical bills may be mounting on your family's stack of mail and bills, and the child with the spinal cord damage and spinal cord injury may need around the clock home nursing care to keep clean, healthy and as happy as possible. The parents or guardians of the child with the injured spine, or other family members who take care of a child with damage to the spinal cord, may need a break from caring for the injured child. This is known as respite care. Where can a parent or guardian turn if they need help with medical bills? If they need help taking care of the child with a spinal cord injury? If they need to get some respite care?
Christopher Keane, a California personal injury lawyer and attorney for children with spinal cord injuries and his law firm will help a child get his or her medical bills paid, and get attendant and respite care for the family.
Most cervical spine injuries in children are from auto accidents, or truck accidents. Subluxation, or displacement, of the cervical and lumbar vertebrae are the most common injuries, followed by fractures. Spinal cord injuries are of special concern because children by virtue of having smaller necks and larger heads in proportion to their bodies are at risk for sustaining these injuries. Younger children may not be developmentally able to express or verbalize accurately how they feel and where they hurt. Spinal cord injuries can cause attention, mood and sleep disturbances, and loss of appetite with nightmares or fearful behavior. These symptoms may be present if the child has sustained a closed head injury as well. One may suffer head injury from impact as low as 4 mph if unrestrained, depending on what surface the passenger’s head hits. Thorough evaluation for closed head trauma and spinal cord injury is indicated for children involved in car accidents and other traumatic events.
What are the causes of spinal cord injuries?
According to McCance, there are approximately 40 million spinal cord injury victims. Annually, approximately 11,000 - 10,000 people sustain spinal cord injuries. Generally, 80% of victims are young adult males involved in motor vehicle accidents and sports-related mishaps. A large portion of spinal cord injuries (SCI) are related to diving accidents. Violence and falls result in less than 50% of the remaining SCI victims. Traumatic events such as sudden force to the spine from any direction or any mechanism can cause a spinal cord injury. Individuals with degenerative disc disease are more susceptible to spinal cord injuries from mild to moderate trauma related to falls; because the fragments of bone and disc material from a weak vertebral column can be forced into a nerve tract and cause spinal cord injury. Injured ligaments may also cause disruption to the spinal cord if swelling and inflammation encroach in adjacent areas.
Once a spinal cord injury occurs, what are the symptoms of a spinal cord injury?
The spinal cord is composed of nerve fibers that run through the center of the spinal column. These spinal cord nerve fibers transmit nerve impulses from and to the brain. The spinal cord nerve fibers also relay information to other parts of the body.
Spinal cord injuries interfere with sensory and/or motor function by disrupting the nerve tracts. And sensory and motor dysfunction may occur with or without fractures of the vertebrae. Spinal cord injuries may be complete or incomplete, and may cause segmental, sensory, motor or both sensory and motor deficits. Complete spinal cord injuries refer to injuries that result in no function below the level of the spinal injury, such as in the case of tetraplegia. Tetraplegia (also known as – quadriplegia) refers to paralysis in all four extremities. Incomplete spinal cord injuries partially affect neurological function below the level of the injury. The victim may retain a level of feeling or some movement on one region or side of the body. Many survivors of spinal cord injuries go on to experience chronic forms of pain and may also develop bowel and bladder dysfunction. Segmental neurological deficits refer to the type of neurological dysfunction that affects an area, or level, of the body.
The location and level of the spinal cord injury determines what symptoms the victim will have. Traumatic events deliver forces that pull, shear or stretch the soft tissue around the vertebral column and spinal cord; or dislocate and fracture the vertebrae. The swelling from these types of injuries potentially compress the spinal cord, because soft tissue trauma allows vertebral bodies to become misaligned. Some areas of the spine are more vulnerable to traumatic forces. The cervical spine, especially at C1, C2, and C4 to C7, are the most vulnerable to acceleration, deceleration and torque forces.
Spinal cord injuries of the neck cause different symptoms depending on the level of the injury. For example, spinal cord injury between the levels of C1 to C4 may cause the loss of ability to breathe, as well as the loss of other involuntary functions, such as blood pressure stability, body temperature regulation and sensory function. Approximately one third of cervical spinal cord injuries result in the need for breathing assistance. Quadriparesis or tetrapalgia may result if injury occurs above C5. A spinal cord injury at the level of C5 may spare the motor function of the shoulders and upper arms, but cause the loss of motor function of the hands, lower forearms and legs. Injury at the level of C6 may spare the function of the shoulders, upper arms and wrists but not the hands and legs. Injury at the level of C7 and T1 may spare the function of the arms but leave the victim with poor dexterity and paralysis of the legs. Spinal cord injuries at the upper thoracic level may spare motor control of the upper extremities but result in impaired trunk muscle control. Lower trunk spinal cord injuries may spare trunk control but impair function of the lower extremities or paralysis of the legs. With any spinal cord injury, there may be a loss of bowel and bladder control and/or a loss of sensation below the injury level.
Spinal nerve roots that originate from the spinal cord, and are not in the spinal cord, but are leading to a specific part of the body may become compressed and result in neuro-muscular impairment for the area of the body that it is connected to the injured nerve. Whenever a victim of trauma experiences an alteration in sensation, tenderness, and pain near the spine, evaluation by an experience healthcare provider is indicated. If spinal cord injury is suspected based on mechanism of injury and clinical presentation, immediate spinal immobilization should be implemented to prevent further insult to injury.
Spinal injuries, like head injuries, suffer secondary injuries related to inflammation and swelling after the primary injuries are sustained from injurious events. Inflammation and microscopic bleeding within the grey and white matter of the spinal cord begin immediately after the injury and result in significant swelling 2 – 4 hours afterwards. The swelling impedes circulation to the spinal cord. This results in ischemic injury, axonal deterioration and necrosis. This is otherwise known as auto-destruction. If spinal cord swelling is severe, a significant cross-sectional region of self-destruction and post-traumatic cell death may unfold. There are different types of spinal cord injury that depend on how fast symptoms develop.
What are spinal cord syndromes?
Various mechanisms of injuries may result in different spinal cord syndromes due to the anatomy of the spinal cord. Spinal cord syndromes include Anterior Cord Syndrome, Brown-Sequard Syndrome, Central Cord Syndrome, Conus Medullaris Syndrome and Spinal Cord Injury Without Evidence of Radiological Abnormality (SCIWORA).
- Anterior Cord Syndrome - Anterior Cord Syndrome usually results when blood supply from the anterior spinal artery is impeded. Herniation of a disc or bone fragments may cause compression of the anterior spinal artery. Loss of muscle strength is the most common symptom. A person with Anterior Cord Syndrome may or may not have sensation below the level of the injury. Perception of pain and temperature is diminished or lost. Perception of positioning may not be lost.
- Brown-Sequard Syndrome - Brown-Sequard Syndrome is rare and accounts for approximately 2-4% of traumatic spinal cord injuries. Though it may have other causes, Brown-Sequard Syndrome is generally caused by penetrating trauma to one side of the spinal cord or area adjacent to one side of the spinal cord. The clinical symptoms include a loss of motor function on one side with loss of sensory function on the opposite side. The clinical picture with this syndrome is highly variable, with variation ranging from mild to severe.
- Central Cord Syndrome - Central Cord Syndrome is considered the more common incomplete spinal cord injury. Trauma by way of hyperextension injury is the most common cause. Motor impairment is actually more pronounced in the upper extremities versus the lower extremities. Literature describes a cape-like distribution of sensory loss over the neck, shoulders and upper torso.
- Conus Medullaris Syndrome - Conus Medullaris Syndrome is a sudden onset of neuro-motor dysfunction that originates in lower segments of the spinal cord, such as L1. So symptoms may include weakness in the legs, peri-anal sensation loss, urinary incontinence and erectile dysfunction, all symptoms associate with abnormal lower body and pelvic neuro-motor function. The neurological dysfunction may be described as saddle anesthesia. Spinal trauma and lumbar stenosis are common causes of this syndrome.
- Spinal Cord Injury Without Evidence of Radiological Abnormality (SCIWORA) - SCIWORA is most commonly found in children that are victims of trauma. The mechanism of injury is clinically correlated with skillful assessment. This syndrome should be suspected in children that have transient neurological dysfunction that follows traumatic events. Children that sustain spinal cord injury or neurological dysfunction should be transferred to a major medical center that specializes in pediatrics.
What is acute spinal cord compression?
Acute spinal cord injuries with acute cord compression develop symptoms within a very short time after an injury. Generally symptoms begin to develop between minutes and hours after the injury as inflammation starts to set in around the spinal cord. The causes of acute spinal cord injury and compression are generally the result of trauma, bleeding and infection.
What is sub-acute cord compression?
Spinal cord injuries with sub-acute cord compression develop worsening of symptoms over a period of days to weeks after an accident. It may indicate an infection or increased swelling near the spinal cord.
What is chronic cord compression?
Chronic cord compression unfolds when symptoms worsen over long time spans like months to years. Old injuries or inflammation of the vertebrae may lead to chronic degenerative changes and cause narrowing of the spinal canal that the spinal cord runs through. The result may cause gradually worsening of neurological or neuromuscular function below the site the injured spinal cord.
What are the complications of a spinal cord injury?
- Autonomic Dysreflexia - Autonomic dysreflexia occurs in individuals with high spinal cord injuries. Reflexes become abnormal with irritation and may result in very high blood pressure and significant drops in heart rate. Medications and comfort measures may prevent this condition. Autonomic dysreflexia is a life-threatening condition and must be treated.
- Blood clots - Immobilization may lead to blood clots forming in the deep veins and becoming dislodged. Medications and devices may be necessary to prevent this from occurring in individuals that are not fully ambulatory.
- Bowel control problems - Bowel elimination patterns are reliant on both involuntary and voluntary muscle and sphincter control. Individuals with spinal cord injury may lose control of their elimination pattern.
Bowel elimination involves some voluntary control which may be lost after spinal cord injury is sustained.
- Contractures - Muscle spasms, immobility and disuse may lead to contractures of an extremity. The affected joint or limb may develop a decreased range of motion or eventual lack of range of motion if preventative methods are not implemented. Physical therapy, occupational therapy and patient teaching will help prevent this complication. It is important to avoid the development of contractures to maximize an injured individual’s functionality and prevent more complications associated with immoblity.
- Muscle Spasm - Muscle spasms may cause pain and contractures. Medications and therapies designed to prevent and reduce muscle spasms will increase the comfort of a spinal cord injured individual.
- Neurogenic Bladder - This condition results in bladder spasms which may be painful. And it also may result in inadequate emptying of the bladder. Medications may help with bladder pain and a method of catheterization may be necessary to facilitate the emptying of the bladder.
- Neurogenic pain - Individuals with spinal cord injury may experience pain in regions below the level of the spinal cord injury. Pain in mobile parts may also be experienced from learning new maneuvers and methods of repositioning.
- Paraplegia - Paraplegia is partial paralysis. An individual may be able to move two extremities, but not the other two extremities. Paraplegic patterns vary according to the location and type of spinal cord injury.
- Pressure ulcers - Immobilization and sensory dysfunction may increase the risk for pressure sores to develop after a spinal cord injury. With sensory dysfunction, the usual triggers to moving and shifting positions may be diminished or absent. Immobilization may also lead to pressure sores due to the inability of moving and changing positions without assistance.
- Quadriplegia - Quadriplegia is also known as Tetraplegia. Quadriplegia is the paralysis of all four extremities and involves the trunk of the body to varying degrees.
- Respiratory insufficiency - Respiratory insufficiency is the impediment of the respiratory effort. The injured individual may experience a complete lack or partial ability to breath after sustaining a high neck injury. This impaired ability to breath interferes with gas exchange, oxygenation and mobilization of respiratory secretions. It also taxes the immune system, rendering an person with spinal cord injury to be a greater risk for infection.
- Spasticity - Exaggerated reflexes may cause muscle spasms in the lower extremities. This condition may be very painful and uncontrollable. Medications may be needed to manage this symptom.
- Spinal Cord Compression - Spinal cord compression may be acute, sub-acute or chronic. If someone is rendered immobile or partially immobile from an acute spinal cord injury, chronic changes will start to unfold. The chronic degenerative changes associated with immobility will culminate into chronic cord compression under some circumstances. Exercise and therapy will impede this undesirable process.
- Tetraplegia - Tetraplegia is also known as quadriplegia. Tetraplegia is the paralysis of all four extremities and involves the trunk of the body to varying degrees.
- Urinary Tract Infection - The lost of urinary bladder function may result in an increased risk to develop infections because of inefficient sphincter control and bladder emptying. Drinking adequate amounts of fluid will reduce the number of bladder infections that may occur. If bladder function is inadequate, an indwelling urinary catheter or regular self-catherization may be necessary to empty the bladder.