Back surgery carries with it a risk of spinal cord injury, with certain procedures such as laminectomy having a higher degree of risk in comparison to less invasive surgery such as the X-Stop procedure. Damage to the spinal cord can have serious, long-term consequences including permanent disability, paralysis, and even death. There are also lesser symptoms of spinal cord trauma, with a simple headache often indicating the presence of a dural tear or spinal fluid leak and, potentially, spinal meningitis. Conversely, it may be necessary to undergo back surgery in order to prevent spinal cord injury, particularly in cases of severe spinal stenosis or acute trauma where pressure on the spinal cord threatens to permanently affect its function.
Accidental Injury to the Spinal Cord
Whenever the spine is operated on there is a risk that the surgeon will accidentally knock the spinal cord, or the spinal nerves. Tears can occur in the dura that covers the spinal cord, particularly in extensive decompression surgeries such as a laminectomy, or laminectomy with fusion where part of the backbone, which affords some spinal cord protection, is removed. If a dural tear occurs in surgery and the surgeon notices it then it will be repaired during the procedure and no effects are usually felt. Prophylactic antibiotics may be given to reduce the possibility of the spinal fluid becoming infected due to the tear. In other cases, the tear may go unnoticed and further surgery may be required if it fails to heal of its own accord, with spinal fluid leakage and infection occurring that could spread to the meninges.
The spinal cord is the brain’s connection to the rest of the body, meaning that any damage can have serious consequences for the sensory information that the brain receives and the motor innervation that it sends out to instruct muscle activity, and other essential functions. Throughout the cervical, thoracic, and lumbar spine the spinal nerves branch off from the spinal cord in pairs at each vertebral level. Damage at a certain level of the spinal cord can cause the spinal nerves below that level to alter or cease functioning, with cord damage in the neck potentially causing severe impairment and widespread paralysis. Spinal cord injury above the T4 level may develop respiratory problems five to ten years after the injury occurs. This is due to a progressive weakening of the muscles, and other tissues involved in breathing due to the loss of nerve innervation. Restrictive lung disease requires careful monitoring in order to prevent fluid building up in the lungs, and infection.
Problems associated with spinal cord injury
Spinal cord injury can lead to significant problems in, perhaps, unexpected areas of the body. Osteoporosis is a risk following spinal cord injury, due to the restricted movement and weight-bearing exercise that may be undertaken following alterations in nerve function. This means that phosphorus and calcium begin to leach from the bones, leaving them brittle and at higher risk of fracture or curvature. Patients usually experience some degree of bone-density loss two years after a spinal cord injury although this can be ameliorated by physical therapy programmes, walking with a frame, or electrical stimulation of the muscles in some cases.
Muscle Spasms and twitching
Spasticity can occur with spinal cord injury as the shock to the nervous system may result in an exaggeration of the normal reflexes controlling the muscles. Areas of the body innervated by nerves below the spinal cord trauma site may initially become hyper-responsive, with muscle twitching, spasms, contractions, and pain. These symptoms can be triggered by almost anything, particularly the stretching of the muscles, and the spasticity will usually worsen if the patient has a bladder or kidney infection. Regular physical therapy and range of motion exercises can help reduce the symptoms to some degree but spasticity may always be present for a number of patients. Medications such as baclofen, Valium, and Dantrium may be prescribed to reduce, but not remove, the symptoms, although these can have side-effects that some patients consider worse than the spasms themselves. Spasticity can be beneficial in some respects as it can alert a patient to trauma in an area where there is no feeling of pain itself (such as damaging heat or cold). The muscle activity also staves off, to some extent, the osteoporosis that can otherwise occur with spinal cord injuries and can aid circulation.
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