SPINAL CORD INJURY

First Aid Measures for Spinal Cord Injuries

If faced with a potential spinal cord injury, it’s crucial to act swiftly but cautiously, ensuring the safety of the injured person. Here are steps to follow:

Assess the Situation

• Stay Calm: Panicking can lead to hasty decisions. Take a deep breath and approach the situation methodically.
• Call for Help: Immediately dial emergency services. Explain the situation clearly and provide the exact location.

Secure the Environment

• Avoid Moving the Person: Keep the injured person still. Movement can worsen the injury, so it’s imperative they remain in the position they were found.
• Stabilize the Head and Neck: Gently hold the head and neck in alignment with the spine. Use your hands to provide support until professional help arrives.

Provide Basic Support

• Monitor Breathing and Consciousness: Ensure the person is breathing and conscious. If they stop breathing and you’re trained, be prepared to perform CPR without tilting the head.
• Prevent Shock: Keep the person warm and comfortable using a blanket or coat, especially if they report feeling cold.

Post-Emergency Measures

• Reassure and Stay With Them: Offer comfort and assurance that help is on the way. Staying with them until help arrives is crucial.
• Avoid Giving Food or Drink: Eating or drinking can lead to complications if surgery is needed, so it’s best to refrain.

By following these steps, you can help minimize further injury while waiting for medical professionals to arrive. Remember, maintaining the person’s current condition and preventing any additional movement is key.

Major Causes of Spinal Cord Injury

Spinal cord injuries can result from a variety of traumatic and non-traumatic events. While trauma remains the leading cause of SCI, certain non-traumatic causes such as degenerative spinal diseases, tumors, or infections can also damage the spinal cord.

Traumatic Causes

• Motor Vehicle Accidents (MVAs): MVAs are the leading cause of SCI, accounting for approximately 38-40% of all cases in the U.S. The impact of a collision can result in violent jerking, hyperextension, or fracture of the vertebrae, leading to spinal cord compression or direct injury.
• Falls: Especially common among the elderly, falls are responsible for around 32% of SCI cases. The aging population is particularly vulnerable to fall-related SCIs due to weakened bones (osteoporosis) and reduced physical mobility.
• Violence and Penetrating Injuries: Gunshot wounds, stabbings, and other violent encounters account for around 13-15% of spinal cord injuries. These injuries often result in severe neurological deficits due to the direct penetration of the spinal cord.
• Sports and Recreational Activities: Sports-related injuries, particularly in football, rugby, gymnastics, and diving, are responsible for 9-10% of SCI cases. Young adults and adolescents are especially at risk.
• Workplace Injuries: Industrial accidents, especially those involving heavy machinery, contribute to a smaller proportion of SCI cases but are still significant.

Non-Traumatic Causes

Non-traumatic causes of SCI can stem from medical conditions or diseases that affect the spinal cord or its surrounding structures. These include:

• Degenerative Disc Disease: Age-related wear and tear of the intervertebral discs can lead to spinal stenosis or herniated discs.  Both of which may compress the spinal cord over time.
• Tumors: Benign or malignant tumors within or near the spinal cord can exert pressure on the cord, resulting in neurological damage.
• Infections and Inflammatory Diseases: Conditions like spinal epidural abscesses or transverse myelitis can cause swelling and damage to the spinal cord.
• Vascular Disorders: Ischemia or hemorrhages in the blood vessels that supply the spinal cord can lead to SCI.
• Congenital Disorders: Spina bifida and other congenital malformations of the spine can result in SCI, often manifesting during childhood or adolescence.

Symptoms of Spinal Cord Injury

The symptoms of SCI can vary widely depending on the location and severity of the injury. The higher the injury on the spinal cord, the more profound the effects on motor and sensory functions. SCIs are classified into two types: complete and incomplete.

• Complete SCI: Total loss of motor and sensory function below the level of the injury.
• Incomplete SCI: Partial loss of function, where some motor or sensory function is retained.

Immediate Symptoms (Acute Phase)

• Loss of Movement: Paralysis is a common symptom, ranging from weakness to total loss of movement below the injury level. In cervical SCIs, paralysis can extend to all four limbs (quadriplegia), while in thoracic or lumbar SCIs, it may affect only the lower limbs (paraplegia).
• Loss of Sensation: Loss of feeling, tingling, or numbness below the injury site is a typical feature. Individuals may lose their ability to feel pain, temperature, or pressure.
• Breathing Difficulties: Injuries to the upper cervical spine (C1-C4) can affect the diaphragm, leading to severe respiratory distress or the need for mechanical ventilation.
• Bowel and Bladder Dysfunction: SCI often disrupts the normal function of the bladder and bowels, leading to incontinence or retention.
• Spasticity or Flaccidity: Depending on the injury level, muscles may either become stiff and spastic or weak and flaccid.
• Shock and Hypotension: SCI often results in spinal shock and autonomic dysfunction, leading to low blood pressure, slow heart rate, and reduced blood flow to vital organs.

Chronic Symptoms

Once the acute phase of SCI passes, individuals may experience a variety of long-term symptoms:

• Chronic Pain: Nerve damage often leads to neuropathic pain, which can be severe and difficult to manage.
• Pressure Sores: Limited mobility can lead to pressure sores or ulcers due to prolonged time spent in bed or a wheelchair.
• Muscle Atrophy: Over time, muscles that are no longer in use due to paralysis may shrink and weaken.
• Autonomic Dysreflexia: Individuals with injuries above the T6 level are at risk of autonomic dysreflexia, a potentially life-threatening condition characterized by sudden high blood pressure and other autonomic disturbances.

To prevent bedsores in individuals with spinal cord injuries, a proactive approach is essential. Here are some key strategies:

• Regular Position Changes: Encourage repositioning every two hours if confined to a bed or every 15-30 minutes if in a wheelchair to alleviate pressure on vulnerable areas.
• Use of Support Surfaces: Invest in specialized mattresses and cushions designed to reduce pressure points and enhance comfort.
• Skin Inspections: Conduct daily skin checks to spot early signs of pressure sores, such as redness or irritation, and address them promptly.
• Nutrition and Hydration: Maintain a balanced diet rich in vitamins and minerals to support skin health, along with adequate hydration to maintain skin elasticity and resilience.
• Hygiene and Moisture Control: Keep skin clean and dry to prevent infection and deterioration, using gentle cleansers and moisturizers as needed.

By integrating these preventive measures into daily routines, individuals with SCI can significantly reduce the risk of developing pressure sores, thereby enhancing their overall quality of life.

Understanding Spinal Cord-Associated Injuries

Spinal cord injuries can bring about a range of associated issues that might not be immediately apparent. Understanding these can help in managing overall health and well-being.

Bladder Management Challenges

One significant issue that often arises is the need for effective bladder management. For individuals with spinal cord injuries, the ability to control bladder function can be compromised, necessitating specialized care and strategies to prevent complications like infections or kidney damage.

Mental Health Concerns

Depression is another concern frequently encountered by those with spinal cord injuries. The adjustment to lifestyle changes and physical limitations can weigh heavily on mental health, making it crucial to address psychological well-being alongside physical health.

Self-Care and Dressing

Daily activities such as dressing become more challenging, requiring adaptive techniques to maintain ease, style, and comfort. This involves exploring clothing options and strategies that accommodate limited mobility and provide both functionality and a sense of normalcy.

Pressure Sores Prevention

Pressure sores are also a common issue, resulting from prolonged immobility. Taking proactive measures to care for the skin and change positions regularly can help prevent this painful complication.

Bowel Management

Finally, spinal cord injuries can impact bowel function, making it necessary to establish a routine that addresses these changes. Understanding bowel management basics can significantly improve quality of life and reduce the risk of further complications.

Addressing these issues with a comprehensive approach ensures that individuals with spinal cord injuries can lead healthier, more fulfilling lives.

Understanding the Impact of Spinal Cord Injuries on Children Versus Adults

While spinal cord injuries (SCIs) can be devastating at any age, their effects on children differ considerably from those on adults. Here’s how:

Growth and Development

• Physical Growth: Children are in crucial stages of physical development. SCIs in children can interrupt bone growth and affect overall physical maturation. This can lead to challenges in achieving typical developmental milestones.
• Height and Proportionality: Due to altered growth patterns, children with SCIs might experience differences in limb length or general body proportionality as they age.

Psychological and Cognitive Impact

• Cognitive Development: Young brains are still developing, so an SCI can potentially affect cognitive growth and learning capabilities. This may lead to difficulties in school or social settings.
• Emotional Adjustment: Children may face unique emotional and psychological hurdles. They must navigate personal identity and peer relationships while managing a significant disability, which can affect their self-esteem and behavior.

Rehabilitation and Recovery

• Adaptability: On the positive side, children often possess a greater ability to adapt physically and learn new skills compared to adults. This adaptability can be an advantage during rehabilitation.
• Long-Term Care Needs: Because they have a longer lifespan ahead, children require extensive long-term care planning, including ongoing medical treatment, assistive technologies, and regular assessments to adjust rehabilitation strategies.

Health Complications

• Secondary Conditions: The risk of scoliosis, osteoporosis, and other secondary conditions can be higher in children due to ongoing growth. Consistent monitoring and preventative care become essential as part of their treatment plan.

Social Consideration

• Support Networks: The role of family, peers, and educational systems is crucial in a child’s recovery and adaptation process. Children often need a supportive network to thrive after an injury.

In conclusion, while every individual’s experience with spinal cord injuries is unique, it’s clear that children face distinctive challenges that require a tailored approach in medical care, rehabilitation, and emotional support. For specific questions about a child’s health, consulting with a healthcare professional specialized in pediatric care is highly recommended.

Diagnosis of Spinal Cord Injury

Prompt and accurate diagnosis of SCI is crucial for initiating the appropriate treatment. Several diagnostic tools and methods are used to evaluate the extent of spinal cord damage.

Initial Assessment

• Physical and Neurological Examination: Following a traumatic injury, healthcare providers assess the patient’s ability to move and feel sensations below the level of injury. This helps determine the injury’s severity and whether it is a complete or incomplete SCI.
• ASIA Impairment Scale: The American Spinal Injury Association (ASIA) developed this scale to measure the severity of SCI. It grades the patient’s motor and sensory function on a scale from A (complete loss of function) to E (normal function).

Imaging Studies

• X-rays: X-rays are typically the first imaging test used in trauma cases to assess fractures or dislocations of the vertebrae.
• Computed Tomography (CT) Scan: CT scans provide a more detailed view of the vertebrae and surrounding structures, helping to detect fractures or other spinal injuries.
• Magnetic Resonance Imaging (MRI): MRI is the most valuable imaging tool for SCI diagnosis as it visualizes soft tissues, including the spinal cord, intervertebral discs, and ligaments. It can detect compressions, hemorrhages, and other spinal cord pathologies that X-rays and CT scans cannot.

Electrophysiological Testing

In certain cases, electrophysiological tests such as somatosensory evoked potentials (SSEPs) or motor evoked potentials (MEPs) are used to evaluate the electrical activity in the spinal cord and determine the extent of the injury.

Finding an expert in physical medicine and rehabilitation for spinal cord injuries can be straightforward with the right resources and approach. Here’s a guide to help you locate a qualified specialist:

Steps to Find the Right Specialist

• Start with Professional Organizations
  Explore directories provided by reputable medical associations. Many organizations maintain lists of certified physical medicine and rehabilitation specialists.
• Consult Neurological Institutes
  Institutions focused on neurological disorders often offer information on medical professionals specializing in spinal cord injuries. Their resources may include detailed specialist directories or referral services.
• Use Medical Networks and Referral Services
  Medical networks often have search tools for locating specialists based on your specific needs and location. These platforms can connect you with reputable professionals who have experience in treating spinal cord injuries.
• Ask for Recommendations
  Personal referrals from healthcare providers or community support groups can be invaluable. They often provide insights into the specialist’s experience, approach to treatment, and patient satisfaction.
• Research Online Reviews and Testimonials
  Patient reviews and testimonials can give you a sense of a specialist’s reputation and effectiveness. Look for feedback on aspects like treatment outcomes, bedside manner, and facility quality.

Key Considerations

• Certification and Experience: Ensure the specialist is certified in physical medicine and rehabilitation with experience specifically in spinal cord injuries.
• Approach to Care: Consider whether the specialist’s treatment philosophy aligns with your personal preferences and goals.

By utilizing these strategies, you can find a seasoned expert in physical medicine and rehabilitation who is well-equipped to manage spinal cord injuries effectively.

Understanding the Central Nervous System

If you’re eager to delve into the complexities of the central nervous system, including the intricacies of the brain and spinal cord, several resources can help you gain a comprehensive understanding:

• Online Educational Platforms: Some websites offer free courses covering neurobiology and the structure and function of the brain and spinal cord.
• Interactive Tools: There are interactive models online that provide a 3D view of the central nervous system. These can be found on educational platforms dedicated to biology and medical studies.

Detailed Guides

Introduction to Neurons:

• Learn about the fundamental building blocks of the nervous system. Several scientific and medical websites provide detailed explanations about neuron life cycles and their roles in maintaining nervous system functions.

The Brain and Spinal Cord Explained:

• Check resources like the websites of reputable medical foundations. These often provide easy-to-understand information about how the central nervous system operates, with materials available in various languages.

Expert Consultation

Find an Expert:

• Many universities and medical institutions offer the opportunity to consult with neurology experts. This is a great avenue for obtaining in-depth insights and answers to specific questions about the brain and spinal cord.

These resources are designed to make complex systems more accessible, ensuring a broad understanding even for beginners in neuroscience.

Nonsurgical Treatment:

The treatment of SCI is a multi-faceted process that begins with emergency care and extends into long-term rehabilitation. The treatment goals are to stabilize the spine, prevent further damage, alleviate symptoms, and restore as much function as possible. Non-surgical treatment for SCI focuses on preventing secondary damage, managing symptoms, and promoting recovery through rehabilitation. These approaches are most effective in incomplete SCIs or in situations where surgery is not immediately required.

Immobilization and Stabilization

• Immobilization Devices: Following a traumatic injury, spinal stabilization is crucial to prevent further damage to the spinal cord. Cervical collars, back braces, or specialized traction devices may be used to keep the spine in a neutral position.
• Bed Rest: In cases of minor SCI or where surgery is not immediately necessary, strict bed rest allows the injured area to heal and reduce swelling.

Pharmacological Management

• Methylprednisolone: In some cases, high-dose corticosteroids are administered within 8 hours of injury to reduce inflammation and limit secondary damage. However, the use of steroids remains controversial, and newer research has questioned its efficacy.
• Pain Medications: Non-steroidal anti-inflammatory drugs (NSAIDs), opioids, or neuropathic pain medications may effectively manage pain.
• Muscle Relaxants: Medications such as baclofen or tizanidine are used to manage spasticity in patients with SCI.

Physical and Occupational Therapy

• Rehabilitation Therapy: Physical therapy aims to improve the patient’s strength, flexibility, and coordination, while occupational therapy focuses on developing skills needed for daily living. Both therapies are critical in promoting recovery and enhancing quality of life for individuals with SCI.
• Assistive Devices: Wheelchairs, walkers, or other mobility aids are provided based on the level of injury and degree of mobility retained.

Psychological Support

SCI has profound emotional and psychological impacts. Depression, anxiety, and post-traumatic stress disorder (PTSD) are common in individuals with SCI. Counseling, psychotherapy, and support groups are essential components of comprehensive SCI care.

Surgical Treatment:

Doctors may recommend surgery to stabilize the spine, decompress the spinal cord, or repair damaged tissues. Surgery is normally needed in cases of severe or unstable spinal cord injuries. Surgical options may include spinal fusion, discectomy, laminectomy, or spinal cord decompression procedures. The goal of surgery is to relieve pressure on the spinal cord, restore alignment, and preserve or improve neurological function.

When conservative treatments fail to alleviate pain, doctors will suggest surgery to address the underlying pathology and provide relief. Surgical treatments for spine conditions causing pain can vary depending on the specific diagnosis, severity of symptoms, and patient factors. Below are common surgical procedures used to treat spine-related pain:

Discectomy:

• Description: A discectomy is a surgical procedure performed to remove a portion of a herniated or degenerated intervertebral disc causing pain.
• Procedure: During the procedure, the surgeon makes an incision in the back and removes the portion of the disc.  This will remove the pressure and reduce the pain in the nerve root or spinal cord.
• Benefits: Discectomy can help alleviate radiating pain, numbness, and weakness caused by nerve compression.  This allows patients to experience significant pain relief and improved function.

Laminectomy:

• Description: Laminectomy, also known as decompression surgery, involves removing a portion of the lamina (the bony arch of the vertebra).  By doing this, doctors relieve pressure on the spinal cord or nerves caused by spinal stenosis or other conditions.
• Procedure: During a laminectomy, the surgeon removes the lamina, bone spurs or thickened ligaments that compress nerves.  This procedure helps create more space within the spinal canal, reducing pressure and alleviating pain.
• Benefits: Laminectomy can effectively relieve symptoms of spinal stenosis.  This includes pain, numbness, tingling, and weakness in the back and legs, allowing patients to regain mobility and function.

Spinal Fusion:

• Description: Spinal fusion is a surgical procedure used to permanently join two or more vertebrae together.  This procedure will stabilize the spine and reduce pain caused degenerative disc disease, spinal fractures, or spondylolisthesis.
• Procedure: During spinal fusion, the surgeon removes the damaged disc or portion of the spine and fuses the adjacent vertebrae using bone grafts, metal implants, or biological materials. This promotes bone growth between the vertebrae, creating a solid union to support the spine.
• Benefits: Spinal fusion can provide long-term relief from back pain, restore spinal stability, and prevent further problems with the spine.

Minimally Invasive Surgery (MIS):

• Description: Minimally invasive spine surgery  uses small incisions and specialized instruments. These procedures access the spine with minimal disruption to surrounding tissues.
• Procedure: During MIS procedures, surgeons use advanced imaging technology, such as fluoroscopy or intraoperative navigation.  These devices help doctors precisely target the affected area of the spine. This allows for reduced muscle damage, shorter recovery times, and decreased risk of complications compared to traditional open surgery.
• Benefits: Minimally invasive spine surgery offers several advantages, including less postoperative pain.  It also offers shorter hospital stays, quicker recovery, and a faster return to normal activities. It is often preferred for certain conditions, such as herniated discs, spinal stenosis, or spinal instability.

Non-Invasive Treatments:

Non Invasive Treatments are often effective for treating spine conditions causing pain. These non-invasive approaches may include:

• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, corticosteroids, and neuropathic pain medications may be prescribed to manage pain.  In addition, they will also reduce inflammation, and muscle spasms associated with spine conditions.
• Physical Therapy: Exercises, stretching, and manual therapy techniques can help improve strength, flexibility, and posture, reduce pain, and enhance overall spinal health.
• Interventional Procedures: Epidural steroid injections, facet joint injections, nerve blocks, and radiofrequency ablation are minimally invasive procedures that can provide temporary pain relief.
• Lifestyle Modifications: Adopting healthy lifestyle habits, such as maintaining a healthy weight, practicing good posture, avoiding smoking, and engaging in regular exercise, can help prevent and manage spine-related pain.

In summary, surgical treatments for spine conditions causing pain aim to address the underlying pathology.  Furthermore, surgery relieves pressure on spinal nerves, stabilizes the spine, and alleviates symptoms. While surgery may be necessary in some cases, non-invasive treatments can also play a valuable role in managing pain. Never the less, patients should consult with a qualified spine specialist like those at the Southwest Scoliosis and Spine Institute.  Our expert doctors and surgeons will determine the most appropriate treatment approach based on their diagnosis, symptoms, and health.

Benefits of Surgical Treatment:

Surgical treatment for spinal cord injuries can help prevent further problems, stabilize the spine, and improve outcomes for patients. Also, by addressing structural abnormalities and restoring spinal stability, surgery has a great record of reducing and stopping pain.

Recovery Period:

The recovery period following a spinal cord injury varies depending on the severity and extent of the injury. Recovery may involve a combination of acute medical care, rehabilitation therapies, and long-term support services. These qualities help individuals regain function, independence, and quality of life to the greatest extent possible.

Rehabilitation:

A rehabilitation program is a crucial part of treatment for spinal cord injuries, focusing on maximizing functional abilities, promoting independence, and improving quality of life. Rehabilitation programs may include physical therapy, occupational therapy, speech therapy, and psychological counseling to address physical, cognitive, emotional, and social aspects of recovery. The goal is to help individuals adapt to their injuries, learn new skills, and achieve the highest level of independence and self-care possible.

Managing Spinal Cord injuries on a Daily Basis

When it comes to managing daily care for spinal cord injuries, there are comprehensive patient handouts available that cover a variety of essential topics. Here’s a brief overview of the resources you can expect:

Daily Bowel Care Program

A structured approach is crucial for maintaining a regular bowel routine. The handout provides detailed guidance on creating a personalized bowel management plan that can significantly improve daily comfort and health.

Self-Catheterization for Women

For women needing to self-catheterize, the guide offers step-by-step instructions to ensure the process is as smooth and hygienic as possible. It emphasizes technique and hygiene to minimize discomfort and risk.

Self-Catheterization for Men

Men can also find a similar resource dedicated to their specific needs. The handout walks through each step, highlighting strategies to effectively manage self-catheterization.

Spinal Cord Stimulation

This document delves into using technology to ease symptoms related to spinal cord injuries. It explains how spinal cord stimulation works and its potential benefits.

Spinal Cord Trauma

For those newly experiencing spinal cord trauma, the handout outlines the immediate steps to take and provides long-term care tips to manage and adapt to changes in daily life.

Care Following a Spinal Injury

This resource gives a broad overview of living with a spinal injury, focusing on rehabilitation, daily adjustments, and methods to enhance quality of life.

Suprapubic Catheter Care

This handout covers the maintenance required for those who use a suprapubic catheter. It offers insights into keeping the site clean, signs of potential complications, and regular care routines.

These handouts are available in multiple languages, ensuring accessibility for a diverse audience seeking to manage their care effectively after a spinal cord injury.

Specific Conditions Related to Spinal Cord Injuries

When exploring the realm of spinal cord injuries, several specific conditions stand out. Each of these conditions comes with its own unique challenges and characteristics:

• Central Cord Syndrome: A prevalent type of incomplete spinal cord injury, often resulting from trauma such as falls. It affects the central part of the spinal cord, leading to more pronounced weakness in the arms than in the legs.
• Central Pain Syndrome: Arising due to damage to the central nervous system, this condition is marked by chronic pain. It typically manifests as a burning or aching sensation and might be triggered by light touch or changes in temperature.
• Spinal Cord Infarction: Often referred to as a spinal stroke, this occurs when there is an interruption of blood supply to a part of the spinal cord. Symptoms can range from sudden back pain to partial or complete loss of motor function below the level of the injury.

These conditions illustrate the complexity of spinal cord injuries, each demanding tailored medical attention and rehabilitation strategies. Understanding the specific characteristics of each condition is crucial for effective management and recovery.

Research and Clinical Trials for Spinal Cord Injuries

If you’re exploring the forefront of spinal cord injury research and seeking active clinical trials, there are several key resources and study opportunities available:

• ClinicalTrials.gov Database: This online resource is a comprehensive repository of ongoing clinical trials. Here, you can find detailed information about various studies related to spinal cord injuries, including the objectives, methodologies, and participation requirements for each trial.
• Academic and Medical Research Institutions: Many universities and hospitals conduct groundbreaking research aimed at understanding and treating spinal cord injuries. They often publish their findings and may offer clinical trials that focus on new therapies or surgical techniques.
• Pharmaceutical and Biotech Companies: These organizations often sponsor clinical trials to evaluate the safety and effectiveness of novel drugs or medical devices designed to aid spinal cord injury recovery. Participants can usually access cutting-edge treatments that are not yet widely available.
• Patient Advocacy Groups and Non-Profits: Organizations dedicated to spinal cord injury support often collaborate with researchers to facilitate studies and trials. They can provide valuable information on how to participate and offer support to those involved.

By participating in clinical trials, individuals not only gain access to potential new treatments but also contribute to the advancement of spinal cord injury research. Always consult healthcare professionals for guidance on the suitability and potential benefits of participating in any clinical research.

Reasons to Choose The Southwest Scoliosis and Spine Institute:

Patients facing spinal cord injuries should consider The Southwest Scoliosis and Spine Institute for several reasons. Led by renowned spine surgeons Doctors Richard A. Hostin, Devish Ramnath, and Ishaq Syed, the institute offers comprehensive spinal care with a patient-centered approach. With offices in Dallas, Plano, and Frisco, Texas, the institute provides access to state-of-the-art facilities and advanced treatment options, including both nonsurgical and surgical interventions tailored to individual patient needs. Finally, the team at The Southwest Scoliosis and Spine Institute is dedicated to delivering high-quality care, compassionate support, and optimal outcomes for patients with spinal cord injuries and other complex spinal conditions.

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National Institute of Health: Spinal Cord Injury