Question

Please describe an example of both a primary and secondary spinal cord injury.

Our discussion this week pertains to Spinal Cord Injuries. Primary spinal cord injury involves damage to vertebral or neural tissues from compression, traction, or shearing forces. Secondary spinal cord injury is related to ischemia, excitotoxicity, inflammation, edema, oxidative damage, and activation of necrotic and apoptotic cell death; it begins within minutes after injury and continues for weeks.

Assignment Instructions:

Some learners will use the same injury, such as a fall off of a horse. Describe how the patient experienced both primary and secondary injuries. Be sure to describe symptoms, implications, and testing that helped clinicians to classify the injury into these categories

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Answer 1

Spinal cord injuries can be Primary and secondary. Primary injury refers to the compression, traction or shearing forces causing injury to the spinal cord. For example in a bike accident , the impact caused by the fall from bike can lead to vertebral fractures, disc prolapses or softsoft tissue injuries causing damage to spinal cord acutely. This manifest as sudden onset focal Neurological deficits like paraparesis, quadriparesis or sensoryloss for the patient immediately after the accident. Primary injury can be diagnosed by clinical examination and various investigations. MRI or CT of the spine reveals the discontinuity or contusion of spinal cord as well as the associated injuries like fractures and disc protrusions.

Secondary spinal cord injuries refer to the molecular changes occuring in the spinal cord in response to the injury. There may or may not be any obvious primary injuries following a bike accident. But subsequently patient develops Neurological deficits which cannot be asexplained by primary injury for example in the case of Whip lash injuries or SCIWORA - Spinal Cord Injury Without Radiological Abnormality. The mechanisms involved are secondary to the vascular insufficiency, oxidative stress, neuroinflammation or apoptosis. MRI spine demonstrates thinning, infarction or swelling of the spinal cord without obvious primary injuries.

The most important implication in discriminating primary and secondary injuries is that often the secondary injuries are preventable with appropriate treatment of primary injuries as well as modulation of secondary mechanisms of spinal cord injury.