Medical Conditions Related to the Spinal Cord: A Case-Based Essay

This essay discusses medical conditions related to the spinal cord, including spinal cord injury, adult scoliosis, and herniated lumbar disc. It explores their clinical manifestations, diagnosis, and treatment options.

Running head: CASE BASED ESSAY
CASE BASED ESSAY
Name of the Student
Name of the University
Author’s Note:

1CASE BASED ESSAY
The purpose of this essay is to discuss medical conditions related to the spinal cord which
is generally occurs between the age of 18 years to 25 years and their clinical manifestation. In
this essay, three medical conditions which will be discussed are spinal cord injury, adult
scoliosis, and herniated lumbar disc.
Spinal cord injury - Spinal cord injury is among one of the leading injury related to spinal
cord and in the United States alone, eleven thousand cases of spinal cord injury happens every
year. The occurrence of Spinal cord injury is maximum among people between 16 to 30 years of
age, in whom 53.1 per cent of injuries occur. This age group involves more spinal cord injuries
than all other age groups. The three most important causes of Spinal cord injury
include automotive accidents, falls and gunshots respectively. The seriousness of spinal
cord injury is dependent on the impacted area of the spinal cord. The higher in the spinal cord
injured on the column, or the nearer it is for the brain, and more impact it has on the movement
and sensation of the body. A complete Spinal cord injury causes total sensory and motor loss
below that injury levels. Almost 50 per cent are complete spinal cord injury out of all Spinal cord
injury. In this scenario, body gets equally affected on both sides. In case of incomplete Spinal
cord injury, some of the functions remain below the injury's primary level. A person suffering
from incomplete spinal cord injury may be able to shift a leg or arm far more than the other one
or more on one part of the body (Lee et al., 2014).
Adult Scoliosis - When scoliosis is discovered or occurs after adolescence, it is known
as adult scoliosis to differentiate between the curves triggered by growth. Adult scoliosis can
occur or result during young adulthood as a result of untreated or un- reconciled childhood
scoliosis. In adulthood, the main causes of scoliosis are actually quite different from the varieties
of childhood. Most adult scoliosis cases are idiopathic, meaning that the reason behind it is not

2CASE BASED ESSAY
known. Adult scoliosis is occasionally caused by changes of the backbone which caused by
ageing and spinal degeneration. Back pain might develop as the adult scoliosis progresses. The
abnormality can cause nerve and possibly the whole spinal cord under pressure. It could result in
lower extremity numbness, weakness, and pain (Cho et al., 2014).
Herniated lumbar disc - Herniated lumbar disc can be defined as a displacement outside
of inter-vertebral disks of the disc space (annulus fibrosis or nucleus pulposus). The biggest
incidence has been noticed among the young adult with a 2:1 ratio between males and females.
There is very little evidence that the drug therapy or treatment for herniated discs is effective.
For the age group between 25 to 55 years old, the lower spine (L4/5 and L5/S1)
gets affected in approximately 95 per cent of herniated disc occurrence. Risk factors for disk
herniation include weight bearing sports such as weight lifting, smoking and certain working
activities like continuous lifting. It was suggested that driving a motorized vehicle is a risk
factor; however, there is no conclusive evidence in regard to this aspect (Rasouli et al., 2014).
From above the three conditions, the details of spinal cord injury will discuss in further
details in the following sections. In order to do that, manifestation of spinal cord injury through a
person’s life span, diagnosis, allopathic treatment, chiropractic treatment and medication will be
discussed.
Progression of spinal cord injury through lifespan – Different changes happens through
different system of the body in case of spinal cord injury while aging and it will be discussed
below.
Musculoskeletal changes: In this scenario, Calcium loss ultimately results in
osteoporosis. Muscles lose muscle mass and coordinated strength and coordination, deteriorate

3CASE BASED ESSAY
coordination and balance and stiffen joint capsules, lose flexibility and grow contractures. Lean
muscle mass deteriorate and replaced by adipose tissue. These changes happen irrespective of the
level of activity of an individual. After 60 years, muscle strength decreases by 20 -30 per
cent and maximum output (working rate) decreases by 45 per cent after the five decades.
Progressive degenerative joint alterations of weight bearing joints are generally occurs at 60
years of age (Hagen, 2015).
Neurologic changes: There is also a decrease in peripheral and central nervous systems.
At the age of 24, neurons are lost in a slow, steady decay in the central nervous system. Evident
published in various studies shown that normal aging which would include short-term memory
decreases, speed loss and motor operations, and slower central information processing rates. in
between 25 to 75 years of age, physiological changes in neurological structures include a
decrease of more than 60 per cent in the sense of vibration in the lower limbs and a decrease in
simple response time higher than 20 per cent (Stein & Knight, 2017).
Cardiovascular changes: As a result of the spinal cord injury, cardiovascular system lacks
the capacity to pump blood both by lessening stroke volume and inability to maintain the vessel's
tone. Aging is linked to a progressive, gradual rise in systolic and diastolic blood pressure, which
is likely to occurs because the elasticity loss of artery. There is an increased risk of orthostatic
hypotension and a increased risk of urination related syndromes (Frontera & Mollett, 2017).
Pulmonary changes: The pulmonary system become less compliant or elastic, this affects
the capacity of the lungs to expand. The chest wall also loses its strength and flexibility, which
results in pulmonary function restrictions. All of this declines with aging which includes vital

4CASE BASED ESSAY
capacity, expiratory rate, maximum voluntary ventilation, and forced expiratory ventilation
(Frontera & Mollett, 2017).
Changes in other systems: Other than the system mentioned above, other bodily system
also gets affected due to the spinal cord injury. Renal system starts to lose operational units or
glomeruli which may lead to some kidney failure. Lack of control during urination or
defecation is not a typical component of the ageing process. On the other hand, changes
in endocrine system include hormone declines like testosterone and human growth hormones that
are accountable for cellular tissue maintenance and repair. There is also a decrease in the amount
of insulin or insulin efficacy, such as a growth factor. Commonly, the immune response system
which is mediated by cells and humeral becomes less effective when one ages in regard to spinal
cord injury. The transit time in the GI tract is increasing and some drugs are not absorbed
completely and others are absorbed. In addition, integumentary system suffers the loss of
subcutaneous tissues and adipose tissues as well as a loss of elasticity in the due to skin thinning.
With age, bruising and skin tears become more common (Frontera & Mollett, 2017).
The spinal cord injury patient has a faster decline in other systems and the above
described aging characteristics occur at an unusually early age. A person with spinal cord
injury is relatively young when the injury occurs and, due to the SCI, certain functional reserves
and capacity have been immediately reduced. Consequently, he / she need help with activities of
daily life often. As noted above, several long-term observing studies and many scholars have
recorded the trend towards age faster than for the capable population for people with spinal cord
injuries. That is, Spinal cord injury suffering individuals are usually associated with the ageing
process at a younger age. Some authors have helped to establish when such changes may take
place. A numerous studies have confirmed this practical decline. Depending on the specific

5CASE BASED ESSAY
situations of the patient, it may begin at 10 to 15 years after injury or at the latest at 20 years after
injury (Hagen, 2015).
Diagnosis of spinal cord injury: The spinal cord is the main communication line between
the various parts of the body and the brain. Damage in the spinal cord due
to medical or trauma condition can cause spinal cord injury. Damage may
affect motor, sensory and the reflex actions sent between the body and the brain.
The medical history and timing of the spinal cord injury are two important factors. The more
quickly a patient can be treated, the more likely the recover from injury. It is also important to
know how the injury occurred and the medical history of a patient. Diagnostic proceedings for
spinal cord injuries include X - ray, CT scan, and MRI Tests to assist physicians in assessing
spinal cord abnormalities. A full neurological examination is conducted just few days following
the injury. This time will allow the swelling to subside, which will help the physician to diagnose
the severity of the injury in the spinal cord and to predict the probability of rehabilitation and the
treatment outcomes (Jain et al., 2015).
Treatment of spinal cord injury: Patient suffering from a spinal cord injury usually
admitted to an ICU or intensive care unit. Traction may be used to help bring the spine into
proper alignment for a number of injuries on the cervical spine. Standard intensive care
unit treatment is essential for making sure that patients are given the best possible outcome,
including a cardiovascular function, maintenance of stable blood pressure, proper ventilation and
lung function, and prevention and treatment of infections and other complications. Frequently a
surgeon might wish to bring a patient back to the operation table directly if the
patient has herniated disk, blood clot or other lesion which might compress the spinal cord. Apart
from that, there are many other treatments available for spinal cord injury (Ahuja et al., 2017).

6CASE BASED ESSAY
Allopathic treatment of Spinal cord injury: For primary injury and for the treatment of
secondary conditions medicines and drugs may be used. The very first response after Spinal cord
injury is to prevent and control inflammation. A medication known as methylprednisolone may
immediately be administered and continued for 24 - 48 hours. It is a chemical synthesized
medicine made by humans. Corticosteroids are strong anti-inflammatory medicines. Recent
research, however, has shown the benefits of using this medicine are outweighed by potential
side effects such as blood coagulation and pneumonia. As a consequence, methylprednisolone is
no longer recommended for the routine use following a spinal cord injury. Many secondary
conditions are present which may arise after the spinal cord injury. These include pain and
muscle spasticity control medications and medications that can improve the control of the
bladder mechanism, the sexual function and the bowel (Ahuja et al., 2017).
Chiropractic treatment of Spinal cord injury: Chiropractic care is a traditional non -
invasive method for alleviating discomfort and promoting healing of various non - therapeutic or
minor backbone injuries, which can help patients to improve their quality of life. When
accomplished by qualified, certified practitioners, chiropractic care can be extremely useful for
reducing back, neck, and articular pain in connection with spinal cord injury, compression and
hyperextension. This covers bio-mechanical issues with whiplashing, hernia, bruising, reduced
mobility, herniated disc, and spinal cord misalignment. Each client is different, but it is generally
recommend allowing time for the injury to stabilize for at least six months after diagnosis before
seeking chiropractic cure rehabilitation. Chiropractic therapy is often used to alleviate symptoms
in mild spinal cord injuries by positioning the spinal column vertebra (back and cervical) with
vertebra. It helps lower backward pressure, reduce pain, improve blood flow, and facilitate
healing. It also improves spinal cord pressure. Chiropractors use a number of techniques to

7CASE BASED ESSAY
alleviate pain and improve mobility while performing spinal manipulation to treat subluxation
(spinal malalignment). Chiropractors do not, however, prescribe drugs or painkillers but instead
concentrate on a holistic treatment approach with regard to musculoskeletal issues (Tuchin,
2014). Following a physical exam, ultra sound tests, X-rays, and/ or CT scans or MRIs will be
thoroughly examined for the development of treatment plan. In cases with extreme spinal cord
injury, including surgery, consultation with primary healthcare professional should
be conducted before seeking additional treatments like chiropractic adjustment. This includes
patients with stimulation of the spinal cord, vertebroplasty, kyphoplastia and/or spinal fracture
operation (Swait & Finch, 2017).
Mortality related to spinal cord injury: Younger and patient with incomplete spinal cord
injury usually have a better survival rate than older and completely injured patients. The main
cause of death among spinal cord injury patients is respiratory disorders, 71.2 per cent of which
are caused by pneumonia. Heart disease and infections are respectively the second and third
leading causes. For spinal cord injury patients, a total estimated 20-year survival rate is
possible among 70.65 per cent individuals, but mortality rates can be higher due to various
factors like under reporting and lost cases during follow up (Lee et al., 2014).

8CASE BASED ESSAY
References:
Ahuja, C. S., Wilson, J. R., Nori, S., Kotter, M. R., Druschel, C., Curt, A., & Fehlings, M. G.
(2017). Traumatic spinal cord injury. Nature reviews Disease primers, 3, 17018.
Cho, K. J., Kim, Y. T., Shin, S. H., & Suk, S. I. (2014). Surgical treatment of adult degenerative
scoliosis. Asian spine journal, 8(3), 371.
Frontera, J. E., & Mollett, P. (2017). Aging with spinal cord injury: an update. Physical Medicine
and Rehabilitation Clinics, 28(4), 821-828.
Hagen, E. M. (2015). Acute complications of spinal cord injuries. World journal of
orthopedics, 6(1), 17.
Jain, N. B., Ayers, G. D., Peterson, E. N., Harris, M. B., Morse, L., O’connor, K. C., & Garshick,
E. (2015). Traumatic spinal cord injury in the United States, 1993-2012. Jama, 313(22),
2236-2243.
Lee, B. B., Cripps, R. A., Fitzharris, M., & Wing, P. C. (2014). The global map for traumatic
spinal cord injury epidemiology: update 2011, global incidence rate. Spinal cord, 52(2),
110.
Rasouli, M. R., Rahimi‐Movaghar, V., Shokraneh, F., Moradi‐Lakeh, M., & Chou, R. (2014).
Minimally invasive discectomy versus microdiscectomy/open discectomy for
symptomatic lumbar disc herniation. Cochrane Database of Systematic Reviews, (9).
Stein, D. M., & Knight, W. A. (2017). Emergency neurological life support: traumatic spine
injury. Neurocritical care, 27(1), 170-180.

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Swait, G., & Finch, R. (2017). What are the risks of manual treatment of the spine? A scoping
review for clinicians. Chiropractic & manual therapies, 25(1), 37.
Tuchin, P. (2014). A systematic literature review of intracranial hypotension following
chiropractic. International journal of clinical practice, 68(3), 396-402.