Spinal Cord

The spinal cord is the central pathway connecting the nerves of the body to the brain. The spinal cord is necessary to transmit information from the peripheral nervous system to the brain, allowing people to move, feel, touch, smell, see, and taste. Any damage to the spinal cord can have a major impact on the body’s ability to function. 

Spinal cord injuries caused by trauma, birth defects, disease, infection, or health conditions must be treated with caution. Timely and careful treatment can preserve the individual’s ability to maintain an independent life. Delayed treatment or misdiagnosis can result in unnecessary injury or death.  

Anyone who suffered a spinal cord injury during or after medical treatment should understand what caused the injury, how the injury can be treated, and if the injury could have been prevented. If you have any questions about medical malpractice causing a spinal cord injury, talk to your medical malpractice attorney to learn about your rights.  

How the Spinal Cord Works

The spinal cord is a tubular structure of nervous tissue. The spinal cord extends from the brainstem to the lumbar region of the spine. Cerebrospinal fluid (CSF) runs through the central canal of the spinal cord. The spinal cord is protected by meninges, or layers of tissue around the central canal. These three membrane layers include the dura mater, arachnoid mater, and pia mater.

Nerve signals from the brain are transmitted through the spinal cord to the body and sensory neurons. There are a number of branches off the central spinal cord to sensory and motor nerve roots. These nerve roots, together with the ganglia and nerves make up the peripheral nervous system. 

The spinal cord is protected by the bones of the spinal column. The spinal column is made up of a number of vertebrae, with a vertebral foramen space surrounding the spinal cord. The spinal column is somewhat flexible, allowing for movement while still providing protection to the sensitive spinal cord. 

Sections of the Spine and Spinal Cord

The spinal cord is continuous from the brain to the base but it is generally referred to by the general area, according to the vertebrae. The vertebra is made up of 33 bones, divided from top to bottom into the following sections: 

• Cervical (C1 to C7)
• Thoracic (T1 to T12)
• Lumbar (L1 to L5)
• Sacrum (S1 to S5)
• Coccyx

The cervical vertebrae (neck) have the greatest range of motion, allowing the head to move in a number of directions, nodding, tilting, and turning the head. The thoracic spine holds the rib cage. The lumbar spine is the lower back. The sacrum connects to the hip bones. The coccyx is the base of the spine, or tailbone.

The spinal cord does not run the entire length of the spine and only extends to about the first lumbar vertebrae. However, the spinal nerves are referred to according to the vertebrae above which the spinal nerve exits the spinal canal (C1-C8, T1-T12, L1-L5, S1-S5, and 1coccygeal nerve), for a total of 31 pairs of spinal nerves.

Sections of the spinal cord and spinal nerves are associated with areas of the body. This creates a sort of map across the body that can help doctors diagnose the location of the spinal cord where a problem may be more likely. For example, pain or weakness to areas of the back of the leg is likely tied to the sacral spinal nerves (S1-S5). 

Similarly, when treating a patient with anesthesia, nerve blockers, or an epidural, medication is injected into the epidural space, between the dura mater and bone at the location needed. For example, an epidural for childbirth may involve an injection into the interspace between L2-L3, L3-L4, or L4-L5, which blocks the feeling of pain from about the middle of the abdomen to the upper legs. 

Spinal Cord Injuries

Spinal cord injuries (SCI) are caused by damage to the spinal cord or spinal nerves. Minor spinal cord injuries may be temporary or have the damage mitigated through surgery, treatment, and recovery. However, many spinal cord injuries are permanent and can result in a loss of feeling, muscle weakness, and loss of function of areas of the body. Signs and symptoms of spinal cord injuries generally include: 

• Numbness or tingling
• Muscle weakness
• Back or neck pain
• Incontinence
• Muscle spasms 
• Changes in sexual function
• Difficulty breathing
• Altered sensation
• Paralysis
• Paraplegia
• Quadriplegia

Common Causes of Spinal Cord Injuries

Causes of spinal cord injury are generally divided by traumatic injuries and non-traumatic injuries. The cause of spinal cord injury can also affect how a patient is evaluated and treated. One of the questions doctors may ask when a patient reports symptoms that could be attributed to a spinal injury is whether the individual has suffered a fall or blow to the head. 

Spinal Cord Trauma

Even though the spinal cord is surrounded by vertebrae, sudden or unnatural movement to the spine can injure the spinal cord. Any traumatic blow, compression, dislocation, or crushing of the vertebrae can injure the spinal cord. Some of the common causes of spinal cord trauma include: 

• Car accident
• Motorcycle accident
• Sports injuries
• Fall from a horse
• Bike accident
• Fall down stairs
• Slip and fall injury
• Construction accident
• Gunshot wound
• Hanging

Even when the traumatic injury does not immediately cause spinal cord damage, damage can occur over a matter of days or weeks because of swelling, bleeding, or inflammation.

Non-Traumatic Spinal Injuries 

Non-traumatic spinal injuries can be caused by illness, disease, infection, or degenerative conditions. These include conditions that block the blood flow to the spinal cord, put pressure on the spinal cord, or damage the vertebrae surrounding the spinal cord. Some non-traumatic spinal injuries include: 

• Spinal cord infarction 
• Spinal cord stroke 
• Spinal cord hemorrhage

Spinal Cord Infarction 

A spinal cord infarction is an obstruction in the spinal cord, often caused by a lack of blood supply in an artery that supplies blood to the spinal cord. This may be caused by an aortic dissection, atherosclerosis, or clamping of the artery during surgery. Symptoms of a spinal cord infarction usually include sudden pain in the back, weakness on both sides, and sensory loss, especially loss of feeling of pain or temperature. 

Spinal cord infarction is usually diagnosed through an MRI. Treatment may include addressing the cause and the source of the infarction, such as an aortic dissection. Recovery generally depends on how quickly the infarction was addressed and extent of the damage. The patient may suffer temporary paralysis, which can be treated with physical or occupational therapy. However, in some patients, paralysis may be permanent. 

Spinal Cord Stroke

Spinal cord stroke involves an interference in the blood supply to the spinal cord. This can be caused by a blood clot or other embolus. In other cases, bleeding may cause hemorrhagic stroke of the spinal cord. Injury and damage to the spinal cord may depend on the extent of the stroke and time before the patient is treated. 

Like other spinal cord injuries, symptoms of a spinal cord stroke may depend on where they occur in the blood supply to the spinal column. Symptoms may include neck or back pain, muscle weakness, change in sensation, and incontinence. Treatment options and recovery generally depends on the extent of the injury, and in some cases, the long-term effects can include paralysis. Some options may include drug therapy, physical therapy, and occupational therapy. 

Spinal Cord Hemorrhage 

Spinal cord hemorrhage is bleeding in and around the spinal cord. This can include into the intramedullary bleeding, subarachnoid hemorrhage, subdural hemorrhage, and epidural hemorrhage. The bleeding may be caused by a traumatic accident or injury, or through a non-traumatic disease or condition. Hemorrhage can reduce the blood supply to the spinal cord and can also cause a build-up of pressure and fluid around the spinal cord, causing injury.

Spinal Cord Birth Injuries

Spinal cord injuries during pregnancy or labor can be devastating for a family. During childbirth, spinal cord trauma for infants can cause permanent damage, including paralysis. A spinal cord injury during labor can be caused by: 

• Too much force used to extract a child from the birth canal
• Where the child’s spine is twisted or over-extended during delivery
• When the child is delivered using forceps or a vacuum-extraction tool and too much pressure is used

Birth injuries to the spinal cord can also involve undiagnosed or misdiagnosed conditions in the fetus. Failure to diagnose spina bifida can risk unnecessary injury or harm during childbirth. Spina Bifida is a neural tube birth defect that occurs in an unborn baby’s spine and spinal cord. When an infant has spina bifida, the spinal vertebrae do not fully enclose the spinal cord. This leaves the spinal cord and surrounding nerves susceptible to injury.  

Medical Errors Causing Spinal Cord Injuries

Spinal cord injuries can be caused by medical errors or mistakes. This can range from anything from failure to diagnose a tumor on the spine to a spinal cord puncture during surgery. Unfortunately for the patient, they may not always know when the spinal injury was caused by a doctor’s negligence or if it was unavoidable. 

Many doctors and healthcare professionals do not acknowledge when they made a mistake or even try and cover up a mistake. Colleagues may even cover from a negligent doctor in order to avoid pushback from the employer or risking their jobs. 

Discovering a medical mistake can be difficult for the patient and their family. Even a review of the medical records may not indicate any sign of an error. An investigation and review by a medical malpractice attorney, with expert medical review, can identify problems with the care, inconsistencies, missing records, altered medical records, and indicate possible failures in the standard of care. 

Failure to Diagnose or Delayed Diagnosis

Failure to diagnose a health condition that could cause or worsen spinal cord damage can lead to irreparable harm. Many health conditions are progressive, and the longer they are left untreated, the more harm they can do. This can be a problem with diseases and infections on or around the spinal cord, including: 

• Cancer or tumor on the spine 
• Osteomyelitis (bone infection)
• Spinal arthritis
• Bacterial infection
• Fungal infection
• Spinal cord blood clot
• Disc degeneration
• Osteoarthritis
• Severe hypotension
• Epidural hemorrhage
• Epidural abscess
• Tuberculosis
• Transverse myelitis
• Granuloma
• Cardiac arrest
• Embolism
• Atherosclerosis

Even before suffering permanent spinal cord injury, conditions or diseases that could lead to spinal cord injury may present as having symptoms related to spinal cord injury. 

Errors During Surgery or Anesthesia

Spinal cord injury can also be caused by negligence during an anesthetic procedure on the spinal cord, back surgery, or spinal surgery. Doctors, surgeons, and anesthesiologists working on or near the spine understand how sensitive the spinal cord can be. Failure to act within the standard of care can result in injury or harm. Some injuries to the spinal cord during medical treatment or surgery include: 

• Epidural
• Nerve block
• Epidural steroid injection
• Lumbar puncture
• Myelogram contrast dye injection
• Lumbar fusion
• Improper placement of a spinal stimulation device

Spinal Cord Injury Treatment and Recovery

Treatment options may be limited for patients with a spinal injury. Initial treatment generally relies on reducing any further damage to the spinal cord and correcting the issue that caused the damage in the first place, this may include: 

• Immobilization 
• Medication 
• Reducing pressure
• Surgery
• Treating infection

Treatments may depend on the extent of the spinal cord damage. Ongoing care may treat the conditions that affect many paralyzed individuals, such as pressure ulcer care, bowel and bladder issues, blood clots, and muscle loss. After a spinal cord injury, the patient may go through rehabilitation and therapy to learn to adapt to their spinal cord injuries. This can include: 

• Education
• Physical therapy
• Occupational therapy

Patients who suffer partial or total paralysis may require specialized equipment, like a wheelchair, adjustable bed, home modifications, bathroom modifications, and require regular in-home care. Others may have to live in a residential care facility if they are not able to receive care at home or live independently. 

Spinal Cord Injury Medical Malpractice Lawsuits

If a loved one suffered a brain infarction due to an accident or medical malpractice, talk to an experienced attorney about your options for recovery. Do not hesitate to contact Gilman & Bedigian today for a free consultation.