However, there are very few cases where the resulting disability cannot be overcome with good care, both at the scene of the accident, preventing further damage, and well organised rehabilitation both in hospital and afterwards.

Initial management

Spinal cord injury often accompanies head injury so anyone first at the scene of an accident where there is an obvious head injury has a vital role to play. Unless someone is in a car which is about to burst into flames, or in a very precarious position over the side of a cliff, do not move them until expert help arrives. If you have paramedical training then you will know what to do, but if you do not, leave well alone!

Once the paramedical team arrives the head and neck are stabilised, and the patient is not transferred until on a spinal board. Blood pressure, airways and any other injuries are stabilised and the patients transferred to hospital.

Types of spinal cord injury

Once in hospital the level of the injury can be determined. In a conscious patient examination will focus on back or neck pain, decreased or no power in the limbs, loss of sensation at a certain level, and loss of reflexes.

Injuries above the neck vertebrae level C5 (C for cervical) cause quadriplegia with weakness in the arms. Injuries between C5 and C7 cause varying amounts of weakness in the muscles of the upper limbs and shoulder girdle, depending on where the injury is.

Injuries at and below the thoracic vertebrae level T1 cause paraplegia. The precise level of the cord injury can be determined from the level at which sensation is lost.

Some injuries are potentially reversible if surgery is performed early. Decompression of the cord within two hours of injury may, in some cases, lead to some recovery of cord function. If there is an obvious spinal column fracture then it is important to find out whether the fracture is compressing the cord, if there is any instability or malalignment which will lead to compression in the future and to initiate the correct treatment of the fractures. Some will simply need bed rest for two to three months, others will require surgery to stabilise them.

An injury high in the neck, at the first two vertebrae, called the atlantoaxial junction, is generally fatal. Death results from respiratory failure. However, recent advances in supportive care have meant that some people with injuries high up in the neck can now survive, but with very little function and generally dependent on a ventilator for all or part of the time.

Acute management

In the acute phase of spinal cord injury the bladder, cardiovascular system and gastrointestinal system need care.

Initially the bladder does not have the normal reflexes associated with emptying and will retain urine. This can cause damage to the muscle which allows for reflex emptying through overdistention. The patient generally has the bladder emptied either through intermittent catheterisation or, initially, through a permanent indwelling catheter. The latter is less popular since it can predispose to infection.

In the acute stages of injury spinal shock can cause either very low or very high blood pressure, which needs special care.

The gastrointestinal tract may develop lack of mobility, called an ileus, resulting in nausea and discomfort. Stress ulcers may also occur.

Because the patient is immobile, pulmonary embolus (a clot in the lung) may occur. In some centres patients are given heparin to prevent this.

High cervical cord lesions cause varying degrees of mechanical respiratory failure which needs artificial ventilation.

Long term management

Most spinal injuries are dealt with in specialised centres where all aspects of care are dealt with from the first day of admission by a team of doctors, nurses, physiotherapists, occupational therapists and psychologists and social workers.

Many people find that they are able to return to a near normal life with the correct equipment and training in bladder, bowel and pressure care.

However, we still have a long way to go before society is prepared to integrate disabled members of the community. Many buildings in this country are still inaccessible to wheel chairs, and those buildings which are accessible may still not have adequate toilet facilities. Parking bays reserved for the disabled are frequently abused by the able-bodied. Employers need enough education to realise that a disabled person is as useful in any sedentary job as any able-bodied person. All this will only come through education and awareness.