The physical and emotional consequences from a spinal cord injury (SCI) can be devastating. Loss of spinal cord function can affect activities that are autonomous (e.g. breathing) as well as thought-driven actions such walking.

According to the National Spinal Cord Injury Association (NSCIA), the most common spinal cord injury results from a motor vehicle accident (42%) and violence (24%), falling (22%), or sports (8%) are the other main causes.

Occasionally SCIs are caused by diseases such as polio. Spinal cord injuries are usually described using the following terms :

Paraparesis : A slight degree of paralysis affecting the lower extremities

Paraplegia : Complete paralysis of both lower extremities and usually the lower trunk. The upper extremities are not involved.

Quadriparesis : Partial paralysis of all four limbs (arms, legs)

Quadriplegia (or Tetraplegia) : Complete paralysis of all four limbs.

Other terms used to describe neural dysfunction include :

Paresis : Partial paralysis

Paralysis : Partial or complete loss of motor function

Paresthesias : Abnormal sensation such as burning or tingling

The spinal cord does not have to be severed for function to be lost. Most people with spinal cord dysfunction present with the cord intact. Cord injuries usually fall into one of the following categories :

• Contusions, or bruising of the spinal cord
• Compression injuries that place pressure on the cord
• Lacerations or tearing (e.g., from a bullet)
• Central Cord Syndrome
• Complete severing (rare)

When injury occurs and for a time period following, the spinal cord swells. Loss of function occurs below the level of the injury and may be permanent or temporary. Much depends on the severity of the injury.

Symptoms may include loss of motor function, sensation or proprioception. The nerves responsible for these functions transmit their messages through the muscles, tendons, joints and other organs.

Destruction of sensory nerve fibers may lead to loss of sensation such as touch, pressure, and temperature. Reflexes may become exaggerated, bladder and bowel control may be lost, even the ability to breath normally may be compromised.

Diagnosis
When spinal cord injury is suspected (e.g., spinal fracture) immediate medical attention is required. Spinal cord injury (SCI) is usually first diagnosed when the patient presents with a loss of function below the level of injury.

The initial evaluation includes x-rays, a CT scan, and possibly a MRI. Fractures are demonstrated on plain radiographs. CT scanning and MRI studies are used to evaluate the soft tissues in the spinal column. In addition, a myelogram may be performed to identify and evaluate spinal cord lesions caused by trauma or disease.

The neurologic evaluation includes assessment of the patient's symptoms, which might include loss of motor or sensory function. Other neurologic symptoms may include pain, numbness, paresthesias (e.g., tingling), muscle spasm, weakness, and bowel/bladder changes.

What Are Spinal Tumors?
Spinal tumors rarely occur and are either benign or malignant. Some tumors are known to metastasize (spread) via arteries, veins, the lymphatic system, and directly. Malignant tumors of the breast, prostate, lung, and kidney can spread into the spine. Spinal tumors can be dangerous when they cause spinal canal compression, which may lead to neurologic dysfunction (e.g. paralysis).

Many patients will present with back pain as the primary symptom. The pain can occur at rest, be worse at night, and may or may not be related to activity. Other symptoms may include sciatica, numbness, paraparesis (slight paralysis), spinal deformity (e.g. scoliosis, kyphosis), and fever.

Benign Spinal Tumors
Osteochondroma is a slow growing tumor of the cartilage usually affecting adolescents. It is uncommon and is usually found in the posterior (rear) spine.

Osteoid Osteoma is a small bone tumor (less than 2 cm). It usually affects adolescents causing night pain and may result in spinal deformity.

Osteoblastoma affects children and adolescents. These tumors can be large, aggressive, and painful sometimes causing spinal deformity and paralysis.

Aneurysmal Bone Cysts (ABCs) typically cause pain and swelling usually affecting children and adolescents. These tumors can be large and quite vascular.

Giant Cell Tumor is known to affect children, adolescents and young adults. These tumors can be found at the cervical, thoracic, or lumbar segments of the spine, but are more common in the sacrum.

Hemangioma occurs most often in the thoracic spine. These tumors affect adults and are known to be progressive vascular masses that can cause vertebral collapse and paraparesis (slight paralysis).

Eosinophilic Granuloma is usually seen in the vertebral bodies of children and adolescents. When this tumor is systemic it is termed Histiocytosis X. Rarely do these tumors lead to vertebral collapse and paraparesis. On occasion, they may heal spontaneously.

Malignant Spinal Tumors
Plasmacytoma presents in middle aged and older adults. These tumors are common in the pedicle and vertebral body and may cause paraparesis.

Ewing's Sarcoma is an aggressive tumor affecting adolescents and young adults. In some cases, it may metastasize.

Lymphoma may present in one or more vertebral bodies in middle aged or older adults. Sometimes the lymphatic system is involved.

Chondrosarcoma is a tumor affecting spinal cartilage in middle-aged adults. It grows slowly but can be dangerous. Usually aggressive medical intervention is required.

Osteosarcoma is bone cancer found in adolescents and middle-aged adults. These tumors may metastasize requiring aggressive medical therapy.

Chordoma is usually seen in adults frequently (50%) involving the sacrum, although it can affect other parts of the spine. These tumors often require aggressive medical therapy.

Spine pain does not always indicate tumor presence. However, early medical intervention is always warranted if spine pain does not resolve or if neurologic deficit is experienced.

Description and Diagnosis
The term sciatica is commonly used to describe pain traveling in the distribution of the sciatic nerve. Sciatica is a symptom caused by a disorder occurring in the lumbar spine. The sciatic nerve is the largest nerve in the human body, about the diameter of a finger.

Inflammation of the Sciatic Nerve - Sciatica is a condition which causes pain down the back of one or both thighs. Inflammation of the sciatic nerve (which is the largest nerve in the body-about the diameter of your little finger) can be either constant or intermittent. Success in solving this problem is directly correlated to the diagnosis. Sciatica can be caused by a pinched nerve as it exits the low back spine or it can be caused by prostatic cancer. Odds are usually that the cause is some structural imbalance, but there are so many potential causes, some serious and some benign, it is better to at least know that there may be a grave cause to the symptoms.

This doesn't mean that you shouldn't immediately incorporate a strategy to eliminate any structural imbalances. In most cases, this will resolve the problem. If the problem doesn't respond to these basic efforts, then professional assistance may be needed.

Trigger points can accumulate in the piriformis muscle forcing a contraction and strangulation of the sciatic nerve. The tennis ball exercise should be incorporated to help to relax the piriformis muscle. Stretching may be beneficial, but that is more of a "try and see" exercise.

If there are no improvements with this approach, refer to Low Back Pain to better understand the relationship between the sciatic nerve and the low back spine. Seeking help from a chiropractor or orthopedist may be indicated if the sciatica solution can't be found at home.

Sciatic nerve fibers begin at the 4th and 5th lumbar vertebra (L4, L5) and the first few segments of the sacrum. The nerve passes through the sciatic foramen just below the Piriformis muscle (rotates the thigh laterally), to the back of the extension of the hip and to the lower part of the Gluteus Maximus (muscle in the buttock, thigh extension). The sciatic nerve then runs vertically downward into the back of the thigh, behind the knee branching into the hamstring muscles (calf) and further downward to the feet.

Sciatica Symptoms
Usually sciatica affects one side of the body. The pain may be dull, sharp, burning, or accompanied by intermittent shocks of shooting pain beginning in the buttock traveling downward into the back or side of the thigh and/or leg. Sciatica then extends below the knee and may be felt in the feet. Sometimes symptoms include tingling and numbness. Sitting and trying to stand up may be painful and difficult. Coughing and sneezing can intensify the pain.

The Cause : Nerve Compression
Compression of the sciatic nerve can cause any of the above-cited symptoms. Rarely is nerve damage permanent and paralysis is seldom a danger as the spinal cord ends before the first lumbar vertebra. However, increasing trunk or leg weakness, or bladder and/or bowel incontinence is an indication of Cauda Equina Syndrome, a serious disorder requiring emergency treatment.

Lumbar spine disorders known to cause sciatic nerve compression include the following :

• Herniated discs are the most common cause of sciatica in the lumbar spine.
• Degenerative Disc Disease, a natural biological process associated with aging, is known to cause disc weakness that can be a precursor to a disc herniation.
• Lumbar Spinal Stenosis is a narrowing of one or more neural passageways due to disc degeneration and/or facet arthritis. The sciatic nerve may become impinged as a result of these changes.
• Isthmic Spondylolisthesis results from a stress fracture often at the 5th lumbar vertebra (L5). The fracture combined with disc space collapse may allow the vertebra to slip forward on the first sacral segment (S1). The slippage may cause the L5 nerve root to become pinched as it leaves the spine.

Spinal Tumors and Infections are other disorders that may compress the sciatic nerve, but this is rare.

There are other conditions, which may occur, and may mimic true sciatica but these are difficult to diagnose.

Diagnosis of Sciatica
The physician's examination includes the patient's medical history, a review of current medications, a physical and neurologic examination and, if warranted, x-rays, CT scan and/or MRI. A proper diagnosis requires an analysis of the patient's pain. The patient is often provided a Pain Diagram to illustrate pain distribution and sensation (eg, tingling and burning).

The physician's questions may include :

• "How did the pain develop?"
• "On a scale from 1 to 10, with 10 being the worst pain imaginable, rate your pain."
• "Is the pain worsened by walking uphill or downhill?"
• "How does the pain affect activities of daily living?"
• "What type of treatment has been tried and what was effective?"

The patient's range of motion is observed. Reflexes and muscle strength are tested. The physician may use one or more movement tests to determine the source or cause of the pain.

Sciatica : Treatment and Recovery
Treatment - Non-Surgical Treatment
Sciatica often responds well to non-operative forms of treatment and rarely requires surgical intervention. Time, non-steroidal anti-inflammatory (NSAIDs) medication, short-term use of a narcotic for acute pain, lumbar injections, and physical therapy are beneficial.

Although short-term bed rest is recommended during the acute phase, some activity is good. In this scenario "activity" is defined as being up for periods of time that will not cause severe pain. Prescribed exercise may include light stretching, walking, and aerobic type exercise.

Surgery
Surgery is not for all patients. However, in some situations, surgery may be indicated. Patients who have followed a non-surgical course of treatment for four to six weeks without relief certainly require a re-evaluation by their physician. If a MRI scan reveals a herniated disc or spinal stenosis, surgery may provide relief of the leg pain. The type of surgical procedure is dependent in part on the patient's condition and diagnosis

Recovery
Whether treatment for sciatica is non-operative or surgical, it is always wise to follow the instructions provided by the doctor and/or physical therapist.

Work toward relieving unnecessary mechanical stress to the spine. For example, when standing, alternate resting one foot on a stool. When driving, place a small pillow or rolled towel behind the back to maintain natural spinal curvature. At bedtime, sleep on the back with a pillow under the knees or between the knees if sleeping on the side.

Strive to eat healthy, work toward your ideal body weight, and avoid smoking. These lifestyle changes all benefit the spine's health.