Transcription:
Options for Treating Spinal Cord Injuries

Melanie Cole (Host):   Spinal cord injuries often profoundly affect a patient's life. What treatment options are available for these very serious injuries? My guest today is Dr. Dennis Vollmer. He's a board certified neurosurgeon who specializes in spinal surgery. Welcome to the show, Dr. Vollmer. First, tell us, what are some of the most common causes of spinal cord injuries?

Dr. Dennis Vollmer (Guest):   Well, in general, the most common cause of spinal cord injury is motor vehicle accidents. But, in certain age groups, particularly the elderly, falls then become a very common cause. Less common things that people need to at least be aware of are injury mechanisms like diving into shallow water and also certain athletic events carry some risk of spinal injury. Things like skiing and some competitive sports, one needs to be coached in the proper techniques to avoid these risks.

Melanie:   So, what can people do to avoid those risks? If you're going to go skiing, would a helmet keep you from getting a spinal cord injury? Does a seatbelt help in a car? Tell us about any way that we can, that would give people a little bit of prevention advice.

Dr. Vollmer:   Well, you know, some injuries are just not entirely preventable but certainly safe defensive driving practices are a good place to start in the car, wearing your seatbelt, making sure your car is in good operating condition so that the tires have adequate treads. All of these kinds of things can reduce your likelihood in being involved in a serious accident where you can sustain a spinal cord injury. Now, when it comes to falls, that's a very common area where simple adjustments in how one lives their life can reduce their risk. In the elderly, often falls are caused by environmental hazards:  loose rugs, slippery surfaces, poor shoes, and also things like impaired vision. So, making sure your vision care is up to date so you can see the hazards. Poor lighting is another issue. So, there are many things that elderly folks can do to reduce their own fall risk and if there are questions or they've fallen before, they should really get with their physician to make an assessment of how this could be prevented.

Melanie:  People hear the word spinal cord injury and right away they think “paralysis”. Does it always lead to paralysis? And, please explain those types--paraplegia and quadriplegia--so people have a better understanding.

Dr. Vollmer:  So, to answer the first question, spinal cord injury is a continuum. Unfortunately, the margin between a partial injury to the spinal cord and a complete injury is relatively narrow. But that being said, many patients come to medical attention after an injury with residual function and that's a world better situation when it comes to the likelihood of some return of function. The term quadriplegia, quadriplegia literally means paralysis of all four limbs. Paraplegia refers to paralysis of the lower extremities and that has more to do with the level of injury, in other words, a quadriplegia relates to injuries of the cervical spinal cord in the neck versus paraplegia where it's generally something that occurs below the nervous outflow to the arms and affects the legs primarily. Of course, in both instances, bowel and bladder function can also be affected, so these are very devastating injuries.

Melanie:  Are there treatment options available? Because nerves take so long to heal, in the case of a spinal cord injury, do they heal or is this something permanent?

Dr. Vollmer:  Well, nerves do have some capacity to heal. If somebody has a complete injury with complete loss of function below the injury, generally the prognosis is quite poor. People who have residual function across the injury site do have the potential to recover. In many respects, once the injury has occurred, certain things cannot be recovered. Our focus in the health care system is to optimize the situation and prevent what we call “secondary injury.” That is injury that can occur because of associated problems. For instance, somebody who is involved in a motor vehicle accident may injure their spine and thereby their spinal cord but can also have problems with a lung injury or other types of trauma that an effect their ability to recover from the spinal cord injury. So, a comprehensive approach has to be taken in that patient to address all of these other associated injuries to minimize their effect on the healing spinal cord.

Melanie:  So, speak about treatment options and even therapy afterward to resume some sort of normalcy in life.

Dr. Vollmer:  The treatment options, initially, when someone presents with a spinal cord injury, unfortunately, there is no silver bullet to reverse many effects of the injury. Our goals in many patients are to repair the associated spinal damage to prevent further injuries:  stabilize the spine, realign the spine, and protect the cord in that respect. In some cases, the cord can be decompressed and this can help, but it doesn't necessarily reverse things. There are clinical trials that are ongoing. We're participants in a large multi-center trial here at UVA of some promising investigational drugs to try and reverse some of the effects or prevent secondary injury. But, again, these are really investigations. We are optimistic but the data is still pending as to how effective these things will be. Some of the treatments really are directed at optimizing function in the context of some irreversible or only partially reversible injury. That's where comprehensive rehabilitation efforts come into play. At UVA, we have people who specialize in physical medicine and rehab of the patient with spinal cord injury. These physicians and specialists will work with patients to teach them how to function in the context of some deficit, whether it's some weakness or numbness or an increase in muscle tone that sometimes occurs that we call “spasticity”. All of these things can limit mobility and function and then, we have ways, both physical modalities of treatment as well as drug therapies, that help with that.

Melanie:  Dr. Vollmer, what do you want the loved ones of those who have suffered a spinal cord injury to know? What do you tell them, generally?

Dr. Vollmer:  Well, I try and tell them that a spinal cord injury, that while it may initially appear devastating, may not preclude that person from living a very satisfying, rewarding life. I've worked with patients who've had severe, complete cervical cord injuries that have gone on to get married, raise a family, hold a full time job and even drive a vehicle. So, these injuries, while they're quite devastating, and, especially to the families who love these individuals, they're not the end of hope. Many times, there is improvement as well. So, if the patient is cared for, optimally, there can be recovery, particularly with incomplete injury. When the injury is incomplete, we certainly have a high degree of optimism that we're going to see improvements.

Melanie:  In just the last minute, why should patients come to the UVA Neuroscience Center for their care for their spinal cord injuries?

Dr. Vollmer:  Well, of course, many times these things happen suddenly and patients don't have a lot of time to weigh their options. Many times, there aren't options. You need to get them into care as soon as possible. The thing about UVA is that it has a broad range of surgical and medical specialists who are available to provide really comprehensive care for patients who have suffered these unfortunate injuries. Much of the optimization of care really goes beyond what we do in the spinal surgery realm and includes people like respiratory therapists, pulmonologists, cardiologists, intensive care physicians and a whole range of others. Those kinds of teams of expertise are not available just anywhere and that's why I think UVA stands out, certainly in our region, as a leader in this kind of care.

Melanie:  Thank you so much, Dr. Vollmer. That's great information and I applaud all the great work that you do. You're listening to UVA Health Systems Radio. For more information you can go to UVAHealth.com. That's UVAHealth.com. This is Melanie Cole. Thanks so much for listening.