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THORACIC AND SACRAL SPINAL CORD INJURY
Thoracic Spinal Cord Injury
The thoracic spinal cord is protected by vertebrae that are stabilized by a marvelous anatomical bracing system – the rib cage. Because of this protection, thoracic spinal cord injuries are uncommon, but this region can be injured in shootings, stabbings, and severe accidents. Some patients require surgery to decompress the thoracic spinal cord, and surgery can be difficult because this part of the spinal cord is so close to the lungs and kidneys. Most patients need to wear a brace on the trunk after surgery, to provide extra stability to the healing vertebral column.
Traction is typically not needed, given the stability provided by the rib cage.
Lumbar or Sacral Spinal Cord Injury
With trauma to the lower back (sacral vertebrae); the injury often occurs in the cauda equina, not the spinal cord itself. If the injury involves the uppermost part of the lumbar vertebrae, the lowermost portion of the spinal cord, the conus medullaris, may be damaged. Injuries of the conus medullaris and the cauda equina usually cause weakness of the lower limbs and loss of bowel and bladder control.
These injuries often require surgery and external spinal stabilization, because the lower back has no bony protection to hold the vertebrae in alignment. Several kinds of external stabilization are used. The first is the thoraco-lumbar-sacral orthosis (TLSO), or “clam shell” brace. The TLSO is a custom-molded, form-fitting device that surrounds the body, front and back, extending from the upper back and chest down to the lower back and groin. It usually has Velcro straps so that it can be removed for bathing. For lesser degrees of external stabilization, various other back braces and corsets with metal stays are used. These are more comfortable than the TLSO but provide less support to the spine.
*9/156/5*