Our 14-year-old son was in a terrible bike accident last night. They have him in ICU and are trying to stabilize him in order to do surgery. There’s a bone fracture in the lower thoracic spine that is pressing on his spinal cord. They say he could be paralyzed but they won’t know for awhile. How long does it take to know for sure about things like this?

In this review article, neurosurgeons from Thomas Jefferson University Hospital in Philadelphia take a look at the diagnosis, treatment, and results of treatment for spinal cord injuries. They focus specifically on fractures and cord injury at the thoracolumbar area.

The thoracic spine ends at T12 (the last thoracic vertebra). The lumbar spine (L1) begins right after T12. The union between T12 and L1 is call the thoracolumbar junction. Spinal cord injuries at this level can result in one of two neurologic injury syndromes. These are the cauda equina syndrome (CES) and the conus medullaris syndrome (CMS).

The word “syndrome” tells us that each one of these conditions is defined by a set or collection of signs and symptoms that are always present. The cauda equina syndrome affects the spinal cord where the main cord ends and a “tail” of nerves forms down to the tip of the tailbone and down the legs. The conus medullaris syndrome occurs when the injury has affected the area between the spinal cord and the spinal nerve roots.

Injuries to these areas of the spinal cord are most often the result of car accidents or traumatic sports injuries in young patients. At first, the spinal cord may go into “shock.” The patient loses all function below the level of the injury. There may be paralysis of the legs, loss of bowel and bladder control, and for men, loss of penis erection. These symptoms may last a short time with recovery in 24 to 48 hours or there may be a longer period of time for recovery (several weeks).

The ultimate (final) prognosis does not depend on early recovery of function. Instead, the timing of surgery may be a better indicator. Some studies show that surgical decompression (taking pressure off the spinal cord, spinal nerve roots, or other neural tissue) within the first eight to 48 hours yields the best results. Other factors that may impact prognosis are age (younger age patients have better results) and the presence of blood within the spinal column (as seen on MRI — blood is a poor prognostic sign).

Your son’s medical and surgical team will do everything they can to stabilize him and his spine. The two main goals of any treatment for spinal cord injury are first to stabilize the spine and second to restore as much neurologic function as possible. Surgery is required to accomplish both goals. Early stabilization of the spine surgically is the key to the best result.