Lesión de la médula espinal

A spinal cord injury means the bundle of nerves inside the spine has been damaged, so messages between the brain and parts of the body below the injury are partly or completely disrupted. This can affect movement, feeling, bladder and bowel control, blood pressure, and even breathing, depending on where and how bad the injury is.​

1) What is this condition?

  • The spinal cord (the “information highway” between brain and body) is bruised, compressed, cut, or otherwise damaged by trauma (falls, car crashes, sports, violence) or sometimes non‑traumatic causes (tumors, infection, arthritis).​

  • Injuries can be “complete” (no movement or feeling below the level) or “incomplete” (some signals still get through), and can occur anywhere from the neck to the low back.​

2) How serious is it?

  • Emergency warning signs after an accident include: severe back/neck pain, weakness, numbness, loss of feeling, loss of bladder/bowel control, trouble walking, or trouble breathing.​

  • Spinal cord injury is medically very serious because it can cause permanent paralysis, breathing failure, dangerous blood‑pressure swings, and life‑threatening complications, especially in the first year.​

3) Non‑surgical treatments

  • Initial care in hospital or ICU:

    • Immobilizing the spine, supporting breathing and blood pressure, and preventing low oxygen or low blood pressure that can worsen cord damage.​

  • Medicines and medical care:

    • Pain control, blood‑pressure support, prevention of blood clots, pressure sores, and infections; high‑dose steroids are used much less now and only in select cases.​

  • Rehabilitation:

    • Intensive physical therapy (strength, stretching, balance, walking or wheelchair skills) and occupational therapy (self‑care, transfers, equipment training).​

    • Assistive devices such as wheelchairs, braces, standing frames, and sometimes electrical stimulation or robotic gait training.​

4) What type of surgery may be necessary?

  • Decompression: removing broken bone, disc, or thickened tissue that is squeezing the spinal cord or nerves.​

  • Stabilization/fusion: placing screws and rods, sometimes with bone graft, to realign and hold unstable vertebrae so they no longer move dangerously.​

  • Surgery can be done from the front, back, or both sides of the spine, depending on where and how the spine is injured.​

5) Goals of surgery vs non‑surgical care

  • Non‑surgical goals:

    • Protect the spine and spinal cord, prevent further damage, and aggressively manage complications (lungs, skin, bladder, blood clots, pain).​

    • Maximize remaining function and independence through long‑term rehabilitation and adaptive equipment.​

  • Surgery goals:

    • Relieve pressure on the cord/nerves, restore better alignment, and stabilize the spine so it cannot collapse or shift.​

    • Create conditions that give the best possible chance for neurologic recovery and allow earlier, safer mobilization.​

6) If surgery is necessary, how will it fix the problem?

  • Decompression surgery opens more space around the cord and nerves by removing bone fragments, disc material, or thickened ligaments that are crushing them.​

  • Stabilization/fusion uses screws and rods anchored in healthy vertebrae above and below the injury; these are connected and supported with bone graft so the segment heals into a solid block over time.​

  • Early decompression (preferably within 24 hours) has been shown to be safe and is linked with better neurologic outcomes in many studies.​

7) Risks of surgery (general and specific)

  • General risks: infection, bleeding, blood clots, lung or heart problems, and anesthesia complications, especially in multi‑injury trauma patients.​

  • Spine‑specific:

    • Worsening weakness or numbness if the cord or nerves are further injured during surgery.​

    • Hardware failure or failure of the bones to fuse, which may require additional surgery.​

8) Chances this surgery will work

  • Surgery is usually effective at stabilizing the spine and preventing further mechanical damage; neurologic recovery depends mostly on how severe the initial injury was.​

  • Large studies and guidelines show that decompression within 24 hours is associated with higher odds of meaningful neurologic improvement, especially in incomplete cervical injuries.​

9) Possible complications from the surgery

  • Wound infection, spinal fluid leak, or blood clots in the legs or lungs can occur, particularly after large fusions.​

  • Persistent pain, spasticity, or deformity despite technically successful surgery.​

  • Medical complications such as pneumonia, pressure sores, urinary infections, and autonomic blood‑pressure crises are common after severe spinal cord injury and require ongoing prevention.​

10) Typical recovery from the condition (overall)

  • Recovery usually happens in phases: acute hospital care (days–weeks), inpatient rehab (weeks–months), and then long‑term outpatient rehab and adjustment.​

  • People with incomplete injuries (some preserved movement or feeling) have a better chance of regaining walking and hand function than those with complete injuries.​

  • Many complications can arise (spasticity, chronic pain, bladder/bowel issues, pressure sores, bone thinning), so ongoing medical and rehab care are essential.​

11) Typical recovery after surgery

  • Early days: intensive monitoring, pain control, prevention of complications, and very early sitting or standing with help if safe.​

  • Weeks to months: focused rehab on transfers, wheelchair skills or walking, hand function, self‑care, and community re‑entry.​

  • Neurologic improvement, when it happens, is usually fastest in the first 6–12 months but can continue more slowly afterward; rehab remains useful long term.​

12) How long in the hospital

  • Uncomplicated, lower‑severity injuries may need about 1–2 weeks of acute hospitalization before moving to rehab.​

  • More severe injuries with major surgery, breathing support, or complications can require several weeks or longer in hospital before transfer to a specialized rehab center.​

13) Long‑term outlook

  • Life expectancy is reduced compared with the general population, especially for high neck injuries requiring ventilators and in low‑resource settings, but has improved with modern care.​

  • Many people with spinal cord injury live for decades, work, have relationships, and participate actively in life with the right equipment, support, and environment.​

  • Long‑term issues (pain, spasticity, bladder/bowel and sexual dysfunction, mood changes) are common but can often be managed with coordinated care.​

14) Need for outpatient follow‑up

  • Lifelong follow‑up with rehabilitation medicine and primary care to monitor skin, lungs, bladder, bowel, bones, circulation, and mood.​

  • Regular physical and occupational therapy “tune‑ups” to adjust equipment, maintain strength, and prevent contractures.​

  • Periodic review by spine surgery and/or neurology if there are changes in pain, posture, or neurologic symptoms that might signal late complications.