The discussion breaks down:
How pressure on the spinal cord causes progressive nerve damage
Why even short delays in decompression can permanently affect mobility
How patients may initially walk into a hospital with mild symptoms — but deteriorate rapidly
The anatomy of the spinal cord and why it is so vulnerable to delayed care
Real-world medical scenarios involving trauma, infections, and post-operative complications.
The Vigna Law group created this episode is designed to educate patients, families, and medical professionals on why rapid response is essential and how early intervention can be the difference between recovery and lifelong disability.
Learn more about spinal cord injuries HERE: https://vignalawgroup.com/
Call NOW if you've suffered from a spinal cord injury: 817-809-9023
TRANSCRIPT:
B: I'm Ben C.
V: I'm Doctor V.
The Medical Legal Guys.
V: Our topic today is a concept called time is spine.
B: What does that mean?
V: It relates to the onset of a spinal cord injury, and the time between the onset of neurological symptoms that relate to a spinal cord injury, and the time to the operating room to take pressure off the spinal cord. So injuries to the spinal cord can be caused by physical trauma. It can be caused by medical problems. So a physical trauma is a motor vehicle accident where there may be a fracture dislocation of the spine.
A person is taken by the ambulance to the emergency room, and then they are taken to the operating room to take the bone, crushing the spinal cord and decompress the spine.
B: Clear this up for me. So the spinal cord. Right? That's what you mean. Decompression of the spinal cord and the spinal cord. Is that a nerve?
V: The spinal cord connects to the brain and descends from the goal all the way to the sacrum. And on the way it sends out the the nerve roots that turn into nerves as those nerves and supply the arms the bowel, bladder, heart, colon, all that, all the organs and your lower extremities is.
B: A spinal cord, a bony structure?
V: No spinal cord is made of hundreds of millions and potentially billions of neurons that are nerve conducting.
B: So all right. And does the spinal cord, which you said is not a bony structure, does the spinal cord sit within a bony structure?
V: Yes. The spinal cord is by the spinal column. If you have infection of the bones around the spinal cord, that infection can press on the spinal cord and cause a spinal cord injury. You could have a spinal cord injury from a broken back where the bones are fractured, and some of those fractured fragments go into the spinal cord.
Whenever there is a spinal cord injury from pressure or trauma, the treatment is to take that pressure away and stabilize the spine. And that leads to the concept of time as spine, that the longer the spinal cord is under pressure, the less ALP.
B: The less chance of a good out. Why is it that shorter time is better, right? Why is it that just generally the fewer seconds or minutes that it takes to get to where there is an actual decompression and decompression of the spine?
V: Meanwhile, a removal of whatever is pressing on the spinal cord.
B: Cord okay, and pressing on the spinal cord is bad why?
V: Because changes neurological function. If the pressure is severe for a short period of time, the injury can be permanent. If it's if the pressure is not horrible, it could be reversible if you take the pressure off.
B: But even a lesser pressure over a longer period of time can create the same or even a worse situation, then greater pressure for a shorter period of time, right?
V: Correct. And time as spine. They've been studying this for the last 50 years and the conclusion is now that the best outcomes occur within 24 hours, and that a person who's having neurological loss because of pressure or injury to the spinal cord, those patients should be decompress within 24 hours unless there is some other significant medical problem, such as a brain injury or a heart attack, or worse, significant bleeding, that you can't decompress.
Okay, there are some medical conditions that would take priority over a spinal cord injury, but those are catastrophic cases. But we're going to be talking about the patients who present to the hospital who are walking and not diagnosed with a spinal cord injury, then get admitted and then become paralyzed when we see those cases all the time.
B: So we're going to talk about patients that walk into the hospital, but they don't walk out of that hospital water to the causes for that.
V: The big causes for that are infection. And where patients might come in sick, they have fever. They're obviously getting septic or hypertension, and they're running fever.
B: Of septic means that's an infection of the blood, isnt it?
V: Infection. It's in the blood. And there are significant negative effects from that infection that is causing a person to be maybe confused. And these patients walk into the emergency room, they're sick. They're diagnosed with the pneumonia, but they may have severe back pain. They may have numbness in the legs. They may have some developing weakness, but they're admitted for pneumonia and they miss the opportunity for that diagnostic test.The MRI, the CT milligram that can diagnose a pending spinal cord injury.
B: So you've outlined one way and one reason and basis that somebody can walk in and not walk out. And that is:
V: the infection...It can also be that people sometimes have bleeding around the spine where they have -
B: that causes bleeding can cause pressure, right?
V: Yes. A hematoma where that blood collection that presses on the spinal cord that causes neurological loss.
B: Now I'm going to guess that in some ways, a spinal cord is resilient. Right. But you don't just touch a spinal cord and all of a sudden you become paralyzed. So it's a resilient material and obviously resilient part of the anatomy in some respects. But we know now that pressure on the spinal cord then can lead to catastrophic problems. Can you explain that a little bit?
V: Well, pressure if there's pressure on the spinal cord it could lead to symptoms. And then the main symptom is pain. Or it could also be numbness. If you have a thoracic bleed or a thoracic infection, you could have pain that goes around the ribcage. You could have some numbness of the legs. You could have problems with walking. So any symptom of back pain with neurological weakness, those people need to get a scan.
And we have clients who have come to us, who walk into the hospital and then ultimately have progressive neurological loss on the floor. And there's a delay in diagnosis, a delay in the nurses communicating with doctors of neurological findings. Patients are not getting decompressed in a timely fashion. They walk into the hospital, they leave in a wheelchair. They go to rehab.
If there is a scenario such as that, those are cases that we would want to evaluate and review. Me being a spinal cord injury doctor, I understand the standards of care and we could, you know, have an answer pretty quick in terms of if we have a case or so.
B: There is a concept that you might want to talk about. I think most people know a little bit about this. Have I have some knowledge of the fact that at the level of the spinal cord, where the pressure is such that it damages the spinal cord and therefore damages the nerves and creates a situation, sometimes it's called necrosis, which is the death of tissue.
Right. So at the level of your spinal cord, the higher the level of injury, the less function you're going to have at a certain level of your body. In other words, if you're talking about the cervical spine, which is a C1 through the C7, that's the top right, you have a cervical spine injury that creates pressure at one level, say the C2 or the C3, because it goes up to down 1 to 7, right. You're up close to the brain C 2 or 3. That's going to be usually more problematic than if you have, let's say a spinal cord injury that is down near the lower spot.
V: So in terms of the levels of injury as a rehab doctor working with neurosurgeons and orthopedic surgeons, injuries that happen at the level of C2 three that would affect breathing and everything lower C5 injuries affect the shoulder, so people have weakness of the shoulder pain to the shoulders. If it advances to affect the whole spinal cord. Everything lower C6 wrist extension, C7 elbow extension C8, T1 hand function, thoracic T6 is out, the nipple line everything lower so you have the level of injury and distal loss -
B: Distal meaning away from..?
V: From the side of injury. Yeah. And further away from the brain. You know, of course, people who go to the hospital with serious medical problems, they have various complaints, they have various symptoms and signs. But the clients that we need to see and evaluate are those who walk into the hospital or have symptoms that aren't as severe when they present, and then they get worse in the hospital and they aren't decompress.
So we have a client in Los Angeles, an example. He was riding a bike and then couldn't ride his bike and was sitting on the curb, and he was taken to the emergency room, diagnosed with pneumonia and then diagnosed with an epidural abscess that is right next to the spinal cord. And he didn't get decompress for eight days. And he required a lot of function, a lot of help. He couldn't turn, he couldn't walk. He had progressive loss of mobility and strength, and he didn't get decompress. And he could have been saved.
B : yeah, time is spine.
V: Time is spine.
