Spinal cord injuries
A spinal cord injury (sometimes referred to as an SCI) happens when damage occurs to any part of the spinal cord or the spinal nerves. This is usually a result of a traumatic event, and it can lead to permanent changes in the ability to feel sensations or control movement in parts of the body below the injury.
Spinal cord injuries: causes and at-risk populations
Common causes of spinal cord injuries
Spinal cord injuries are usually caused by a trauma or sudden force to the spine that causes a fracture, bruise or creates pressure on the spinal cord. This trauma can come from a variety of sources, such as:
- Car accidents, which are the leading cause of spinal cord injuries.
- A fall, the most common cause of spinal cord injuries in people over the age of 65.
- Sport-related accidents, especially for sports like mountain biking or rock climbing.
- Acts of violence, like a gunshot or stab wound, that pierce the spinal cord.
- Disease, like cancer or arthritis, that injures the spinal cord.
- Birth injuries.
- Congenital birth defects, like spina bifida.
A spinal injury may also be made worse after the initial trauma if there is swelling or bleeding.
Those most at risk
While motor vehicle accidents and serious falls are the most common causes of spinal cord injuries, other causes include sports injuries, medical or surgical injury, industrial accidents, diseases and conditions that can damage the spinal cord.
Older adults are also at risk for spinal injuries, usually as a result of falls.
However, spinal cord trauma can happen to anyone, at any time.
Anyone who suffers head or neck trauma could be at risk for a spinal cord injury, so call 911 if you or someone near you experiences trauma.
Spinal cord injury symptoms
The most common symptoms of acute spinal cord injury include:
- Muscle weakness or paralysis in the trunk, arms or legs.
- Loss of feeling in the trunk, arms or legs.
- Muscle spasticity, or muscle stiffness that prevents movement.
- Breathing problems.
- Problems with heart rate and blood pressure.
- Digestive problems and constipation.
- Loss of bowel and bladder function.
- Sexual dysfunction. In males, erectile dysfunction, or inability to sustain an erection, is common. In females, lubrication may be reduced.
Diagnosing spinal cord injuries
Call 911 for a suspected spinal cord injury
SCIs are not always easy to recognize, especially right after trauma has happened. If the symptoms or accident occur at home or in the community, call 911 immediately. Stop any bleeding and provide first aid, but do not move the injured person. The paramedics will use extreme care to treat the person and get them to an emergency room.
Once in the emergency room, providers will focus on stopping life-threatening problems (like bleeding or breathing problems). Then they will perform a series of tests on the patient’s reflexes and ability to feel or move the limbs to help identity a spinal cord injury.
Tests to confirm an SCI
If a spinal cord injury is suspected, one or more of the following tests may be done:
Imaging tests. These tests allow doctors to assess the location and severity of the spinal cord injury. Common imaging exams are:
- CT scan. A CT scanner creates detailed, cross-sectional images of various parts of the body.
- MRI. An MRI uses strong magnets and radio waves to create a detailed image of the body.
- X-rays.
Neurological exam. After life-threatening injuries have been treated and swelling subsides, a healthcare professional will perform a full neurological exam.
This involves testing a patient’s strength, response to light and stimulation, and other abilities to assess the impact of the injury and help formulate a targeted treatment plan.
Spinal cord injury treatment
Currently, there is no cure or way to reverse a spinal cord injury. People with incomplete spinal cord injuries may be able to regain some of their function as their body heals and swelling goes down. For most cases, a full recovery is not possible.
Despite this, there are many options available for managing a spinal cord injury and adapting to life afterward.
Immediate treatment
Immediate treatment for a spinal cord injury happens in the emergency room. Rapid treatment is often essential for preserving as much function as possible following an injury. Immediate treatment may involve:
- Immobilization. If a spinal cord injury is suspected, the healthcare team may use a rigid neck collar or another device to stabilize the neck
- Surgery. Surgery may be used to remove bone fragments or foreign objects (like a bullet) from around the spine. It may also be used to stabilize the spine or treat any herniated discs or fractured vertebrae that may be compressing the spinal cord. This can help prevent further damage.
- ICU care. A patient with a spinal cord injury may be placed under intensive care in an ICU. This may involve putting the patient on a mechanical ventilator if they have trouble breathing.
Ongoing care for spinal cord injuries
A spinal cord injury is a life-changing event. Depending on the location and severity of the injury, a patient may lose significant functionality and may need help to accomplish everyday activities. There are also many complications that can arise from a spinal cord injury, so ongoing care is an important part of life following a spinal cord injury.
Spinal injury rehabilitation
After immediate treatment, rehabilitation is the next step in a spinal cord injury patient’s care. The process of rehabilitation is unique to each injury. It may involve working with a variety of care professionals, like physical or occupational therapists, movement specialists, psychiatrists, nurses and others.
Rehabilitation focuses on helping maintain strength and flexibility in functional limbs, regaining fine motor skills, learning how to use devices like wheelchairs and braces, and figuring out how to navigate the world. There is also a strong emphasis on education to learn to prevent complications and stay healthy. These complications and their treatments include:
- Loss of bladder control. The spinal cord is the primary messenger between the brain and the bladder, so a spinal cord injury may limit bladder control. Additionally, changes in bladder control increase risks for kidney and bladder stones and urinary tract infections. Part of rehabilitation is learning how to manage bladder control and prevent infection. A doctor may also prescribe medications to improve bladder control.
- Loss of bowel control. Similar to bladder control, a spinal cord injury can affect bowel movement control. During rehabilitation, dietitians and nutritionists help formulate diet plans for regulating bowel control and optimizing bowel function. Prescription and over-the-counter medications can also help deal with common problems like constipation.
- Respiratory and cardiovascular problems. The spinal cord controls autonomic functions like breathing and heart rate. It also controls the chest and back muscles, which are important for coughing. These functions may be impaired by a cervical or thoracic spinal cord injury, leading to a variety of complications:
- Orthostatic hypotension (low blood pressure caused when the body moves to an upright position) is a common problem among spinal injury patients.
- Blood clots are also more common.
- Respiratory diseases like pneumonia are also more common.
All of these risks can be reduced by a combination of medications and therapies.
- Sores and infections. Loss of sensation in the skin and limbs increases the risk of developing sores, as the brain can’t tell when the skin is injured. For this reason, proper skin care and learning how to avoid sores are an important part of the rehabilitation process.
- Fitness and health. Loss of mobility can quickly lead to weakening muscles (muscle atrophy). It can also lead to a more sedentary lifestyle, increasing risk for diabetes and cardiovascular disease. Physical and occupational therapists can design exercise and wellness plans to help reduce these risks and increase patient wellbeing.
- Pain. Many spinal cord injury patients experience chronic pain. This can be from overuse of functioning muscles or, in the case of an incomplete injury, nerve pain. Medications and therapy can help address this pain.
Rehabilitation is also about helping patients take control of their lives.
In addition to helping patients navigate and prevent complications, our care team also works to empower patients. This can include helping them find live-in care providers who can help with everyday tasks, explore options to improve bowel and bladder control, such as self-catheterizing, or take control of their sexual health and fertility.
Additionally, we help patients learn to make the most of modern technologies, like electronic aids and modern wheelchairs.
Additional support
Emotional and mental health support are essential parts of care, especially after an acute spinal cord injury. Many patients experience grief, depression, and anxiety following their injury. These are normal and valid reactions that can take time to heal. This is why, in addition to physical therapy, we offer psychological therapy and other mental health support.
Some patients find that getting support from their family or support groups can also help in their healing process. These groups can help patients understand their situation and accept it.
Spinal cord injury outlook
Life will never be the same following a spinal cord injury, and the long list of potential complications that come with it can be scary to think about. However, finding a good care team and a supportive network can not only help avoid complications, but they can help any patient thrive.
Spinal cord injuries: clinical information
Complete v. incomplete SCIs
- Complete spinal cord injury. This means there is a complete loss of feeling and control in the parts of the body below the spinal injury. A complete injury affects both sides of the body equally.
- Incomplete spinal cord injury. This means there is still some feeling and control in the parts of the body below the injury. One side of the body may be more or less affected than the other.
SCI location
The location (or level) of a spinal injury refers to which spinal nerve was damaged. For instance, an injury on the seventh vertebra in the cervical spine would be denoted as a C7 complete or incomplete injury. Spinal cord injury levels are as follows:
Cervical spinal cord injury. The injury affects one or more of the nerves extending from the 7 cervical vertebrae (located in the neck). These nerves control essential automatic functions, like breathing and heart rate, as well as the function of the upper body.
- High cervical nerve injury (C1-4): this is the most severe level of spinal cord injury, as these vertebrae control essential functions like breathing and heart rate. Patients may need the aid of a mechanical ventilator to breathe. Quadriplegia (inability to move all four limbs) or triplegia (loss of function in 3 limbs) may occur, depending on whether an injury is complete or incomplete. Bowel and bladder control may be limited.
- Low cervical nerve injury (C5-C8): these nerves control motion of the fingers, hands and arms. Depending on the severity of the injury, the function of the arms, hands and fingers may be impaired, along with partial or complete paralysis of the lower part of the body. Bowel and bladder control may be limited.
Thoracic nerve injury. The injury affects one or more of the nerves extending from the 12 vertebrae in the thoracic spine. This section of the spine controls the muscles of the upper chest, mid-back and abdomen. Arm and hand function is usually normal. Depending on the vertebrae affected, control of the trunk and upper body may be relatively normal. Paraplegia (loss of feeling and movement in the legs) may occur, and bowel and bladder control may be limited. Many people with thoracic spine injuries use a manual wheelchair, walking frame or braces to get around.
Lumbar nerve injury. The injury affects the nerves in the lumbar spine (lower back). These nerves control the hips and legs, so paraplegia is common. Bowel and bladder control may be limited but can usually be managed independently using special equipment. Depending on the exact place of the injury, a wheelchair or braces may be used to get around.
Sacral injury. An injury to the sacral vertebra usually results in some loss of function in the legs or hips, but many people can walk with the help of braces or other equipment. Bladder and bowel control may be limited, but can usually be managed independently.
References
National Institute of Neurological Disorders and Stroke (NINDS). Spinal Cord Injury (https://www.ninds.nih.gov/health-information/disorders/spinal-cord-injury)
American Association of Neurological Surgeons (AANS). Spinal Cord Injury (https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Spinal-Cord-Injury)
MedlinePlus: National Library of Medicine. Spinal Cord Injuries (https://medlineplus.gov/spinalcordinjuries.html)