Acute Spinal Cord Injury

What is an acute spinal cord injury (SCI)?

The spinal cord is a bundle of nerves that carries signals between the brain and the rest of the body. Acute spinal cord injury (SCI) is due to a traumatic injury. The injury may cause a bruise (contusion), a partial tear, or a complete tear (transection) in the spinal cord. SCI is more common in men and young adults.

SCI results in a decrease or loss of movement, feeling, and organ function below the level of the injury. The most common sites of injury are the cervical and thoracic areas. SCI is a common cause of permanent disability and death in children and adults.

The spine has 33 vertebrae. They are:

  • 7 cervical (neck)
  • 12 thoracic (upper back)
  • 5 lumbar (lower back)
  • 5 sacral* (sacrum, located in the pelvis)
  • 4 coccygeal* (coccyx, located in the pelvis)

* By adulthood, the 5 sacral vertebrae fuse to form 1 bone. The 4 coccygeal vertebrae fuse to form 1 bone.

These vertebrae form the spine and protect the spinal cord. In general, the higher up the spine that the injury happens, the more severe the symptoms. Injury to the vertebrae does not always mean the spinal cord has been damaged. And damage to the spinal cord can happen without breaks or dislocations of the vertebrae.

SCI can be divided into 2 main types of injury:

  • Complete injury. There is no function below the level of the injury. This means no feeling or movement. Both sides of the body are equally affected. Complete injuries can happen at any level of the spinal cord.
  • Incomplete injury. There is some function below the level of the injury. This could be movement in 1 limb more than the other, feeling in parts of the body, or more function on 1 side of the body than the other. Incomplete injuries can happen at any level of the spinal cord.

What causes an acute spinal cord injury?

There are many causes of SCI. The more common injuries happen when the area of the spine or neck is bent or compressed. This can be caused by:

  • Birth injuries, which often affect the spinal cord in the neck area
  • Falls
  • Car accidents, either when a person is a passenger in a car or is hit by a car
  • Sports injuries
  • Diving accidents
  • Trampoline accidents
  • Violence, such as injuries that pierce the spinal cord, including gunshots and stab wounds

Who is at risk for an acute spinal cord injury?

Age is the main risk factor linked to spinal cord injuries. Young adult males (between the ages of 15 and 35) and older adults are at the highest risk. 

SCI risk peaks during young adulthood. Young adults tend to have increased risk due to violence, motor vehicle accidents, and sports injuries. The rate of violence-related SCIs in young adults has gone down since the 1990s.

In older adults, falls are the leading cause of SCIs. These numbers have gone up since the 1990s.

What are the symptoms of an acute spinal cord injury?

Symptoms vary depending on the severity and location of the SCI. At first, the person may have spinal shock. This causes loss of feeling, muscle movement, and reflexes below the level of injury. Spinal shock often lasts from several hours to several weeks. As the shock lessens, other symptoms appear. This depends on the location of the injury.

For SCI, the higher up on the spinal cord, the more severe the symptoms. For example:

  • Injury at C2 or C3. These are the second and third vertebrae in the spinal column. This affects the respiratory muscles and the ability to breathe. 
  • Injury in the lumbar vertebrae. This may affect nerve and muscle control to the bladder, bowel, and legs.

SCI is classified according to a person’s type of loss of motor and sensory function. These are the main types:

  • Quadriplegia (quad means 4). This is loss of movement and feeling in all 4 limbs (arms and legs). It often happens as a result of injury at T1 or above. Quadriplegia also affects the chest muscles. Injuries at C4 or above require a mechanical breathing machine (ventilator).
  • Paraplegia (para here means side by side). This is loss of movement and feeling in the lower half of the body (right and left legs). It often happens as a result of injuries at T1 or below.
  • Triplegia (tri means 3). This is loss of movement and feeling in 1 arm and both legs. It often results from incomplete SCI.

The most common symptoms of acute spinal cord injury may include:

  • Muscle weakness or paralysis in the trunk, arms, or legs
  • Loss of feeling in the trunk, arms, or legs
  • Muscle spasticity
  • Breathing problems
  • Problems with heart rate and blood pressure
  • Digestive problems
  • Loss of bowel and bladder function
  • Sexual problems

The symptoms of SCI may look like other health conditions or problems. Always talk with your healthcare provider for a diagnosis.

How is an acute spinal cord injury diagnosed? 

SCIs are not always easy to recognize. These situations should be considered as a possible spinal cord injury:

  • Head injury, especially with trauma to the face
  • Pelvic fractures
  • Penetrating injuries to the spinal area
  • Injuries from falling from heights
  • Complaints of spinal pain
  • Weakness or a loss of feeling in the hands or feet (extremities)
  • Loss of urine or bowel control

If the symptoms or accident occur at home or in the community, 911 should be called. The person should not be moved until paramedics arrive. To prevent more spinal cord injury, the paramedics will use extreme care and allow as little movement of the spine as possible. The injured person will be taken to an emergency room or trauma center.

The first medical care focuses on reducing any life-threatening problems such as bleeding or breathing problems. Movement and feeling tests are done to see if a spinal cord injury occurred. If a spinal cord injury is suspected, tests are done. These include lab tests, X-rays, CT scans, and MRIs. These tests are used to find the location and severity of the injury. To protect the spine, the neck and body is kept immobile. 

A person with a traumatic spinal cord injury goes to an intensive care unit (ICU). There they are watched for things such as breathing problems and heart problems. A full neurologic exam is done as soon as possible. This is done to diagnose the exact level and severity of the injury. These factors determine both the treatment and the expected level of recovery.