A spinal cord injury is clinically defined as any paralysis (partial or complete) relating to the damage of the spinal cord. This is not really a “cord” so much as it is a bundle of nerves that act as the body’s information superhighway, carrying nerve impulses to and from the brain. The spinal cord of a fully grown adult is approximately 18 inches long, and extends from the base of the brain (called the brainstem) down the middle of the back to the waist. It is protected by a group of ring-shaped bones called vertebra which form the spinal column.
It’s a common misconception that the spinal cord must be severed for paralysis or loss of function to occur. The truth is that most people with SCIs have an intact spinal cord, but the damage to it was severe enough to cause a loss of function.
The majority of SCIs occur as a result of traumatic injuries sustained from motor vehicle accidents. In 2017, almost 70% of SCI patients admitted to TIRR Memorial Hermann were there because of traumatic spinal cord injuries. However, spinal cord injuries can stem from non-traumatic incidences as well. Some examples include:
A spinal cord injury is a devastating event, both physically and psychologically. In addition to paralysis and loss of sensation below the level of injury, a spinal cord injury also impacts many different bodily functions, including circulation, metabolism, temperature regulation, nutritional health, skin, respiration, bowel and bladder elimination and sexuality.
The severity of a spinal cord injury depends on which part of the spinal cord itself is damaged. In basic terms, the higher on the spinal column – and therefore closer to the brain – an injury occurs, the more likely it is to affect mobility and feeling. Spinal cord injuries sustained to lower parts of the vertebral column generally have less of an impact on a patient’s feeling, movement and voluntary control.
If you are suspected of having sustained a spinal cord injury, you will be given a full neurological examination by a licensed physician, who will then determine the level of your injury and whether the SCI is complete or incomplete. While individual outcomes may vary, the following are considered general levels of spinal cord injury.
A complete spinal cord injury results in the total loss of all voluntary motor and sensory function below the primary level of injury. This affects both sides of the body equally. Close to 50% of all spinal cord injuries are considered complete.
It is important to note that just because there is a total absence of motor and sensory function does not necessarily mean all nerves across the injury site have been damaged. It is possible that there are some axons still intact, they are simply no longer functioning properly as a result of the injury. This may not seem like a big distinction, but it could mean a great deal for paraplegic or tetraplegic patients undergoing spinal cord injury rehabilitation.
Unlike a complete spinal cord injury, for incomplete SCIs the spinal cord’s ability to carry messages to and from the brain is not completely lost. This means that the patient may have some faint sensation and/or movement below the level of injury to the spinal column. However, the sensation or movement is somewhat random; patients may have more functioning on one side of the body than another, or have feeling in limbs or extremities that they cannot move.
With current advances in acute treatment for spinal cord injuries, this type of injury is becoming more common.
Also known as quadriplegia, tetraplegia results in paralysis or weakness in both arms and legs. This condition stems from injury to the cervical area of the spinal column (vertebra C1-C8) which controls signals to the head, neck, shoulders, arms, hands and diaphragm. Located in the neck area, the cervical region is difficult to stabilize, and may result in patients being required to wear a neck brace or other stabilizing device. Patients with spinal cord injuries above the C4 vertebra may need a ventilator to breathe.
In addition to paralysis of the appendages, tetraplegia is often accompanied by a few other issues:
Injuries to the thoracic spine (T1-T12) and below often result in paraplegia, which is denoted by paralysis and lack of sensation in the legs and lower extremities. It can also affect the chest, stomach, lower back and hips. Patients with paraplegia may struggle with bowel, bladder and sexual dysfunction as well. Fertility is affected more often for male patients than females.
While traumatic injury is still the leading cause for paraplegia (and spinal cord injuries in general), non-traumatic congenital conditions such as spina bifida play a role as well. It’s possible for some patients with paraplegia to walk to some degree; however, most paraplegics require wheelchairs or other supportive measures as a means of movement.
According to the American Association of Neurological Surgeons, the following are some possible signs and symptoms of spinal cord injury:
A lesser-known condition called cervical cord neurapraxia (CCN), also known as a “spinal cord concussion,” can afflict patients who play contact sports such as football. Severe head collisions that extremely compress or bend the neck can cause transient spinal cord dysfunction, meaning it is not permanent and generally resolves in a few days. Spinal concussions and contusions may produce the following symptoms:
Treatment of SCI begins before the patient is admitted to the hospital. Emergency medical personnel carefully immobilize the entire spine at the scene of the accident.
Immobilization is continued in the emergency department while more immediate life-threatening problems are identified and addressed. If the patient must undergo emergency surgery because of trauma to the abdomen, chest or another area, immobilization and alignment of the spine are maintained during the operation.
Even if surgery cannot reverse damage to the spinal cord, surgery may be needed to stabilize the spine to prevent future pain or deformity.
Once a patient is stabilized, care and treatment focuses on supportive care and rehabilitation. Family members, nurses or specially trained aides all may provide supportive care.
Rehabilitation usually begins during the initial hospitalization and includes physical therapy, occupational therapy and counseling for emotional support.
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