Medicine and Health
Spinal cord injury
Your spine is made of many bones called vertebrae. Your spinal cord runs downward through a canal in the center of these bones. The spinal cord is a bundle of nerves that carries messages between the brain and the rest of the body for movement and sensation.
Acute spinal cord injury (SCI) is due to a traumatic injury that bruises, partially tears, or completely tears the spinal cord. SCI is a common cause of permanent disability and death in children and adults.
What causes an acute spinal cord injury?
Many things can cause SCI. The more common injuries occur when the area of the spine or neck is bent or compressed, as in the following:
- Falls
- Motor vehicle accidents (automobiles, motorcycles, and being struck as a pedestrian)
- Sports injuries
- Diving accidents
- Trampoline accidents
- Violence (gunshot or stab wounds)
- Infections that form an abscess on the spinal cord
- Birth injuries, which typically affect the spinal cord in the neck area
What are the symptoms of an acute spinal cord injury?
Symptoms of an acute SCI can vary widely. The location of the injury on the spinal cord determines what part of the body is affected and how severe the symptoms are.
Right after a spinal cord injury, your spine may be in shock. This causes loss or decrease in feeling, muscle movement, and reflexes. But, as swelling eases, other symptoms may appear depending on the location of the injury.
Generally, the higher up the level of the injury is to the spinal cord, the more severe the symptoms. For example, an injury to the neck, the first and second vertebrae in the spinal column (C1, C2), or the mid-cervical vertebrae (C3, C4, and C5) affects the respiratory muscles and the ability to breathe. A lower injury, in the lumbar vertebrae, may affect nerve and muscle control to the bladder, bowel, and legs, and sexual function.
- Quadriplegia is loss of function in the arms and legs.
- Paraplegia is loss of function in the legs and lower body.
The extent of the damage to the spinal cord determines whether the injury is complete or incomplete.
- A complete injury means that there is no movement or feeling below the level of the injury.
- An incomplete injury means that there is still some degree of feeling or movement below the level of the injury.
These are the most common symptoms of acute spinal cord injuries:
- Muscle weakness
- Loss of voluntary muscle movement in the chest, arms, or legs
- Breathing problems
- Loss of feeling in the chest, arms, or legs
- Loss of bowel and bladder function
The symptoms of SCI may look like other medical conditions or problems.
How are acute spinal cord injuries diagnosed?
Acute SCI is a medical emergency. Emergency evaluation is needed anytime there is a suspected injury to the spinal cord.
The effects of an SCI may not be clear at first. A full medical evaluation and testing are needed. The diagnosis of SCI starts with a physical exam and diagnostic tests. During the exam, the healthcare provider will ask about your medical history and how the injury occurred. A spinal cord injury can cause ongoing neurological problems that require further medical follow-up. Sometimes, surgery is needed to stabilize the spinal cord after acute SCI.
Diagnostic tests may include:
- Blood tests
- X-ray. This test uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
- Computed tomography scan (also called a CT or CAT scan). An imaging test that uses X-rays and computer technology to produce detailed images (often called slices) of the body. A CT scan shows images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
- Magnetic resonance imaging (MRI). This test uses large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body.
How is an acute spinal cord injury treated?
SCI requires emergency medical attention on the scene of the accident or injury. After an injury, your head and neck will be immobilized to prevent movement. This may be very hard when you are frightened after a serious accident.
Specific treatment for an acute spinal cord injury is based on:
- Age, overall health, and medical history
- Extent of the SCI
- Type of SCI
- How you respond to initial treatment
- The expected course of the SCI
- Your opinion or preference
There is currently no way to repair a damaged or bruised spinal cord. But, researchers are actively seeking ways to stimulate spinal cord regeneration. The severity of the SCI and the location determines if the SCI is mild, severe, or fatal.
Surgery is sometimes needed to evaluate the injured spinal cord, stabilize fractured backbones, release the pressure from the injured area, and to manage any other injuries that may have been a result of the accident. Your treatment may include:
- Observation and medical management in the intensive care unit (ICU)
- Medicines, such as corticosteroids (to help decrease the swelling in the spinal cord)
- Mechanical ventilator, a breathing machine (to help you breathe)
- Bladder catheter. A tube that is placed into the bladder that helps to drain urine into a collection bag.
- Feeding tube (placed through the nostril to the stomach, or directly through the abdomen into the stomach, to provide extra nutrition and calories)
Recovery from a SCI often requires long-term hospitalization and rehabilitation. An interdisciplinary team of healthcare providers, including nurses, therapists (physical, occupational, or speech), and other specialists work to control your pain and to monitor your heart function, blood pressure, body temperature, nutritional status, bladder and bowel function, and attempt to control involuntary muscle shaking (spasticity).
Living with an acute spinal cord injury
Recovery from a SCI often requires long-term hospitalization and rehabilitation. Physical therapy will likely be a very important part of your rehabilitation. In this treatment, specialists will work with you to prevent muscle wasting and contractures, and to help you retrain other muscles to aid in mobility and movement. Another type of therapy is occupational therapy, which helps you learn new ways of doing everyday tasks in spite of your new physical limitations.
A traumatic event that results in a SCI is devastating to both you and your family. The healthcare team will help educate your family after hospitalization and rehabilitation on how to help care for you at home and understand the specific problems that require immediate medical attention.
You will need frequent medical evaluations and testing after hospitalization and rehabilitation to monitor your progress.
It’s important to focus on maximizing your capabilities at home and in the community.
You may feel sad or depressed after your injury. If this happens to you or a loved one, your healthcare provider may recommend that you see a mental health professional. Antidepressants and psychotherapy, or “talk therapy,” are both available to help treat depression.