Spinal Cord Injury

The spinal cord is a long rope-like cord. It is about the width of a little finger. The spinal cord runs from the base of the brain to the lower back. The spinal cord is a complex system of nerve pathways. It sends messages to the brain from organs and nerves all over the body. The brain translates these signals as sensation, such as pain, hot, and cold.

The brain also sends orders through the spinal cord to motor nerves. These orders cause the muscles to move. Some motor messages result in automatic actions of the bowel and bladder. Other motor signals cause purposeful, coordinated movements of the body.

The spinal cord is protected by back bones called vertebrae (VER-teh-bray). The vertebrae are stacked on top of one another. They are cushioned by disks, which act like shock absorbers. The vertebrae are hollow. This makes a tunnel through which the spinal cord passes.

There are four sections of the spine:

  • Cervical (SER-vih-kul) – from the base of the brain to the lower portion of the neck
  • Thoracic (THOR-ass-ick) – from the bottom of the neck to the waist
  • Lumbar – from the waist to the lower back
  • Sacral (SAY-krul) - from the bottom of the lower back to the tailbone

Spinal cord injuries usually occur when the back is damaged by a strong blow to the area such as from an automobile accident or a diving accident. When a spinal cord injury occurs, the damaged nerve pathways can not send the messages properly. The person loses sensation and control of the muscles. The extent of the damage depends on the location of the spinal cord injury.

Quadriplegia (QUAD-rih-PLEE-jah) is an injury at the neck, or cervical spinal cord, causing paralysis of the arms, torso, and legs. Breathing problems and problems with bowel and bladder control also may occur.

Paraplegia (PAR-ah-PLEE-jah) is a spinal cord injury that occurs anywhere between the base of the neck and the lower back. An injury to the thoracic area results in paralysis of the torso and legs. An injury at the lumbar area causes paralysis of the legs.

Spinal Cord Injuries Can Be “Complete” or “Incomplete"

  • A complete injury occurs when the spinal cord is cut all the way through. When this occurs, the person has no feeling. He or she cannot move below the injury level.
  • In an incomplete injury, there is some feeling or voluntary movement below the level of the injury. This happens when there is little damage to the spinal cord.

Diagnosis

First, the injury is diagnosed according to location of the injury. Sometimes an injury affects all of the thickness of the cord. Other injuries affect only a portion of the thickness. The doctor makes the diagnosis by testing:

  • Strength and movements of specific muscles
  • The patient’s ability to feel a light touch and a pinprick on the skin in key areas of the body
  • The patient’s ability to feel pressure at the anus and rectum

The results of these tests show which functions of the spinal cord are not working and where the damage begins from top to bottom. The doctor then determines the extent of the injury using the ASIA scale (American Spinal Injury Association). This scale has 4 levels of severity, ASIA A,B,C, and D. ASIA A is the most severe and is classified as a complete injury. ASIA D is classified as an incomplete injury with better motor and sensory function. ASIA B and ASIA C are in between. Your doctor will discuss this with you.

Other tests may help with the diagnosis. For example, x-rays are used to show bone fractures. X-rays also show if the bones of the spine are lined up properly. This helps the doctor determine if the spine needs to be held steady by bracing or an operation. X-rays can not reveal actual damage to the spinal cord tissue. However, an MRI (magnetic resonance imaging) or CT scan (computed axial tomography) may reveal cord tissue damage.

What to Expect

Recovery from a spinal cord injury depends on the extent of the injury. Only a doctor can give you a good idea how much you are likely to recover.

Treatment

Spinal injuries may cause the patient’s body to go into “shock.” To treat shock, the medical team focuses on the patient’s breathing, heart rate, and blood pressure. During the first few days after the injury, the medical team strives to limit any further damage. If the spinal cord injury occurred at the top of the neck, the muscles that control breathing may be paralyzed. In this event, a machine called a ventilator will be used to help the patient breathe.

Often after a traumatic injury, the spinal cord continues to swell. The swelling can cause more damage to the area. Medicine may help, but it must be given within the first 24 hours after the injury. If a bone was broken, it may pinch or tear at the spinal cord tissue. Bracing or surgery may be necessary to prevent future damage.

Rehabilitation (Rehab)

Once the patient is considered stable, the rehab phase of treatment begins. Rehab services may include:

  • Physical therapy
  • Occupational therapy
  • Recreational therapy
  • Respiratory therapy
  • Speech and language therapy
  • Social services
  • Psychology
  • Medical and nursing care

Rehab should begin as soon as possible. The patient will learn how to use special equipment and how to care for his or her body to prevent injury or complications. Examples of these complications are skin breakdown, high blood pressure, and kidney or bladder infections.

In rehab, the patient and caregivers learn ways to deal with the patient’s disabilities. For example, the paralysis may affect the ability to perform activities of daily living, walking, and bowel or bladder control. Muscles that are not affected or are only partially damaged are built up to make up for the injured muscles. Depending on the extent of the injury, the patient may learn to use canes, crutches, walkers, braces, or a wheelchair. The patient may receive counseling on sexual function, leisure activities, and employment.

Rehab cannot bring back function in most severe spinal cord injuries. For instance, not everyone will regain the ability to walk. But rehab can teach a person to improve quality of life. By learning proper seating and pressure relief to avoid skin breakdown, a person can be completely independent, even in a wheelchair.

Research in drugs given at the time of the injury and research in other areas, such as stimulating nerves to “teach” paralyzed muscles to move, offer exciting and hopeful outlooks for spinal cord injury survivors.

Resources

The Rehabilitation Institute 
www.upmc.com/irr  

National Spinal Cord Injury Association
6701 Democracy Blvd., Suite 300-9
Bethesda, MD 20817
1-800-962-9629
www.spinalcord.org
Email: NSCIA2@aol.com

Paralyzed Veterans of America
(you do not need to be a veteran to get help from this organization)
801 18th St. N.W.
Washington, D.C. 20006
http://www.pva.org

National Spinal Cord Injury Hotline
1-800-232-1782
www.pva.org
Email: info@pva.org

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