Spinal Cord Injuries

What Are Spinal Cord Injuries?

Damage to the spinal cord, a bundle of nerve fibers that starts at the base of the brain and travels through the spinal column, can cause various symptoms depending on the location of the injury within the spinal cord. Spinal cord injuries interrupt the pathways of information, including sensations sent to the brain and signals from the brain to move muscles. The level of the injury along the length of the spine often determines the severity of symptoms. Spinal cord injuries can be complicated, depending on the type and cause of the injury.

Types of Spinal Cord Injuries

There are two main types of spinal cord injury: complete and incomplete.

Incomplete spinal cord injuries occur when some of the injured areas of the spinal cord remain undamaged. In a complete spinal cord injury, the spinal cord generally doesn’t have any healthy tissue in the injured region.

A neurologist will further classify the injury in categories defined by the American Spinal Injury Association Impairment Scale:

Grade A

A complete injury with no information about sensation or muscle movement in the lower part of the spinal cord (the lower sacral region). This means that the person will not be able to feel or move any area of the body below the hips.

Grade B

An incomplete injury with some information about sensation in the spinal cord below the injury. In a Grade B injury, the person will be able to feel some things below the level of the injury.

Grade C

An incomplete injury with some of the major muscles exhibiting minimal movement below the injury.

Grade D

An incomplete injury with some of the major muscles exhibiting significant movement below the injury.

Grade E

Normal sensation and muscle movement.

Another way to describe spinal cord injuries is based on whether the cause is external, like an accident, or internal in the case of a disease. These are called traumatic and nontraumatic spinal cord injuries, respectively.

What Are the Symptoms of a Spinal Cord Injury?

The symptoms of a spinal cord injury vary significantly based on where the injury is located along the length of the spine. Since the spinal cord is the highway of information between the brain and body, injuries that cut off this pathway will cause symptoms below the level of the injury. For example, if the injury is in the middle of the back, parts of the body below the middle of the back may be affected, including the lower torso and legs.

Symptoms of a spinal cord injury include:

• Pain in the back or neck
• Loss of the ability to move muscles or paralysis
• Bowel and bladder control issues
• Problems breathing or coughing
• Numbness or tingling sensations

The severity of symptoms and which are present vary depending on the type of injury.

What Can Cause a Spinal Cord Injury?

Primary injuries can be traumatic or nontraumatic. Traumatic injuries are caused by serious physical damage induced by things like:

• Car and motorcycle accidents
• Contact sports
• Gunshot or knife wounds
• Falls

These injuries may break the spinal column bones that cut or compress the spinal cord.

Nontraumatic injuries are caused by viral infections, diseases that affect the spinal cord, and genetic disorders, including spinal muscular atrophy, multiple sclerosis, osteoporosis, cervical spondylosis, ankylosing spondylitis, and rheumatoid arthritis. The spinal cord can also be injured when the blood circulation is reduced or interrupted due to a clot or blood vessel defect.

What Are the Complications?

Spinal cord injuries are medically complex and can be associated with many complications secondary to the injury.

Medical Conditions

Some people with spinal cord injuries experience neurogenic shock, which is a sudden drop in blood pressure, or cardiovascular disease due to long-term issues with regulating heart rate and blood pressure. This is a serious complication and requires medicines to restore normal circulation and prevent tissue damage.

Since signals controlling temperature, heart rate, and blood pressure travel through the spinal cord, a condition called autonomic dysreflexia can develop. This can cause side-effects, including:

• An abrupt change in temperature
• Headache
• High blood pressure
• Pneumonia
• Dyspnea and exercise intolerance
• Pressure ulcers due to friction
• Poor nutrition
• Skin changes
• Permanently shortened muscles (contractures)
• Urinary tract infections (UTIs)

The appearance of these symptoms should be addressed immediately by a healthcare provider.

Chronic Pain

Pain can also be a challenging issue for people with spinal cord injuries. Changes in the spinal cord can cause some sensations that are typically not painful to feel like pain. People may also feel pain without any stimulus.

Mental Health Disorders

These aforementioned complications, combined with the often intense medical needs of spinal cord injuries, can lead to mental health issues, including anxiety and depression.

How is it Diagnosed?

When a person seeks medical assistance for a suspected spinal cord injury, a healthcare provider will first ask questions about the symptoms and what led to their development.

Functional exams are also performed to determine whether the person can feel different sensations and move different muscles of their body, focusing below the level of the injury.

Additionally, imaging is a vital component of diagnosing spinal cord injuries, with common modalities including:

X-Rays

X-rays are a fast and effective way to detect bone breaks in the spine. Using electromagnetic energy, an X-ray produces an image of bones and soft tissue.

CT Scans

Computed tomography (CT) scans utilize electromagnetic energy to visualize the injury to the spinal cord. CT scans also use digital technology to create a three-dimensional view of the injury that can be used to determine its extent.

Magnetic Resonance Imaging

Magnetic resonance imaging (MRI) uses strong magnets to create a three-dimensional image that includes bone and different types of tissues. MRIs are used to determine the extent of spinal cord injury with high resolution. It can show if there is bleeding, bruising, and injury to surrounding ligaments that can cause secondary injuries. MRIs are also used to guide surgical strategies and are considered the gold standard for the diagnosis of a spinal cord injury.

How Are Spinal Cord Injuries Treated?

Time is an important component of treating spinal cord injuries. Spine stabilization and surgery may be performed to reduce compression, and steroids are often administered to reduce swelling that can compress the spinal cord after an injury.

In the longer term, rehabilitation becomes an important component of treatment. Physical and occupational therapy can help to strengthen muscles that you can still control to maximize your independence.

Regular visits to your healthcare provider will also be necessary to address complications from the injury, like pressure injuries if you use a wheelchair and sit for long periods or osteoporosis that can occur due to a lack of weight-bearing movement. Mental health treatment is also important; nearly 10% of people with spinal cord injuries experience depression, anxiety, and post-traumatic stress disorder.

Researchers are actively working on treatments that aim to restore sensation and movement. These are currently in clinical trials and have been yielding promising results to improve function in people with spinal cord injuries.

Can Spinal Cord Injuries Be Prevented?

Spinal cord injuries caused by accidents can be challenging to prevent, but some steps can be taken to reduce the risk. The risk of traumatic spinal cord injuries can be reduced by:

• Wearing your seatbelt, not exceeding posted speed limits, and avoiding distraction when driving
• Using appropriate safety equipment when engaging in sports
• Wearing a helmet when riding a motorcycle, scooter, or skateboard
• Checking the depth of water before diving and not diving into water where you cannot see the bottom
• Reducing access to firearms
• Avoiding driving while under the influence of alcohol or drugs
• Creating a safe environment to prevent falls

Addressing risk factors, including structural blood vessel repair, may reduce the odds of nontraumatic spinal cord injuries. Early diagnosis and treatment may also reduce the severity of these injuries. Regular visits to your healthcare provider and discussing any concerns will help address any emergent issues and improve your quality of life.

What Can I Expect if I Have a Spinal Cord Injury?

If the cause of the injury was traumatic, like a motorcycle accident, healthcare providers will focus on stabilizing your health first. These injuries are often accompanied by other issues that must be addressed to support vital bodily functions. People with traumatic spinal cord injuries are frequently hospitalized for extended periods and then progress to a rehabilitation center before returning home^.

Rehabilitation includes strategies for improving muscle control and sensation and addressing the home situation to maximize independence, also through equipment and training. A healthcare provider may also discuss treatments that are currently in clinical trials.

It is common for a person to have less function immediately following the injury compared to months or years after. In a study by Thomas Jefferson University, in people with spinal cord injuries near the neck, approximately 70% with a grade A injury four hours after the injury demonstrated some sensation and/or muscle movement a year after the injury. About 50% had improvements of two AIS levels. If the injury is assessed after 4 hours, the degree of improvement is smaller but still occurs in about 47% of patients.

What’s the Outlook for Spinal Cord Injuries?

Managing the injury in the first 48 hours is a strong predictive factor for quality of life. The many tiers of the healthcare system provide a lifetime of care for people with spinal cord injuries beginning at the time of the injury. Assistive technology provides people with the highest level of independence possible.

When Should I See My Healthcare Provider?

If you have experienced an injury that may have damaged your neck or spine, you should contact your healthcare provider right away. Symptoms of a spinal cord injury should be assessed as soon as possible, even if you have not been in an accident. Your healthcare provider can determine whether your symptoms require a referral to a neurologist, who can diagnose and treat your injury.

Recovery and Beyond

Spinal cord injuries are considered permanent injuries. However, early diagnosis and intervention can dramatically improve sensation and muscle control in people with these injuries. Significant advances in assistive technology and research provide hope that the quality of life of people with spinal cord injuries will continue to improve.