Spinal Cord Injury

Spinal cord = The bundle of nerves that connect the brain to the rest of the body
Injury = Damage

The spinal cord is the bundle of nerves and other tissue that connects brain to body. It carries instructions about movement from the brain, and information about sensation to the brain. It runs from the base of the brain down through the cervical spine (in the neck) and the thoracic spine (in the upper and mid-back). There it ends–the spinal cord does not actually run the entire length of the spine.  After the spinal cord ends, in the lumbar (lower) spine, is the cauda equina: the bundle of nerve roots that branch out to the legs.

Acute spinal cord injury (SCI) is caused by a trauma to the cervical or thoracic spine, where the spinal cord is located. SCI can disrupt movement, sensation, and body organ function below the level of the injury.

Spinal cord injuries can be either complete or incomplete.

• Complete injury: no sensation or movement below the level of the injury; both sides of the body are equally affected.
• Incomplete injury: some function below the level of the injury–for example, movement in one limb more than another, sensation in some parts of the body, or more function on one side of the body than the other.

Although there is currently no cure for spinal cord injury, the outlook for people affected by SCI has improved dramatically over the last few decades. New treatments, specialized rehabilitation training, and novel technologies may all improve the life experience of people with spinal cord injury. Worldwide, scientists are researching ways to someday repair the injured spinal cord.

Symptoms of a spinal cord injury vary by location and severity of the injury.

• Location: the higher in the spinal column the injury occurs, the more widespread the resulting disability.
• Severity: the more severe the injury, the more severe the resulting deficits.

Symptoms may include:

• Muscle weakness or paralysis in the trunk, arms or legs:
  • Quadriplegia (quad = four) — loss of movement and sensation in all four limbs (both arms and both legs). It usually occurs as a result of an injury toward the top of the neck.
  • Paraplegia (para = two like parts) — loss of movement and sensation in the lower half of the body (both legs). It usually occurs as a result of an injury at the first thoracic vertebra or below.
  • Triplegia (tri = three) — loss of movement and sensation in one arm and both legs. It usually results from incomplete spinal cord injury.
  • Quadriparesis and paraparesis —  partial loss of function in two or four limbs.
• Muscle spasms
• Difficulty breathing (if the injury has occurred in the upper portion of the spine)
• Changes in heart rate and blood pressure
• Digestive problems
• Loss of bowel and bladder function (if the injury has occurred in the lower portion of the spine)
• Sexual dysfunction

Symptoms do not always begin immediately. They can develop gradually after an injury if bleeding or swelling put pressure on the spinal cord. Any person who has experienced a dangerous fall or motor vehicle accident should be evaluated for a spinal injury. Prompt treatment may help control this type of gradual damage.

The most common causes of spinal cord injury are car accidents, falls, gunshot or knife wounds, and sports accidents.

Most spinal cord injuries occur in young men between the ages of 16 to 30.

After a trauma, doctors will ask questions about what happened and conduct a careful examination. If patients are conscious, doctors may test patients’ ability to move different parts of the body, and their ability to feel strong or light sensations in different parts of the body. These tests help determine whether movement and sensation have been affected by the injury. Doctors will ask about any pain in the neck or back.
If doctors cannot rule out a spinal cord injury, patients will need imaging tests like X-ray, CT scan, or MRI:

• X-ray (also known as plain films) –test that uses invisible electromagnetic energy beams (X-rays) to produce images of bones. Soft tissue structures such as the spinal cord, spinal nerves, the disc and ligaments are usually not seen on X-rays, nor on most tumors, vascular malformations, or cysts. X-rays provide an overall assessment of the bone anatomy as well as the curvature and alignment of the vertebral column. Spinal dislocation or slippage (also known as spondylolisthesis), kyphosis, scoliosis, as well as local and overall spine balance can be assessed with X-rays. Specific bony abnormalities such as bone spurs, disc space narrowing, vertebral body fracture, collapse or erosion can also be identified on plain film X-rays. Dynamic, or flexion/extension X-rays (X-rays that show the spine in motion) may be obtained to see if there is any abnormal or excessive movement or instability in the spine at the affected levels.
• Computed tomography scan (also called a CT scan) — a diagnostic procedure that uses a combination of X-rays and computer technology to produce detailed 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) — a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. MRIs are the most helpful scan for visualizing the spinal cord.

Specific treatment for a spinal cord injury varies by case. The type of treatment depends on a variety of factors, which may include:

• Age, overall health, and medical history
• Extent and type of the spinal cord injury
• Tolerance to specific medications, procedures, or therapies

In some cases, surgery may be necessary to stabilize fractured bones, decompress (relieve the pressure on) the injured area, and to manage any other injuries. However, there is not yet a way to reverse damage to an injured spinal cord. Even so, as the body heals from the injury, some patients may recover some spinal cord function up to six or twelve months after injury.

Recovery from a spinal cord injury requires long-term hospitalization and rehabilitation. An interdisciplinary team of physicians, nurses, therapists (physical, occupational, or speech), and other specialists work together with each patient affected by a spinal cord injury.

New types of rehabilitation, new technologies, and other treatments are constantly being developed and improved. And around the world, researchers are working to find methods of healing spinal cord injuries.

Drs. Paul C. McCormick, Michael G. Kaiser, Peter D. Angevine, Alfred T. Ogden, Christopher E. Mandigo, Patrick C. Reid and Richard C.E. Anderson (Pediatric)  are experts in treating spinal cord injuries.  They can also offer you a second opinion.