Spinal cord injury refers to any injury of the spinal cord—the bundle of nerves encased in the spinal column that runs from the base of the skull to the tail bone.
The spinal cord, part of the central nervous system, is a bundle of nerves that is encased in the spinal column, which runs from the base of the skull to the tailbone, or coccyx (KAHK-siks). The spinal column comprises 33 bony vertebrae (7 cervical [neck], 12 thoracic [chest], 5 lumbar [middle back], 5 sacral [lower back], and 4 coccyx [lowest back]) that protect the spinal cord as it leaves the brain. Intervertebral disks lie in between the vertebrae cushioning them, and ligaments hold the spinal cord, vertebrae, and intervertebral disks in place. Nerve fibers leave the spinal column through holes in the vertebrae. The nerves then branch out to send and receive messages between the brain and the various parts of the body. The messages transmitted from the body to the brain through the spinal cord are called sensory messages and include all the information that is perceived by the senses (sight, hearing, touch, taste, smell) from the various parts of the body. The messages transmitted from the brain to the body through the spinal cord are called motor messages. The motor messages tell the body how to respond to the sensory information.
An injury to the spinal cord disrupts the transmission of the sensory messages and motor messages to and from the brain. A spinal cord injury can be complete or incomplete. In a complete injury, the spinal cord cannot send or receive messages from nerves below the level of the injury. The resulting injury is called paralysis. In an incomplete injury, there is still some movement and sensation below the level of the injury. In some injuries, the person will recover fully; in other injuries, the person may lose partial or all function below the level of injury.
The following terms are associated:
An acute spinal cord injury is a medical emergency. Prompt evaluation and treatment can minimize the injury and promote recovery.
According to Paralyzed Veterans of America, more than 10,000 people experience a spinal cord injury each year in the United States, and according to the Christopher and Dana Reeve Foundation, there are approximately six million people in the United States living with paralysis.
Most spinal cord injuries are caused by accidents while at work (28%), motor vehicle * accidents (24%), sports and recreation injuries (16%), falls (9%), and assaults (4%).
A spinal cord injury is usually caused by a sudden traumatic blow to the spine that fractures (breaks) or displaces (dislocates) vertebrae. Damage to the spinal cord occurs as displaced bone fragments, disk material, or ligaments bruise or tear into spinal cord tissue, damaging nerves.
Spinal cord injury can also be caused by infections and chronic diseases such as arthritis, cancer, or degeneration of the vertebral disks.
Males are almost twice as likely to experience spinal cord injury as females. Sports and recreation spinal cord injuries are most likely to occur in people under 29 years of age. Spinal cord injuries in people under 65 years of age are most likely to be caused by motor vehicle accidents, and injuries caused by falls are more likely to occur in people over 65 years of age.
Symptoms of spinal cord injury depend on the level of the injury. They include loss of sensation, movement, muscle strength, bowel and bladder control, and sexual function. If the injury is in the neck or cervical area, the person may have difficulty breathing or be unable to breathe independently. These losses may be temporary or permanent, depending on the extent of the injury.
The patient's neck and spine must be kept immobilized to prevent further injury during history taking, physical examination and the performance of diagnostic studies. The healthcare provider obtains a complete health history and asks specific questions about the injury, such as what caused the injury, whether there was there any movement following the injury, whether there was any sensation following the injury, and whether there is any difficulty breathing or speaking. These questions help determine the level of injury.
Computed tomography * (CT scan) is the most effective way of determining injuries to the spine and spinal cord. X-rays may show injuries to the spine (bony vertebrae) but do not show injuries to the spinal cord. Magnetic resonance imaging * (MRI) is used to identify injuries of the spinal cord and the ligaments of the spine.
The immediate goals of treatment are to ensure that the person can breathe and to prevent any further injury by keeping the neck and spine immobilized, if possible. If the person is having difficulty breathing, the individual may be placed on a mechanical ventilator, a device that assists the person to breathe effectively.
The treatment team for people with spinal cord injuries is usually led by a neurosurgeon or orthopedic surgeon with specialized knowledge and experience in treating the injuries and potential long-term effects of spinal cord injury. The treatment team usually consists of doctors, nurses, physical therapists * , occupational therapists * , nutritionists * , and psychologists * .
Surgery may be needed to remove blood and any bone fragments that may be pressing on the spinal cord. If the spine is unstable, causing the spinal cord to be unprotected, the person will be placed in traction or in a device to stabilize the spine. Other treatments will address possible complications of spinal cord injury such as pressure sores (bedsores), pain, infection (e.g. urinary tract infection, pneumonia), spinal shock * , muscle atrophy (wasting), gastrointestinal problems, problems in urination and sexual function, and weakening of the bones.
Medications used in the treatment of people with spinal cord injuries include corticosteroids * to prevent swelling around the injury (swelling can place pressure on the spinal cord); pain medications, called analgesics * ; and muscle relaxants to relieve any spasms that may develop.
Most people who have spinal cord injuries start a program of rehabilitation * as soon as the spine has been stabilized. Early rehabilitation, including physical therapy, occupational therapy, psychological support, and nutritional support, often restores or improves function and facilitates recovery to the highest level possible.
Spinal cord injury often can be prevented. The following are selected strategies to prevent spinal cord injuries:
See also Arthritis • Brain Injuries • Cancer: Overview • Concussion • Drowning • Emergency Resuscitation (CPR) • Paralysis • Sports Injuries: Overview • Trauma
Reeve, Christopher. Nothing Is Impossible: Reflections on a New Life. New York: Random House Publishing Group, 2004.
Reeve, Christopher. Still Me. New York: Random House Publishing Group, 1999.
American Association of Neurological Surgeons. “Spinal Cord Injury Prevention Tips.” http://www.aans.org/Patient%20Information/~/media/Files/Patient%20Information/Patient%20Safety%20Tips/spinal_cord_injury_prevention.ashx (accessed July 11, 2016).
MedlinePlus. “Spinal Cord Injuries.” U.S. National Library of Medicine. https://www.nlm.nih.gov/medlineplus/spinalcordinjuries.html (accessed July 11, 2016).
Merck Manual: Consumer Version. “Injuries of the Spinal Cord and Vertebrae.” http://www.merckmanuals.com/home/injuries-and-poisoning/spinal-injuries/injuries-of-the-spinal-cord-and-vertebrae (accessed July 11, 2016).
Merck Manual: Consumer Version. “Rehabilitation After a Spinal Injury.” http://www.merckmanuals.com/home/fundamentals/rehabilitation/rehabilitation-after-a-spinal-injury (accessed July 11, 2016).
Christopher & Dana Reeve Foundation. 636 Morris Tpke., Suite 3A, Shorthills, NJ 07078. Toll-free: 800-225-0292. Website: www.christopherreeve.org (accessed July 11, 2016).
Miami Project to Cure Paralysis. PO Box 016960, R-48, Miami, FL 33010-6960. Toll-free: 800-782-6387. Website: www.themiamiproject.org (accessed July 11, 2016).
Paralyzed Veterans of America (PVA). 801 18th St. NW, Washington, DC 20006-3517. Toll-free: 800-555-9140. Website: www.pva.org (accessed July 11, 2016).
United Spinal Association. 120-34 Queens Blvd., #1320, Kew Gardens, NY 11415. Toll-free: 800-962-9629. Website: www.spinalcord.org (accessed July 11, 2016).
* motor vehicle is any vehicle that has a motor including cars, trucks, motorcycles, motorized bicycles, and scooters.
* computed tomography (komPYOO-ted toe-MAH-gruh-fee), or CT scan, is a technique in which a machine takes many x-rays of the body to create a three-dimensional picture. Formerly called computerized axial tomography (CAT).
* magnetic resonance imaging (or MRI) uses magnetic waves instead of x-rays to scan the body and produce detailed pictures of the body's structures.
* physical therapist is a health professional who has specialized knowledge and experience in assisting people to reduce pain and improve or restore mobility.
* occupational therapist is a health professional who has specialized knowledge and experience in assisting people to perform normal activities of daily living and working (occupation).
* nutritionist is a person who has specialized knowledge and experience in nutrition. A nutritionist may also be called a dietitian.
* psychologist (sy-KOL-o-jist) is a mental health professional who treats mental and behavioral disorders by support and insight to encourage healthy behavior patterns and personality growth.
* spinal shock is a condition that relates to the loss of neurological activity, including motor, sensory, reflex, and autonomic functions, below the level of injury.
* corticosteroids (kor-tih-ko-STAIRoyds) are chemical substances made by the adrenal glands that have several functions in the body, including maintaining blood pressure during stress and controlling inflammation.
* analgesics (an-al-JEEZ-iks) are medications to reduce or relieve pain.
* rehabilitation is a program that helps people return to more normal physical, mental, or emotional function following an illness or injury. Rehabilitation also helps people find ways to better cope with conditions that interfere with their lives.