Spinal Cord Injury

A spinal cord injury happens when any part of the spinal cord, or the nerves at the very bottom (called the cauda equina), are harmed. The spinal cord acts like a superhighway, carrying messages back and forth between your brain and the rest of your body. When it's injured, this communication breaks down, often causing lasting changes in things like strength, sensation, and other bodily functions, all below the point of the injury.

Beyond physical changes, spinal cord injuries can also have a big impact on a person's mental, emotional, and social well-being. For example, people might experience depression, anxiety, or challenges connecting with others socially.

Scientists are hopeful that future research will lead to ways to repair spinal cord injuries. Many research projects are underway globally. While a complete fix isn't available right now, existing treatments and rehabilitation programs help many people with spinal cord injuries live full and independent lives. This includes learning new ways to move and interact with the world, adjusting to new limitations, and building support networks.

Understanding Spinal Cord Injuries: A Guide for Everyday People

After a spinal cord injury, your ability to use your arms and legs depends on two things: where the injury happened on the spinal cord, and how severe the injury is.

Location of the Injury: The lowest part of the spinal cord that's not damaged is called the "neurological level" of the injury. This helps doctors understand the extent of the damage.

Severity of the Injury: Doctors also look at the "completeness" of the injury, which describes how much feeling (sensation) and movement control is lost below the damaged area.

• Complete Injury: If you lose all feeling and movement control below the injury, it's considered a complete injury.

• Incomplete Injury: If you still have some feeling and movement control below the injury, it's an incomplete injury. There are varying degrees of incomplete injuries. The loss of feeling and movement control is often called paralysis.

Types of Paralysis:

• Tetraplegia (Quadriplegia): This type of paralysis affects all four limbs (arms, hands, legs), the torso, and the pelvic organs.

• Paraplegia: This type of paralysis affects the torso, legs, and pelvic organs, but not the arms.

Diagnosis: Healthcare providers use tests to figure out the neurological level and completeness of the injury.

Symptoms of Spinal Cord Injuries:

Spinal cord injuries can cause many problems, including:

• Loss of movement: This can range from slight weakness to complete inability to move certain parts of the body.

• Loss or change in sensation: This means changes in your ability to feel heat, cold, or touch.

• Loss of bowel or bladder control: You may not be able to control when you urinate or have a bowel movement.

• Exaggerated reflexes or spasms: Sudden, involuntary muscle contractions can occur.

• Changes in sexual function, sensitivity, and fertility: These can be affected due to nerve damage.

• Pain or intense stinging: Damage to nerve fibers in the spinal cord can cause pain.

• Breathing, coughing, or clearing lung secretions problems: Injury can make it hard to breathe, cough, or clear mucus from the lungs.

Emergency Symptoms (Following an Accident):

If you suspect a spinal cord injury, seek immediate medical attention. Emergency symptoms include:

• Severe back pain or pressure in the neck, head, or back: This is a serious sign.

• Weakness, incoordination, or loss of control in any part of the body: This could indicate nerve damage.

• Numbness, tingling, or loss of feeling in the hands, fingers, feet, or toes: This is a warning sign.

• Loss of bladder or bowel control: This can be a symptom of spinal cord injury.

• Trouble with balance or walking: This could indicate a problem with the spinal cord.

• Trouble breathing: Breathing problems are a critical concern.

• Twisted neck or back: A twisted neck or back warrants immediate medical assessment.

Important Considerations:

• Immediate Medical Attention: Assume a spinal injury until proven otherwise, especially after a head or neck injury. Don't move the injured person. Call 911 or your local emergency number. Keep the person still.

• Protecting the Spine: Place heavy towels or pillows on both sides of the neck to prevent movement. Support the head and neck until emergency help arrives. Only provide basic first aid, such as controlling bleeding, without moving the head or neck.

• Time is Critical: The sooner the injury is diagnosed and treated, the better the chance of recovery. Numbness or paralysis can develop quickly or slowly.

• Professional Help: Do not attempt to move or transport the injured person. Let trained medical personnel handle the situation.

Head or neck injuries require immediate medical attention. It's crucial to assume a spinal injury exists until a doctor can confirm otherwise. This is important because:

• Hidden Injuries: A serious spinal injury might not be noticeable right away. If a spinal injury is present but undiagnosed, the situation could worsen. This means that early diagnosis and treatment are critical.

• Gradual or Sudden Symptoms: Numbness or paralysis can develop quickly or slowly after an injury. The speed of onset doesn't always indicate the severity.

• Time is Crucial: The time between injury and treatment is a key factor. Determining the location of the injury helps doctors predict the potential for recovery.

• Do Not Move the Injured Person: Moving a person with a suspected spinal injury can cause permanent paralysis or other serious complications. This is a top priority.

• Call for Help Immediately: Dial 911 or your local emergency number right away. Emergency medical professionals are trained to handle these situations.

• Keep the Person Still: Do everything you can to prevent the person from moving their head or neck.

• Immobilize the Neck: Place heavy towels, rolled-up blankets, or similar supportive items on both sides of the neck to stabilize it. If you can't use towels, carefully hold the person's head and neck still. The goal is to prevent any movement.

• Give Basic First Aid Carefully: Provide basic first aid, like stopping any bleeding and making the person comfortable, without moving their head or neck. Focus on immediate stabilization and comfort.

Remember: Your actions in the initial moments after an injury can significantly impact the outcome. Always prioritize the safety and stabilization of the injured person until professional help arrives.

Spinal cord injuries happen when the spinal cord or the bones protecting it (vertebrae) are damaged. This damage can come from different sources.

How Spinal Cord Injuries Happen:

Sometimes, a sudden, forceful blow to the spine can break, move out of place, crush, or squeeze the vertebrae. A gunshot or knife wound can directly cut the spinal cord. After an injury, bleeding, swelling, and fluid buildup around the spinal cord can cause further damage over days or weeks.

These injuries aren't always caused by accidents. Conditions like arthritis, cancer, infections, or spine problems (like disk degeneration) can also harm the spinal cord.

What is the Spinal Cord?

The spinal cord is a bundle of soft tissue, like a long cable, that runs from the base of the brain down the back. It's protected by the vertebrae. Inside the spinal cord are nerve cells and bundles of nerves called tracts. These tracts carry messages to and from different parts of the body. The spinal cord's lower end, just above the waist, is called the conus medullaris. Below that are nerve roots called the cauda equina.

How Messages Travel:

The tracts in the spinal cord act like communication lines. Motor tracts send signals from the brain to control muscles, telling them to move. Sensory tracts bring information back to the brain about things like heat, cold, pressure, pain, and where your arms and legs are in space.

Effects of Spinal Cord Injuries:

Damage to the spinal cord affects the nerve fibers passing through the injured area. This can make it hard or impossible to use the muscles and nerves below the injury. For example, an injury to the chest or lower back can affect the torso, legs, bowels, bladder, and sexual function. A neck injury can affect all of these areas, plus arm movement and potentially breathing.

Common Causes of Spinal Cord Injuries in the US:

The most frequent causes of spinal cord injuries in the United States are:

• Motor Vehicle Accidents (MVAs): Car crashes and motorcycle accidents are the leading cause, making up nearly half of new spinal cord injuries each year. This highlights the importance of safe driving practices.

• Falls: Falls are a significant cause, particularly in older adults (over 65).

• Acts of Violence: About 12% of spinal cord injuries result from violent acts, such as gunshot or knife wounds.

• Sports and Recreation Injuries: Impact sports (like football) and diving in shallow water can sometimes cause spinal cord damage, making up about 10% of injuries.

• Diseases: Conditions like cancer, arthritis, osteoporosis, and spinal cord inflammation can also lead to spinal cord injuries.

Understanding the causes and effects of spinal cord injuries is crucial for preventing them and supporting those affected.

Spinal cord injuries are often caused by accidents and can happen to anyone. However, some factors increase the chances of getting one.

Gender: Men are more likely to experience a spinal cord injury than women. In the US, for example, women make up only about 20% of traumatic spinal cord injuries.

Age: A significant number of spinal cord injuries happen between the ages of 16 and 30. This age group is particularly vulnerable. Another group at risk is those aged 65 and older. Falls are a common cause of spinal cord injuries in seniors.

Alcohol: Alcohol is a factor in about a quarter of spinal cord injuries. Drinking and engaging in activities that could lead to injury significantly increase the risk.

Risky Behaviors: Accidents, like car crashes, are the most frequent cause of spinal cord injuries for people under 65. Other risky behaviors, such as diving into shallow water or participating in sports without appropriate safety gear or precautions, also contribute.

Health Conditions: Pre-existing conditions can make even minor injuries more dangerous. If you have conditions that weaken your bones or joints, like osteoporosis, a relatively minor accident could cause a spinal cord injury. This is because weaker bones or joints are more susceptible to damage.

Essentially, while accidents can happen to anyone, certain factors make some individuals more prone to spinal cord injuries. Being aware of these factors can help people take steps to reduce their risk.

Living with a Spinal Cord Injury: Common Complications and Management

A spinal cord injury (SCI) can cause various complications that affect many aspects of daily life. Fortunately, a rehabilitation team plays a crucial role in helping individuals manage these issues and regain independence. The team provides strategies, equipment, and resources tailored to each person's specific needs.

Bladder and Bowel Function:

After an SCI, the bladder may continue to store urine, even though the brain might not receive the signals needed to release it. This can lead to urinary tract infections (UTIs), kidney infections, and even kidney or bladder stones. Rehabilitation helps individuals learn techniques to empty their bladder regularly. Similarly, bowel movements might become irregular. A high-fiber diet can often help regulate bowel function, and the team can teach specific management strategies.

Pressure Sores (Decubitus Ulcers):

A common issue is pressure sores, also known as decubitus ulcers. Below the level of the injury, individuals may lose some or all sensation in their skin. This means the brain doesn't receive signals that the skin is being injured from prolonged pressure. This increases the risk of pressure sores. Regular position changes, often with assistance, and proper skin care are essential for prevention.

Circulatory Problems:

People with SCIs might experience low blood pressure when standing (orthostatic hypotension), swelling in their limbs, and an increased risk of blood clots (like deep vein thrombosis or pulmonary embolism). A potentially life-threatening rise in blood pressure, called autonomic dysreflexia, is another concern. The rehabilitation team can teach individuals strategies to manage these issues.

Respiratory Issues:

If the SCI affects the muscles used for breathing and coughing, problems can arise. The level of the injury determines the specific breathing challenges. For example, injuries affecting the neck and chest can increase the risk of pneumonia or other lung conditions. Medical treatments and therapies can help manage and prevent these issues.

Bone Health and Muscle Tone:

An SCI increases the risk of osteoporosis and fractures below the injured area. Some individuals experience muscle tightness (spasticity), while others may have limp, floppy muscles (flaccidity).

Fitness and Nutrition:

After an SCI, weight loss and muscle loss are common. Limited mobility can lead to a more sedentary lifestyle, increasing the risk of weight gain, heart disease, and diabetes. A registered dietitian can help create a nutritious meal plan to maintain a healthy weight. Physical and occupational therapists can help develop an exercise program tailored to individual needs.

Sexual Health:

SCIs can affect sexual function, including erections, ejaculation, or lubrication. Healthcare professionals specializing in urology or fertility can offer guidance and support.

Pain Management:

Some individuals experience pain, such as muscle or joint pain, from overuse of certain muscle groups. Nerve pain can also occur, especially in those with incomplete injuries.

Mental Health:

The physical changes and challenges of an SCI can sometimes lead to feelings of depression. Support groups and counseling can be beneficial for managing emotional well-being.

To lower your chances of a spinal cord injury, follow these safety tips:

1. Drive Carefully: Car accidents are a major cause of spinal cord injuries. Always wear your seatbelt when driving or riding in a car. Make sure children are properly secured with a seatbelt or a child safety seat that fits their age and weight. Crucially, keep children under 12 in the back seat to protect them from potential airbag injuries.

2. Be Cautious Around Water: Before diving into any body of water, check the depth. Only dive into pools that are at least 9 feet (about 2.74 meters) deep and clearly marked as safe for diving. Competition diving needs even greater depths. Never dive into an above-ground pool or unfamiliar water where you don't know the depth.

3. Prevent Falls: Use a step stool with a handrail when reaching high places. Install handrails on stairways. Place non-slip mats in bathrooms, including the tub and shower. For young children, use safety gates at the top and bottom of stairs and consider window guards.

4. Play Sports Safely: Always wear the recommended safety equipment for the sport you're playing. Avoid hitting or leading with your head during sports. For instance, don't slide headfirst in baseball. In football, don't tackle using your helmet. When learning new gymnastics moves, use a spotter.

5. Never Drink and Drive: Don't drive if you've been drinking alcohol or using drugs. Also, never ride with someone who has been drinking. Avoid driving under the influence of any substance.

Doctors in the emergency room (ER) carefully check people who've been in accidents. They examine the injured person, checking for any problems with feeling and movement. They also ask questions about what happened. Sometimes, this initial check is enough to tell if there isn't a spinal cord injury.

However, if the person has neck pain, isn't fully alert, or shows signs of weakness or problems with their nerves, further tests are needed. These tests are important to make sure there isn't a spinal cord injury.

These extra tests might include:

• X-rays: X-rays look at the bones around the spinal cord (vertebrae). They can show if there are any breaks, tumors, or other problems with the spine's bones.

• CT scan: A CT scan gives a more detailed picture than an X-ray. It uses a computer to create detailed cross-sectional images of the spine, showing problems with the bones, discs, and other tissues.

A few days after the injury, when swelling might have gone down, doctors will often do a more thorough check of the nerves and muscles. This exam is to see exactly where and how bad the injury is. They will test the strength of muscles and the ability to feel light touch and sharp sensations. This helps determine the severity and location of the spinal cord damage.