Spinal Cord Injury
If you've recently experienced a spinal cord injury, it might seem like every aspect of your life will be affected by this injury. A spinal cord injury often causes permanent disability or loss of movement (paralysis) and sensation below the site of the injury. Many scientists are optimistic that advances in research will someday make the repair of spinal cord injuries an attainable goal. In the meantime, treatments and rehabilitation allow many people with a spinal cord injury to lead productive, independent lives.
Complications of Spinal Cord Injury
At first, changes in the way your body functions may be overwhelming. However, you can learn new skills and ways to adapt old skills to deal with the physical effects of a spinal cord injury. Possible difficulties you may encounter include:
- Bladder control. Your bladder will continue to store urine from your kidneys. However, your brain may no longer be able to control bladder emptying, as the message carrier (the spinal cord) has been injured. The loss of bladder control increases your risk of urinary tract infections. It may also cause kidney infection and kidney or bladder stones. Drinking plenty of clear fluids may help. And during rehabilitation, you'll learn new techniques to empty your bladder.
- Bowel control. Although your stomach and intestines work much like they did before your injury, your brain may no longer be able to control the muscles that open and close your anus. This may cause fecal incontinence. A high-fiber diet may help regulate your bowels, and you'll learn techniques to better control your bowels during rehabilitation.
- Impaired skin sensation. Below the neurological level of your injury, you may have lost part or all skin sensations. Therefore, your skin can't send a message to your brain when it's injured by things such as prolonged pressure, heat or cold. This can make you more susceptible to pressure sores, but changing positions frequently — with help, if needed — can help prevent these sores. And, you'll learn proper skin care during rehabilitation, which can help you avoid these problems.
- Circulatory control. A spinal cord injury may cause circulatory problems ranging from spinal shock immediately following your spinal cord injury to low blood pressure when you rise (orthostatic hypotension) to swelling of your extremities throughout your lifetime. These circulation changes may increase your risk of developing blood clots, such as deep vein thrombosis or a pulmonary embolus. Another problem with circulatory control is a potentially life-threatening rise in blood pressure (autonomic hyperreflexia). Your rehabilitation team will teach you how to prevent autonomic hyperreflexia.
- Respiratory system. Your injury may make it more difficult to breathe and cough if your abdominal and chest muscles are affected. These include the diaphragm and the muscles in your chest wall and abdomen. Your neurological level of injury will determine what kind of breathing problems you may have. If you have cervical and thoracic spinal cord injury you may have an increased risk of pneumonia or other lung problems. Medications and therapy can treat these problems.
- Muscle tone. Some people with spinal cord injuries may experience one of two types of muscle tone problems: spastic muscles or flaccid muscles. Spasticity can cause uncontrolled tightening or motion in the muscles. Flaccid muscles are soft and limp, lacking muscle tone.
- Fitness and wellness. Weight loss and muscle atrophy are common soon after a spinal cord injury. However, limited mobility after spinal cord injury may lead to a more sedentary lifestyle, placing you at risk of obesity, cardiovascular disease and diabetes. A dietitian can assist you in attaining a nutritious diet to sustain an adequate weight. Physical and occupational therapists can help you develop a fitness and exercise program.
- Sexual health. Sexuality, fertility and sexual function may be affected by spinal cord injury. Men may notice changes in erection and ejaculation; women may notice changes in lubrication. A spinal cord injury may cause decreased or absent sensation and movement below the level of injury, but a person may notice a heightened sensitivity in areas above the level of injury. Doctors, urologists and fertility specialists who specialize in spinal cord injury can offer options for sexual functioning and fertility.
There's usually no physical change in women with a spinal cord injury that inhibits sexual intercourse or pregnancy. Most women with a spinal cord injury can experience labor, have a normal delivery and breast-feed.
- Pain. Some people may experience pain, such as muscle or joint pain from overuse of particular muscle groups. Nerve pain, also known as neuropathic or central pain, can occur after a spinal cord injury, especially in someone with an incomplete injury.
Causes of Spinal Cord Injury
Common causes of spinal cord injury
The most common causes of spinal cord injuries in the United States are:
- Motor vehicle accidents. Auto and motorcycle accidents are the leading cause of spinal cord injuries, accounting for more than 40 percent of new spinal cord injuries each year.
- Acts of violence. As many as 15 percent of spinal cord injuries result from violent encounters, often involving gunshot and knife wounds, according to the National Institute of Neurological Disorders and Stroke.
- Falls. Spinal cord injury after age 65 is most often caused by a fall. Overall, falls cause about one-quarter of spinal cord injuries.
- Sports and recreation injuries. Athletic activities, such as impact sports and diving in shallow water, cause about 8 percent of spinal cord injuries.
- Alcohol. Alcohol use is a factor in about 1 out of every 4 spinal cord injuries.
- Diseases. Cancer, arthritis, osteoporosis and inflammation of the spinal cord also can cause spinal cord injuries.
Signs & Symptoms of Spinal Cord Injury
Your ability to control your limbs after spinal cord injury depends on two factors: the neurological level of the injury and the completeness of injury. The lowest normally functioning segment of your spinal cord is referred to as the neurological level of your injury. The completeness of the injury is classified as either:
- Complete. If all sensory (feeling) and motor function (ability to control movement) is lost below the neurological level, your injury is called complete.
- Incomplete. If you have some motor or sensory function below the affected area, your injury is called incomplete.
Additionally, paralysis from a spinal cord injury may be referred to as:
- Tetraplegia or quadriplegia. This means your arms; trunk, legs and pelvic organs are all affected by your spinal cord injury.
- Paraplegia. This paralysis affects all or part of the trunk, legs and pelvic organs.
Your health care team will perform a series of tests to determine the neurological level and completeness of your injury.
Spinal cord injuries of any kind may result in one or more of the following signs and symptoms:
- Loss of movement
- Loss of sensation, including the ability to feel heat, cold and touch
- Loss of bowel or bladder control
- Exaggerated reflex activities or spasms
- Changes in sexual function, sexual sensitivity and fertility
- Pain or an intense stinging sensation caused by damage to the nerve fibers in your spinal cord
- Difficulty breathing, coughing or clearing secretions from your lungs
Emergency signs and symptoms
Emergency signs and symptoms of spinal cord injury after an accident may include:
- Extreme back pain or pressure in your neck, head or back
- Weakness, incoordination or paralysis in any part of your body
- Numbness, tingling or loss of sensation in your hands, fingers, feet or toes
- Loss of bladder or bowel control
- Difficulty with balance and walking
- Impaired breathing after injury
- An oddly positioned or twisted neck or back
Diagnosis of Spinal Cord Injury
In the emergency room, a doctor may be able to rule out a spinal cord injury by careful inspection, testing for sensory function and movement, and asking some questions about the accident. But if the injured person complains of neck pain, isn't fully awake, or has obvious signs of weakness or neurological injury, emergency diagnostic tests may be needed.
These tests may include:
- X-rays. Medical personnel typically order these tests on all people who are suspected of having a spinal cord injury after trauma. X-rays can reveal vertebral (spinal column) problems, tumors, fractures or degenerative changes in the spine.
- Computerized tomography (CT) scans. A CT scan may provide a better look at abnormalities seen on an X-ray. This scan uses computers to form a series of cross-sectional images that can define bone, disk and other problems.
- Magnetic resonance imaging (MRI). MRI uses a strong magnetic field and radio waves to produce computer-generated images. This test is extremely helpful for looking at the spinal cord and identifying herniated disks, blood clots or other masses that may be compressing the spinal cord.
- Myelography. Myelography allows your doctor to visualize your spinal nerves more clearly. After a special dye is injected into your spinal canal, X-rays or CT scans of your vertebrae can suggest a herniated disk or other lesions. This test is used when MRI isn't possible or when it may yield important additional information that isn't provided by other tests.
Treatments of Spinal Cord Injury
If you do have a spinal cord injury, you'll usually be admitted to the intensive care unit for treatment. You may even be transferred to a regional spine injury center that has a team of neurosurgeons, orthopedic surgeons, spinal cord medicine specialists, psychologists, nurses, therapists and social workers with expertise in spinal cord injury.
- Medications. Methylprednisolone (Medrol) is a treatment option for an acute spinal cord injury. If methylprednisolone is given within eight hours of injury, some people experience mild improvement from their spinal cord injury. It appears to work by reducing damage to nerve cells and decreasing inflammation near the site of injury. However, this is not a cure for a spinal cord injury.
- Immobilization. You may need traction to stabilize your spine, to bring the spine into proper alignment or both. Sometimes, traction is accomplished by securing metal braces, attached to weights or a body harness, to your skull to keep your head from moving. In some cases, a rigid neck collar also may work. A special bed also may help immobilize your body.
- Surgery. Often, surgery is necessary to remove fragments of bones, foreign objects, herniated disks or fractured vertebrae that appear to be compressing the spine. Surgery may also be needed to stabilize the spine to prevent future pain or deformity.
- Experimental treatments. Scientists are trying to figure out ways to stop cell death, control inflammation and promote nerve regeneration. Ask your doctor about the availability of such treatments.
Prevention of Spinal Cord Injury
Following this advice may reduce your risk of a spinal cord injury:
- Drive safely. Car crashes are one of the most common causes of spinal cord injuries. Wear a seat belt every time you drive or ride in a car. Make sure that your children wear a seat belt or use an age- and weight-appropriate child safety seat. To protect them from air bag injuries, children under age 12 should always ride in the back seat. Don't drive while intoxicated or under the influence of drugs.
- Be safe with firearms. Lock up firearms and ammunition in a safe place to prevent accidental discharge of weapons. Store guns and ammunition separately.
- Prevent falls. Use a stool or stepladder to reach objects in high places. Add handrails along stairways. Put nonslip mats on tile floors and in the tub or shower. For young children, use safety gates to block stairs and consider installing window guards.
- Take precautions when playing sports. Always wear recommended safety gear. Check water depth before diving to make sure you don't dive into shallow water. Avoid leading with your head in sports. For example, don't slide headfirst in baseball, and don't tackle using the top of your helmet in football. Use a spotter for new moves in gymnastics.
When to seek Medical Advice
A spinal cord injury isn't always obvious. Numbness or paralysis may result immediately after a spinal cord injury or gradually as bleeding or swelling occurs in or around the spinal cord. In either case, the time between injury and treatment can be a critical factor that can determine the extent of complications and the amount of recovery. Anyone who has experienced significant trauma to the head or neck needs immediate medical evaluation for the possibility of a spinal cord injury. In fact, it's safest to assume that trauma victims have a spinal cord injury until proved otherwise. If you suspect that someone has a back or neck injury, don't move the injured person. Permanent paralysis and other serious complications may result. Instead, take these steps:
- Call your local emergency medical assistance number.
- Keep the person still.
- Place heavy towels on both sides of the neck or hold the head and neck to prevent them from moving, until emergency care arrives.
- Provide basic first aid, such as stopping any bleeding and making the person comfortable, without moving the head or neck.