Cause and Effect of Spinal Cord Injury

Spinal cord injury may be due to either traumatic or non-traumatic causes. Non-traumatic causes include diseases and medical conditions such as arthritis, cancer, spinal stenosis, polio, spina bifida, and birth defects. Traumatic causes include vehicle accidents, acts of violence, falls, and other events in which an external force damages the spinal cord.

When the spinal cord is injured, messages from the brain cannot be carried below the point of the injury; this means that the closer the injury is to the head, the more parts of the body that are affected. Typically, the result of SCI is some degree of paralysis as well as symptoms including pain, muscle spasms, loss of bowel & bladder control, and sexual dysfunction to name a few. Some SCI survivors also experience secondary medical problems such as bladder infections, lung infections, and bedsores.

Spine

The spine has seven neck (cervical) segments or vertebrae, twelve chest (thoracic) vertebrae, five back (lumbar) vertebrae, and five tail (sacral) vertebrae. The segments are designated by a letter-number combination that corresponds to the position of the segment on the spine. For example, C1 refers to the first vertebra in the cervical area, and T3 refers to the third vertebra in the thoracic area. In total, there are seven cervical vertebrae (C1 – C7), twelve thoracic vertebrae (T1 – T12), five lumbar vertebrae (L1 – L5) and five sacral vertebrae (S1 – S5).

Spinal Cord

Spinal cord segments are named in the same fashion as the spine’s segments, but the two do not always match-up. For instance, the C1 vertebra on the spine and the C1 cord correspond to each other, but the C7 vertebra contains the C8 cord. The spinal cord does not travel the entire length of the spine; it ends at the second lumbar segment (L2). Spinal roots exit below the spinal cord’s tip (conus) in a spray; this is called the cauda equine (horse’s tail). Damage below the L2 generally does not interfere with leg movement, although it can contribute to weakness.

A traumatic injury devastates the lives of survivors and their families; the injured person’s needs are complex: they must learn new ways to physically carry-out daily activities and/or emotionally cope with being more dependent on others for basic needs (like feeding or toileting). On top of the pains of recovery and rehabilitation, the injured person and their families or care-givers will need to navigate the healthcare system, interfacing with doctors, lawyers, government agencies, etc. Navigating the “system” can be confusing and demanding; the uncertain outcomes and constant pressure puts a strain on everyone’s ability to cope, and has a negative effect on the survivor’s recovery.

Medical Case Management

Medical Case Management refers to the planning and coordination of healthcare & other professional services; it may include, but is not limited to, evaluating the status of a person’s medical condition, developing and implementing a plan of care, coordinating medical resources, communicating healthcare needs, monitoring an individual’s progress, and facilitating cost-effective care.

Learn more about Medical Case Management

Social Work Support

Anyone facing a life-altering event, chronic condition, disability, or everyday stressors may benefit from social work; it helps a person to resolve emotional and mental concerns, manage on-going or recurring challenges, and overall maximize their quality of life. A social worker addresses an individual’s physical and social needs to minimize the negative effects of life’s difficulties and complications.

Learn more about Social Work Support

Dealing with a Brain Injury

Soon after the injury, most people tend to focus on the abilities that have been lost. Emotionally, the experience can be overwhelming, confusing, and frustrating. But as time goes on, everyone begins to grapple with their injury in both productive and non-productive ways. One common response is to deny the significance of the injury; unfortunately, a brain injury can’t simply be “walked off.” Brains are notoriously slow to heal, which only compounds the frustrating aspects of TBI. Brain injury also has a tendency to bring a lot of emotional challenges and may affect mental health. Depression, anger, and anxiety are common repercussions of brain injury, so people with TBI should be vigilant to seek out qualified care and support if they experience mental health problems. As people begin to regain lost abilities or acquire new coping skills, they also begin to accept the realities of their injury. At this stage, a person might express that they are no longer fighting the injury but rather seeking ways to integrate their TBI into their lives. For most people who experience a brain injury, life will return to a similar pace. But for many others, a TBI may mean months, years, or even a lifetime full of changes.

Moving Forward After TBI

A brain injury sets off a clear chain of medical events, all of them around the injured person’s healthcare: the emergency room, intensive care, hospital recovery, and then rehabilitation. But there isn’t a roadmap for all the aspects of life that fall outside of medical care as life marches on despite the injury. While most people who sustain a TBI recover quickly, for those with moderate to severe TBIs — and their families — life may need to be reinvented, reinterpreted and accepted as something different.

Communicating with TBI Survivors

• Speak in short sentences
• Give time to respond
• Repeat information
• Avoid over stimulation
• Put things in writing

Level of Spinal Cord Injury

The level of spinal-cord injury refers to the location along the spinal cord where the injury occurred and also indicates which body parts are most likely to experience a loss of movement and/or sensation. The level of injury is designated by a letter-number combination such as C2; the letter represents an area of the spinal cord (cervical, thoracic, lumbar, or saccral) while the number represents a specific cord within that area. For example, in the thoracic area, the fifth cord is called T5.

Type of Spinal Cord Injury

The type of spinal-cord injury can either be complete or incomplete. In a complete injury, there is total paralysis (lack of movement and sensation) equally on both sides of the body; either two limbs are paralyzed (paraplegia) or all four limbs are paralyzed (tetraplegia, also called quadriplegia). With an incomplete injury, there is only a partial loss of function usually more or less on one side of the body or the other; for example, the injured person may have sensation but no movement in a limb or the person has greater control over the left limb more than the right limb.

Some of the complications a SCI survivor may experience include loss of control over bladder and/or bowels, pressure sores (bed sores), breathing problems, spastic muscles, autonomic dysreflexia, and being unaware of new injuries due to a lack of sensation in a body part. Although these complications may be difficult to manage, they are not insurmountable.

Bladder Control

A person who has a spinal-cord injury may benefit from using a catheter at regular intervals to empty their bladder; intermittent catheterization is less likely to lead to an infection versus leaving the catheter in around-the-clock.

Bowel Function

A spinal cord injury can cause either a lack of bowel control or constipation; a high fiber diet and medications can help to manage bowel function. Also, a rehabilitation specialist can help the injured person learn new ways to regulate bowel movements.

Pressure Sores (Bed Sores)

A person having a spinal-cord injury may routinely sit or lie in the same position for extended periods of time; as a result, the skin on the body parts that are being rested on, may break-down and lead to pressure sores. Since there may be little or no sensation in the affected area, the injured person may not realize that there is a problem. Pressure sores can become a grave health-concern if they are infected and/or un-treated, but sores can be prevented by regularly changing position.

Spastic Muscles

A person living with a spinal-cord injury may experience muscles spasms which cause their limbs to twitch or “jump”; this is relatively rare and unfortunately it is not an indication that the person is regaining sensation or movement in those areas. These involuntary movements occur because some of your nerves have become more sensitive, yet your damaged spinal cord will not allow the brain to interpret and regulate their signals.

Respiratory Problems

If a spinal-cord injury causes paralysis in the diaphragm muscles (chest muscles for breathing), the injured person may be placed on a ventilator. Even if their breathing is not directly impaired, SCI survivors are still at greater risk of pneumonia and may be given respiratory exercises and medications to help prevent lung infections and improve lung function.

Blood Clots

With a spinal cord injury, being immobile for long periods of time slows blood circulation and can cause clots to form. Blood-thinning medications, leg pumps, and special stockings, can help improve circulation and prevent fluid build up.

Related Injuries

A person with a damaged spinal cord may not be able to feel pain or other stimuli on some areas of their body; this means they could experience other injuries (e.g., severe burns or cuts) without realizing it.

Pain

Sometimes, a person with a spinal-cord injury is able to feel pain within areas of their body that cannot feel exterior sensations. The pain may likely be a result of the initial injury and a physician may prescribe medication for relief.

Unfortunately there’s no way to reverse damage to the spinal cord; treatment for a spinal cord injury focuses on preventing further damage and empowering the injured person to have an active and productive life.

Emergency & Hospital Care

Treatment for a spinal cord injury often begins at the scene of the accident; paramedics will act to stabilize the injured person’s heart rate, breathing, blood pressure, and other vital stats. To prevent further injury, the person’s head and neck may be fitted into a brace to immobilize their spine, and their body may be secured to a stiff board to restrain their movement. Once at the hospital, a series of tests such as X-rays, CT scans, and MRIs are performed to help physicians determine the extent of the injury. In cases of severe injury to the neck area of the spinal cord, respiratory problems may occur that require intubation (giving oxygen through a tube inserted down the throat) to help the injured person breathe.

Surgery

A traumatic spinal cord injury may require surgery to remove foreign objects, bone fragments, or herniated disks that are compressing the spinal cord.

Rehabilitation

Rehabilitation helps an SCI survivor re-adjust to life both physically and emotionally. It is important to begin rehabilitation as soon as possible to prevent muscular atrophy and to address emotional or psychological concerns early on. A number of specialists may assist in recovery including a physical therapist, an occupational therapist, a rehabilitation nurse, a rehabilitation psychologist, a social worker, and a physiatrist. Physical therapy begins in the hospital to help the injured person regain strength and control in their limbs and body parts. An occupational therapist will help with fine motor skills and accomplishing every day tasks; for example, the injured person may have to learn how to manage their bowel and bladder, walk with crutches, do breathing exercises, and move between a wheelchair and another location (e.g. a bed). Also, the person will learn how to use adaptive devices that enable them to function independently. Following the hospital recovery, the patient will likely continue daily therapy either at a rehabilitation facility or by an in-home therapist. In some cases, a rehabilitation facility may be required for specialized care or advanced therapy.

Diagnosing a spinal cord injury begins during emergency treatment and usually requires subsequent neurological exams; X-rays, CT scans, and/or MRIs may be administered to determine the level and completeness of the injury. The level of injury refers to the location along the spinal cord where the injury occurred and indicates which parts of the body may be affected. The completeness of the injury refers to the extent of damage to the spinal cord and indicates the degree of paralysis (full or partial) in the body parts that were affected. During diagnosis, the patient’s movement and muscle strength will be tested along with their response to light-touch and pinpricks to various parts of the body. Physicians may use one or more of the following scales to rate an injured person’s responses to the tests.

• American Spinal Injury Association Scale (ASIA)
• Neurological Level of Injury (NLOI)
• Function Independence Measure (FIM)
• Quadriplegic Index of Function (QIF)
• Modified Barthel Index
• Spinal Cord Independence Measure (SCIM)
• Capabilities of Upper Extremity Instrument (CUE)
• Walking Index for SCI (WISCI)
• Canadian Occupational Performance Measure (COPM)

Cervical Injuries

Cervical injuries usually cause loss of function in the arms and legs (quadriplegia or paralysis of all four limbs). People with injuries above the C4 level may need a ventilator to breath, and C5 or C6 injuries may result in loss of hand function.

Thoracic Injuries

Injuries in the thoracic region and below can cause paraplegia (paralysis of the legs and lower body). Injuries at T-1 to T-8 most often result in poor trunk control, but hand control is unaffected. Lower T injuries (T-9 to T-12) allow good trunk control and good abdominal muscle control.

Lumbar & Sacral Injuries

Injuries in the thoracic region and below can cause paraplegia (paralysis of the legs and lower body). Injuries at T-1 to T-8 most often result in poor trunk control, but hand control is unaffected. Lower T injuries (T-9 to T-12) allow good trunk control and good abdominal muscle control.

There are two types of spinal cord injuries: complete spinal cord injuries refer to a total loss of function below the level of the injury, while incomplete spinal cord injuries are those that result in a partial loss of function.

Complete Spinal Cord Injury

A complete spinal cord injury means that there is no movement or sensation below the level of the injury. In a complete injury, both sides of the body are equally affected; the result is either complete paraplegia, total paralysis in two limbs, or complete tetraplegia, total paralysis in all four limbs (also called quadriplegia).

Complete Paraplegia

Complete paraplegia is the permanent loss of motor and nerve function at the T1 level or below; the result is loss of sensation, movement, and/or control in the legs, bowel, bladder, and sexual region, however, arms and hands retain normal function.

Complete Tetraplegia

Complete tetraplegia is the permanent loss of movement and sensation at the C1 to C8 levels; the result is loss of function in all four limbs and in some cases, tetraplegics require ventilator systems in order to breathe. The degree of retained functionality depends on where the injury to the spine occurred.

Incomplete Spinal Cord Injury

Incomplete spinal cord injuries are more common than complete injuries and are characterized by some movement or sensation below the point of injury. A person suffering from an incomplete spinal cord injury can often move one limb more than another, may have more function on one side than the other, or might have some sensation in parts of the body, but unable to move those parts. The effects of an incomplete injury are dependent upon whether the front (anterior cord syndrome), back (posterior cord syndrome), side (brown-sequard syndrome), or center (central cord syndrome) of the spinal cord was affected.