Spinal Cord Injury

What is a spinal cord injury?

Spinal cord injury is damage to the thick bundle of nerves that runs from the brain to the lower back. This bundle of nerves, called the spinal cord, is enclosed in the hollow center of the spine (the spinal canal). The spinal cord carries sensations and messages to and from the brain and the rest of the body.

If the spinal cord is just bruised or swollen from an injury, the nerves may be able to heal. However, if the nerves are crushed, cut, or torn, the damaged nerves are usually not able to heal. This means that the nerves will no longer be able to deliver signals between the brain and the part of the body controlled by the injured nerve.

How does it occur?

The spinal cord may be injured if you have an injury to the back that:

• breaks or dislocates the bones around the spinal cord
• penetrates through or between the bones (such as a bullet)
• crushes the disks between the bones and pushes them into the spinal canal.

Common causes of spinal cord injuries are:

• automobile or motorcycle accidents
• falls from high places
• dives into shallow water
• sports such as hockey, football, water skiing, and surfing
• injuries from stabbing or gunshots.

The spinal cord may also be damaged by tumors growing into the spinal cord.

What are the symptoms?

The symptoms of spinal cord injury depend on how much and what part of the spinal cord is damaged. The nerves in your body allow you to feel hot and cold, touch, and texture. They allow you to control your muscles. They also control body functions that happen without your thinking about them (like breathing while you're sleeping). This means that when the nerves are damaged, any or all of these functions may be lost. For example, spinal cord injury can cause:

• numbness
• tingling
• inability to move parts of your body (paralysis)
• inability to control your bowel and bladder (incontinence).

Nerves in the lower part of the spine control functions and feelings in the lower part of your body, such as your legs. If the spinal cord is damaged in the middle or lower back, you may be paralyzed and lose feeling in the lower body and legs. Nerves in the upper end of the spinal cord control movement and feelings higher in the body, such as your arms, as well as the lower part of the body. This means that injuries at the upper end of the spinal cord affect more nerves and body functions than injuries that are lower in the spine. An injury in the neck may paralyze arms, legs, bladder, bowels, and even the muscles that control breathing.

How is it diagnosed?

Your healthcare provider will diagnose the injury based on how you were injured and your symptoms (such as numbness, tingling, or being unable to move parts of your body). You will have a physical exam to confirm which parts of the body are affected. Tests you will have include:

• X-rays to look for broken or dislocated bones
• CT and MRI scans to look at the cord and the tissues around it.

How is it treated?

A spinal cord injury is a medical emergency that requires admission to the hospital. All spinal cord injuries require careful observation, especially in the first 24 hours.

Right after the injury the spine is immobilized to prevent further injury. This is done using a rigid collar to support and stabilize the cervical spine. Extreme care is taken when someone with a spinal injury is moved from place to place to minimize the movement of the spine. Later, treatment may include:

• Spinal traction to pull bones back into their proper place.
• Surgery to relieve pressure on the cord from a bone or disk that is pushing on it. Broken vertebrae around the injury may be fused together to support the spine and to protect the spinal cord from further injury.
• Medicine (high-dose steroids) to decrease swelling around the cord.
• A cooling of your body to allow the swelling to go away and the nerve to heal.

If you are partially paralyzed, you may recover some movement if the nerves were only bruised.

You may start a spinal cord injury rehabilitation program while you are in the hospital that will help you to learn to deal with some of the functions you may have lost due to the injury. Rehabilitation programs may include physical therapy, occupational therapy and, if needed, speech therapy.

• Physical therapy is a major part of the treatment. It helps you regain muscle strength and may teach you ways to move safely with weak or paralyzed muscles.
• Occupational therapy helps you relearn ways of eating, dressing, and grooming. It may also include career retraining.
• Speech therapy may help if you have problems with swallowing or speaking.

Therapy will include skin, bladder, and bowel care and training. You may need help with daily activities and may require round-the-clock help and care.

How long will the effects last?

If some of the injured nerves were just bruised, they might start to work again days to weeks after the injury. However, nerves that were badly damaged will die. They will not grow back and the injury is permanent.

How can I help take care of myself?

• If your spinal cord injury has affected your ability to chew or swallow, you will need to make some changes in the foods you eat. Ask your provider about the benefits of talking to a dietician to learn what foods you will be able to eat to have a healthy diet.
• Follow the exercise or rehabilitation treatment plan your healthcare provider prescribes. You may need to do special exercises to keep muscles as strong as possible.
• You may need to make changes to your home in order to use special equipment that will help you with your daily activities.
• You may need to make arrangements for someone to be with you to help you with your daily activities.

How can I help prevent spinal cord injury?

Most of the time spinal cord injury is the result of accidents. To help avoid spinal cord injury:

• Wear a seat belt when you are riding in a vehicle. Children should be properly restrained in car seats or booster seats.
• Wear a helmet when you ride a bike or motorcycle.
• Use safety equipment at work, when you play sports, and when you use sports equipment, such as trampolines.
• Check the water depth before you dive.
• Do not move someone with a possible spinal injury until emergency providers arrive. It may make the injury worse to move him or her. Healthcare workers will protect the neck and spinal column before moving the person.
• If you have hurt your back or neck, look for any changes. Report all signs of numbness, tingling, weakness, or problems moving. Consult your healthcare provider right away, even if these feelings come and go.