Spinal Cord Injury

A spinal cord injury (SCI) is damage to the tight bundle of cells and nerves extending from the brain’s lower part to the lower back. The spinal cord sends and receives signals from the brain to the rest of the body.

Spinal cord injury (SCI) is caused by direct injury to the spinal cord or damage to the tissue and bones (vertebrae) surrounding the spinal cord. This damage can cause temporary or permanent changes in sensation, movement, strength and body functions below the injury site.

Motor vehicle accidents and catastrophic falls are the most common causes of spinal cord injury (SCI) in the U.S. The rest are due to acts of violence (primarily gunshot wounds and assaults), sports injuries, medical or surgical injuries, industrial accidents, diseases and conditions that can damage the spinal cord and other less common causes. Risk factors include age (between the ages of 16 and 30 or after 65 for dangerous falls), alcohol use, certain diseases or not wearing proper gear, such as a seat belt or protective sports equipment.

Reducing the risk of a spinal cord injury requires making wise and safe choices. Driving safely is primary, as car accidents are among the most common causes of SCI. Before diving into the water, check the water depth. Additionally, using protective gear and taking precautions while playing sports are essential in protecting the spine.

Emergency medical tests for a spinal cord injury include:

• Magnetic resonance imaging (MRI): produces detailed 3D images of body structures, including tissues, organs, bones and nerves. It can show brain and spinal trauma from injury, herniated discs (cartilage located between the vertebrae), vascular (blood vessel) irregularities, bleeding, inflammation that might compress the spine and spinal cord and injury to the ligaments that support the cervical spine.
• Computed tomography (CT): provides rapid, precise, 2D images of organs, bones and tissues. A CT scan can detect bone fractures, bleeding and spinal stenosis (narrowing of the spinal canal).
• X-ray: shows 2D images of most body parts, such as joints or significant organ systems. Within minutes, misalignment or fracture of vertebrae can be seen.

A spinal cord injury can damage a few, many or almost all of the nerve fibers that cross the site of injury. The extent of disability depends on where along the spinal cord the injury occurs and the severity of the injury. An injury higher on the spinal cord can cause paralysis in most parts of the body and affect all limbs (tetraplegia or quadriplegia). An injury to the lower spinal cord may cause paralysis affecting the legs and lower body (paraplegia). A nearly complete recovery is possible for injuries with little to no nerve cell death.

A spinal cord injury can cause one or more symptoms, including:

• Numbness, tingling or a loss of or changes in sensation in hands and feet
• Paralysis may happen immediately or develop over time as swelling and bleeding affect the spinal cord
• Pain or pressure in the head, neck or back
• Loss of movement
• Weakness or inability to move any part of the body
• Unnatural positions of the spine or head
• Loss of bladder and bowel control
• Problems with walking
• Difficulty breathing
• Changes in sexual function

The emergency room physician will check for movement or sensation at or below the level of injury, as well as proper breathing, responsiveness and weakness. Emergency medical tests for a spinal cord injury include:

• Magnetic resonance imaging (MRI): produces detailed 3D images of body structures, including tissues, organs, bones and nerves. It can show brain and spinal trauma from injury, herniated disks (cartilage located between the vertebrae), vascular (blood vessel) irregularities, bleeding, inflammation that might compress the spine and spinal cord and injury to the ligaments that support the cervical spine.
• Computerized tomography (CT): provides rapid, precise, 2D images of organs, bones and tissues. A CT scan can detect bone fractures, bleeding and spinal stenosis (narrowing of the spinal canal).
• X-ray: shows 2D images of most body parts, such as joints or major organ systems. A misalignment or fracture of vertebrae can be seen within minutes.

At the accident scene, if a spinal cord injury (SCI) is suspected, emergency personnel will place a rigid collar around your neck and carefully place you on a backboard to prevent further damage to your spinal cord. They may use sedatives to help you relax and avoid movement. A breathing tube may be inserted if you have problems breathing and your body isn’t receiving enough oxygen from the lungs.

Immediate treatment at the trauma center may include:

• Realigning your spine using a rigid brace or mechanical force, which is usually done as soon as possible to stabilize your spine and prevent additional damage
• Surgery to remove any fractured vertebrae, bone fragments, herniated disks or other objects that are pressing on your spinal column. Spinal decompression surgery to relieve pressure within the spinal column may also be necessary in the days following the injury. Results of a neurosurgical study show that, in some cases, earlier surgery is associated with better functional recovery.

Possible complications of SCI and treatment may include:

• Autonomic dysreflexia: a life-threatening reflex action that primarily affects those with injuries to the neck or upper back. Symptoms may include flushing or sweating, a pounding headache, anxiety, a sudden increase in blood pressure, vision changes or goosebumps on the arms and legs. You should be seated to keep blood flowing to the legs and feet and help reduce blood pressure.
• Bladder and bowel problems: You may need to use a catheter to empty your bladder or learn ways to empty the bowels. A change in diet may be required.
• Breathing problems: About one-third of people with a neck injury will need temporary or permanent help breathing and may require an artificial breathing tube inserted. Any injury to the spinal cord between the C1 and C4 segments can stop breathing, as the nerves in this region cause the diaphragm to move and the lungs to expand. Special training regarding breathing and swallowing may be needed.
• Circulatory problems: Changes in circulation, including blood pressure instability, abnormal heart rhythms (arrhythmias) and blood clots, may appear days after your injury. Blood pressure needs to be closely monitored. Because the brain’s control of the cardiac nerves can be cut off, your heart can beat dangerously slow or pound rapidly and irregularly. Changes in the control of blood vessels can cause them to widen and allow blood to pool in the small arteries far away from the heart. People with spinal cord injuries are at increased risk for blood clots due to stagnation of blood flow in the large veins in the legs. Treatment includes anticoagulant drugs and compression stockings to increase blood flow in the lower legs and feet.
• Depression: Many people living with a spinal cord injury may develop depression due to lifestyle changes. Therapy and medicine may help treat depression and other mental health conditions.
• Pain: Some people with spinal cord nerve damage develop neurogenic pain, an intense burning or stinging sensation that may be constant due to extreme physical sensitivity (hypersensitivity) in some body parts. It can be spontaneous or triggered by various factors and can occur even in body parts that have lost sensation. Treatments for chronic pain include medications, acupuncture, spinal or brain electrical stimulation and surgery. However, none of these treatments is entirely effective for relieving neurogenic pain.
• Pneumonia: Respiratory complications are the leading cause of death in people with SCI, commonly as a result of pneumonia. If you are placed on a ventilator to assist with breathing (intubation), you are at increased risk of developing pneumonia. You must be carefully monitored and treated with antibiotics if symptoms of pneumonia appear. Clearing secretions from the throat and preventing food and liquids from being sucked into the lungs (aspiration) can prevent pneumonia.
• Pressure sores (also known as pressure ulcers): areas of skin that have broken down due to continuous pressure and reduced blood flow to the area. People with paraplegia and tetraplegia are susceptible to pressure sores, so a caregiver must periodically shift them.
• Sexual function: Depending on the level of injury and recovery from the trauma, sexual function and fertility may be affected. A urologist and other specialists can suggest different options for sexual functioning and health.
• Spasticity and decreased muscle tone: Your reflexes may become exaggerated over time, causing muscle spasticity requiring special treatment. Muscles may deteriorate due to underuse.

Once someone begins to cope psychologically and emotionally, the next concern is how to live with disabilities. Doctors are now able to predict with reasonable accuracy the likely long-term outcome of spinal cord injuries. This helps people experiencing SCI set achievable goals for themselves and gives families and loved ones realistic expectations for the future.

Rehabilitation programs combine physical therapies with skill-building activities and counseling to provide social and emotional support and increase independence and quality of life. The rehabilitation team is usually led by a doctor specializing in physical medicine and rehabilitation (physiatrist) and often includes social workers, physical and occupational therapists, recreational therapists, rehabilitation nurses, rehabilitation psychologists, vocational counselors, nutritionists, a case worker and other specialists.

The initial rehabilitation phase focuses on regaining communication skills and leg and arm strength. For some individuals, mobility is only possible with assistive or adaptive devices such as a walker, leg braces or a wheelchair. Communication skills such as writing, typing and telephone use may also require adaptive devices for those with tetraplegia.

The rehabilitation programs may include:

• Physical therapy: includes exercise programs geared toward strengthening muscles
• Occupational therapy: helps redevelop fine motor skills, particularly those needed to perform activities of daily living (ADLs), such as getting in and out of bed, self-grooming, eating and using the toilet. You may learn how to cope with spasticity (an increase in muscle tone or stiffness of muscles that interferes with movement and speech), autonomic dysreflexia (change in heart rate and excessive sweating due to nervous system stimulation) and neurogenic pain as a result of dysfunction of the peripheral or central nervous system.
• Vocational rehabilitation: includes identifying basic work skills and physical and cognitive capabilities to determine the likelihood of employment, identifying potential workplaces and any assistive equipment that will be needed, and arranging a user-friendly workplace
• Educational training: helps you develop skills for a new line of work that may be less dependent on physical abilities and more on computer or communication skills. People with SCI or other disabilities are encouraged to participate in activities that provide a sense of satisfaction and self-esteem, such as educational classes, hobbies, special interest groups and participating in family and community events.
• Recreation therapy: encourages you to participate in sports or activities appropriate for your level of mobility to access opportunities for socialization and self-expression and help you achieve a more balanced lifestyle

Adaptive devices may help people with spinal cord injuries regain independence and improve mobility and quality of life. Depending on the severity of the injury, people may need a wheelchair, electronic stimulators, assisted walking training, neural prosthetics (assistive devices that stimulate the nerves to restore lost functions), computer adaptations or other computer-assisted technology.

To better understand your diagnosis, consider participating in a clinical trial so clinicians and scientists can learn more about SCI. Clinical research uses human volunteers to help researchers learn more about a disorder and find better ways to detect, treat or prevent disease safely.

All types of volunteers are needed—those who are healthy or may have an illness or disease—of all different ages, sexes, races and ethnicities to ensure that study results apply to as many people as possible and that treatments will be safe and effective for everyone who will use them.

Visit NIH Clinical Research Trials and You for information about clinical research participation. Clinicaltrials.gov, a searchable database of clinical trials, also offers information about clinical trials currently seeking participants with spinal cord injury.

Spinal cord injury and rehabilitation research centers maintain registries of people interested in participating in ongoing or future clinical studies. The NeuroRecovery Network (NRN), a multi-site network supported by the Christopher and Dana Reeve Foundation, also accepts volunteer research participants.