Spinal Cord Injury

What is an acute spinal cord injury?

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The spinal cord is a bundle of nerves that carries messages between the brain and the rest of the body.

Acute spinal cord injury (SCI) is due to a traumatic injury that can either result in a bruise (also called a contusion), a partial tear, or a complete tear (called a transection) in the spinal cord. SCI is more common in men and young adults.

There are about 12,000 new cases of SCI each year. The number of people in the U.S. in 2008 living with a spinal cord injury was approximately 259,000.

SCI results in a decreased or absence of movement, sensation, and body organ function below the level of the injury. The most common sites of injury are the cervical and thoracic areas. SCI is a common cause of permanent disability and death in children and adults.

Anatomy of the spine

The spine consists of 33 vertebrae, including the following:

• 7 cervical (neck)
• 12 thoracic (upper back)
• 5 lumbar (lower back)
• 5 sacral* (sacrum--located within the pelvis)
• 4 coccygeal* (coccyx--located within the pelvis)

* By adulthood, the five sacral vertebrae fuse to form one bone, and the four coccygeal vertebrae fuse to form one bone.)

These vertebrae function to stabilize the spine and protect the spinal cord. In general, the higher in the spinal column the injury occurs, the more dysfunction a person will have.

Injury to the vertebrae does not always mean the spinal cord has been damaged. Likewise, damage to the spinal cord itself can occur without fractures or dislocations of the vertebrae.

What are the types of SCI?

SCI can be divided into two main types of injury:

• Complete injury. Complete injury means that there is no function below the level of the injury--either sensation and movement--and both sides of the body are equally affected. Complete injuries can occur at any level of the spinal cord.
• Incomplete injury. Incomplete injury means that there is some ability for the spinal cord to send messages to and from the brain. There is also some function below the level of the injury--movement in one limb more than the other, feeling in parts of the body, or more function on one side of the body than the other. Incomplete injuries can occur at any level of the spinal cord.

What causes an acute spinal cord injury?

There are many causes of SCI. The more common injuries occur when the area of the spine or neck is bent or compressed, as in the following:

• Birth injuries, which usually affect the spinal cord in the neck area
• Falls
• Motor vehicle accidents. These can be either when a person is riding as a passenger in the car or is struck as a pedestrian.
• Sports injuries
• Diving accidents
• Trampoline accidents
• Violence. This involves penetrating injuries that pierce the cord, such as gunshots and stab wounds.

What are the symptoms of an acute spinal cord injury?

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Symptoms vary depending on the severity and location of the SCI. At first, the patient may experience spinal shock, which causes loss of feeling, muscle movement, and reflexes below the level of injury. Spinal shock usually lasts from several hours to several weeks. As the period of shock subsides, other symptoms appear, depending on the location of the injury.

Generally, the higher up the level of the injury to the spinal cord, the more severe the symptoms. For example, an injury at C2 or C3 (the second and third vertebrae in the spinal column), affects the respiratory muscles and the ability to breathe. A lower injury, in the lumbar vertebrae, may affect nerve and muscle control to the bladder, bowel, and legs.

SCI is classified according to the person's type of loss of motor and sensory function. The following are the main types of classifications:

• Quadriplegia (quad means four). This involves loss of movement and sensation in all four limbs (arms and legs). It usually occurs as a result of injury at T1 or above. Quadriplegia also affects the chest muscles and injuries at C4 or above require a mechanical breathing machine (ventilator).
• Paraplegia (para means two like parts). This involves loss of movement and sensation in the lower half of the body (right and left legs). It usually occurs as a result of injuries at T1 or below.
• Triplegia (tri means three). This involves the loss of movement and sensation in one arm and both legs and usually results from incomplete SCI.

The following are the most common symptoms of acute spinal cord injuries. However, each individual may experience symptoms differently. Symptoms may include:

• Muscle weakness or paralysis in the trunk, arms or legs
• Loss of feeling in the trunk, arms, or legs
• Muscle spasticity
• Breathing problems
• Problems with heart rate and blood pressure
• Digestive problems
• Loss of bowel and bladder function
• Sexual dysfunction

The symptoms of SCI may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

Rehabilitation potential with SCI

The following chart is a comparison of the specific level of SCI and the resulting rehabilitation potential. This chart is a guide, with general information only; impairments and rehabilitation potential can vary depending on the type and severity of SCI. Always consult your doctor for more specific information based on your individual medical condition and injury.

Spinal cord injury rehabilitation

Rehabilitation of the patient with a SCI begins during the acute treatment phase. As the patient's condition improves, a more extensive rehabilitation program is often begun.

The success of rehabilitation depends on many variables, including the following:

• Level and severity of the SCI
• Type and degree of resulting impairments and disabilities
• Overall health of the patient
• Family support

It is important to focus on maximizing the patient's capabilities at home and in the community. Positive reinforcement helps recovery by improving self-esteem and promoting independence.

The goal of SCI rehabilitation is to help the patient return to the highest level of function and independence possible, while improving the overall quality of life - physically, emotionally, and socially.

Areas covered in spinal cord injury rehabilitation programs may include:

The spinal cord injury rehabilitation team

The spinal cord injury rehabilitation team revolves around the patient and family and helps set short-and long-term treatment goals for recovery. Many skilled professionals are part of the spinal cord injury rehabilitation team, including any or all of the following:

• Neurologist/neurosurgeon
• Orthopaedist/orthopaedic surgeon
• Physiatrist
• Internist
• Other specialty doctors
• Rehabilitation specialists
• Social worker
• Physical therapist
• Occupational therapist
• Speech/language pathologist
• Psychologist/psychiatrist
• Recreation therapist
• Registered dietitian
• Vocational counselor
• Orthotist
• Case manager
• Respiratory therapist
• Chaplain

Types of spinal cord injury rehabilitation programs

There are a variety of spinal cord injury treatment programs, including the following:

• Acute rehabilitation programs
• Subacute rehabilitation programs
• Long-term rehabilitation programs
• Transitional living programs
• Day-treatment programs
• Vocational rehabilitation programs

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