Spinal Cord Injury

Spinal cord injury, or SCI, is damage to the spinal cord. The spinal cord is protected by the bones of the spine, called vertebrae. Vertebrae are stacked on top of each other. A tunnel goes through the bones. The spinal cord and nerves go from the brain to the tailbone in this tunnel. Nerves branch off from the spinal cord between each of the bones of the spine. Spinal cord trauma occurs when that protection is damaged.

The spinal cord is the part of the nervous system that runs down from the brain through a canal in the spine. It sends signals between the peripheral nerves in the body and the brain. Signals from sensations such as pain are sent up the peripheral nerves from organs such as the skin. Commands to move the body are known as motor impulses. These impulses begin in the brain and travel down the spinal cord. They then travel through the peripheral nerves into tissues, such as muscle, to produce movement.

What are the causes and risks of the injury?

Spinal cord trauma can be caused by:

Each year in the United States, there are about 10,000 spinal cord injuries that people survive. Of these injuries, half result in paraplegia and half in quadriplegia. The causes of these injuries are:

Of those injured each year, 82% are male. The most common age at the time of injury is 19 years old. Sports produce a special set of risk statistics. Diving accidents cause 2/3 of spinal injuries during sports. Ninety-two percent of sports injuries result in quadriplegia. Alcohol in the bloodstream worsens spinal cord injuries. This is because bleeding can cause the alcohol to come into contact with spinal cord tissue.

What are the signs and symptoms of the injury?

The main symptom of an SCI is a loss of movement and feeling below the level of injury. Trauma to the spine at or below the spot where the neck and chest meet will affect the legs. Complete loss of function at this level is called paraplegia. Incomplete loss is called paraparesis. Injuries involving the neck will also affect the arms. Complete loss of function in the arms and below is called quadriplegia. Partial loss in all four limbs is called quadriparesis. Below the level of injury, the person will lose:

These losses may be partial or complete. They may be temporary or permanent. It depends on the severity of the injury.

How is the injury recognized?

Diagnosis of a spinal cord injury begins with a medical history and physical exam. Various imaging studies, such as MRI or CT scans, may be used.

What can be done to prevent the injury?

A number of actions can help prevent spinal cord injury. They include:

What are the treatments for the injury?

Treatment of an SCI is tailored to the injury, because each case is unique. Steroids, such as methylprednisolone, can reduce swelling. If the spine is fractured, spinal fusion, or joining the bones of the spine with surgery, may be needed. This can stabilize the injury and shorten the recovery period. Rehabilitation often takes a long time. The goal is to achieve the most function and independence possible. Some experimental medicines are being used to reduce scarring at the injury site. They may improve regrowth of nerves.

What are the side effects of the treatments?

Steroids can cause high blood glucose levels and increased risk for infection. Surgery may cause bleeding, infection, or allergic reaction to anesthesia.

What happens after treatment for the injury?

Without proper treatment, many complications can occur.

With treatment, people can relearn ways to control their body and how to do activities. It is possible to go back to normal activities, such as school, work, marriage, and having children. Usually, the person will use a wheelchair. There are special tools that help with tasks such as eating and getting dressed. Doctors who work in rehabilitation, urology, orthopedics, neurology, and other specialties may be needed to provide complete treatment. The person may benefit from physical therapy and occupational therapy.

The financial and emotional costs to society of spinal trauma are great. Medical costs during the first year after leaving the hospital can be more than $50,000 per person. These costs decrease only slightly after the first year. Because of complications, only 85% of people with cord injury are alive 10 years after being injured. This compares to 98% of uninjured people of similar age and gender.

Only 35% of paraplegics and 25% of quadriplegics are employed 8 years after the injury. Marriage rates are lower. Divorce rates are higher. People with SCIs can feel isolated. They may need psychological counseling. Many laws have been created to give more help to people with disabilities. These laws will continue to make it easier for them to work and be productive members of society.

Author:James Warson, MD
Date Written:
Editor:Crist, Gayle P., MS, BA
Edit Date:09/30/01
Reviewer:Eileen McLaughlin, RN, BSN
Date Reviewed:08/20/01