Spinal Cord Injury

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Car and motorcycle crashes, gunshot and knife wounds, and falls and sports injuries are the most common causes of damage to the spinal cord, the bundle of nerves that runs through the backbone. This network transmits sensation and controls movement throughout the body. Damage to it can cause loss of mobility and feeling below the injured area, and can be fatal in severe injuries.

WARNING! Do not move someone if you suspect a spinal cord injury.

About 8,000 new spinal cord injuries are diagnosed every year; more than 80 percent of them are in men age 16 to 30. As many as 450,000 Americans live with spinal cord injuries.

Chances of survival and recovery depend on the severity and location of the injury, as well as quick medical treatment after an accident. A spinal injury at the neck level may impair a person's breathing and paralyze arms, legs and trunk (quadriplegia). Injury lower in the spine may cause weakness and loss of movement or feeling only in the legs and lower parts of the body (paraplegia). A severed spinal cord cannot be repaired. In less severe cases, recovery depends on the extent of damage. Prospects for recovery are good if you are able to move or feel sensation within a week of your injury.

Once the initial injury has healed, rehabilitation -- including physical and occupational therapy -- helps the injured person learn skills to live independently with the disability.

Lack of feeling and strength in parts of the body may lead to complications such as loss of bladder and bowel control; increased risk for urinary tract infections; impotence and lack of ability to reach orgasm (see Sexual Dysfunction); skin break down and pressure sores, particularly in the buttocks; spasticity; blood clots; osteoporosis; and cardiovascular disease because of reduced physical activity.

Symptoms

Symptoms of spinal cord damage usually appear immediately after the injury. Symptoms can develop slowly, however, if an infection or tumor is gradually increasing pressure on the spinal cord.

They may include:

• Weakness, poor coordination or paralysis, particularly below the level of the injury
• Numbness, tingling, or loss of sensation
• Loss of bowel or bladder control
• Pain

Causes

Nearly half of the estimated 7,800 nonfatal spinal cord injuries that occur each year are the result of motor vehicle accidents (44 percent). Other main causes include acts of violence (24 percent), falls (22 percent), and sports injuries (8 percent), primarily diving accidents.

Any trauma that pulls, compresses, pushes sideways or cuts your spinal cord may cause SCI. Penetration of a foreign object, such as bone or metal, into the spinal cord can cause serious damage, as can pressure from bleeding, swelling and fluid accumulation.

Much less commonly, spinal cord injuries are caused by blood clots, abscesses (infections), tumors, polio, spina bifida and Friedrich's Ataxia, a rare inherited disorder.

Diagnostic and Test Procedures

If an SCI is suspected, you'll be examined by a doctor. X-rays of the spine will help determine the extent of the damage. The following imaging tests also may be ordered: CT (computed tomography) scan, MRI (magnetic resonance imaging), and myelogram (X-ray after injection of dye into the spinal canal).

Treatment

At the Time of Injury
Immediate medical treatment focuses on stabilizing the spine and aggressive treatment with corticosteroid drugs to limit damage and improve the chance of recovery. You may need surgery to stabilize the spine, perhaps by fusing together vertebrae or inserting metal pins; to remove bone chips, bullets or other objects; or to drain fluid to relieve pressure. You may need traction and bed rest to immobilize your back while it heals.

Other treatments focus on preventing secondary problems, such as catheterization if bladder control is lost, antibiotics for urinary tract infections, skin care and frequent changes in position to avoid bedsores, and physical therapy to strengthen muscles.

Longer Term
Once the initial injury heals, functional improvements may continue for at least six months. Disability that remains after that point is likely to be permanent. Long-term treatment involves an intense program of rehabilitation therapy. Although SCI often results in permanent disability, rehabilitation can maximize the level of function and help injured people adapt and lead independent, productive lives. Continuing treatment might include nutrition management, psychological counseling, physical and occupational therapy, various mechanical and electrical aids, and careful monitoring by physicians.

The encouragement of loved ones and support from others living with SCI play an important part in helping the person recover and adapt.

Prevention

To help prevent spinal cord injuries:

• Always follow safe driving practices: Observe the speed limit; wear a seatbelt whenever you ride in a vehicle; wear a helmet when riding a motorcycle; yield to other drivers in the interest of safety. Help avoid accidents by watching carefully for motorcycles, which are sometimes harder to spot on the road.
• Walk away from situations that become violent. If you need help avoiding violence in your home or community, talk with your doctor, the police, your religious leader or other trusted sources.
• If you have guns at home, store them in a locked cabinet and use trigger locks to help prevent accidental shootings. Take a gun safety course, and teach gun safety to everyone in your family.
• Take precautions to prevent falls around your home; for instance, keep walkways, indoors and outdoors, free from obstacles and install non-slip materials in the bottom of your bathtub.
• In sports, always wear proper safety equipment that fits and is in good working order. Follow the rules of the activity.
• Never dive into any body of water where diving is prohibited or where you cannot see the bottom to make sure the water is deep enough and free from obstacles.

Call Your Doctor If

• You have or suspect you have injured your neck or back.
• You have weakness, poor coordination or paralysis in any part of your body.

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