Often a spinal cord injury (SCI) is caused by a blow to the spine , resulting in broken or dislocated bones of the spine (vertebrae). The vertebrae bruise or tear the spinal cord , damaging nerve cells.
When the nerve cells are damaged, messages cannot travel back and forth between the brain and the rest of the body. This causes a complete or partial loss of movement (paralysis) and feeling.
At the hospital
A person with a potential SCI is taken to an emergency department and then to an intensive care unit. The first priority is stabilizing blood pressure and lung function, as well as the spine, to prevent further damage. When a spinal cord injury is caused by a serious accident, treatment for other injuries is often needed.
The following tests may be done right away to help find out the extent of the injury. They may also be done routinely throughout and after you leave rehabilitation (rehab).
- An ultrasound of the kidneys checks your bladder function. This is done every 1 to 2 years.
- A spinal X-ray monitors your spine's condition. Your doctor lets you know how often this is done-usually monthly for the first 3 to 6 months.
- Computed tomography scan (CT scan) and magnetic resonance imaging (MRI), which provide detailed pictures of the spine, are done as needed.
- A bone density test measures the minerals (such as calcium) in your bones using a special X-ray, a CT scan, or ultrasound.
A few days after the injury, your doctor will ask you questions. Also, he or she will test not only the strength of key muscles but also your response to light touch and pinpricks all over your body.
Classifying a spinal cord injury
An SCI can be classified based on how much feeling and movement you have or where the damage occurred. When a nerve in the spinal cord is injured, the nerve location and number are often used to describe how much damage there is.
The vertebrae and spinal nerves are organized into segments , starting at the top of the spinal cord. Within each segment they are numbered.
People with SCIs often use a segment of the spine to talk about their functional level. (Your functional level is how much of your body you can move and feel.) For example, you might describe yourself as a "C7."
The nerves around a vertebra control specific parts of the body. Paralysis occurs in the areas of the body that are controlled by the nerves associated with the damaged vertebrae and the nerves below the damaged vertebrae. The higher the injury on the spinal cord, the more paralysis there is.
- Damage to the spinal nerves in the neck can cause paralysis of the chest, arms, and legs (tetraplegia, also known as quadriplegia).
- Damage lower down on the spine (thoracic, lumbar, or sacral segments) can cause paralysis of the legs and lower body (paraplegia).
- Breathing is only affected by injuries high on the spinal cord.
- Bowel and bladder control can be affected no matter where the spinal cord is injured.
Damage to the spinal cord can be complete or incomplete.
- In a complete SCI, you do not have feeling or voluntary movement of the areas of your body that are controlled by your lowest sacral nerves-S4 and S5. These nerves control feeling and movement of your anus and perineum.
- In an incomplete SCI, you have varying amounts of movement and feeling of the areas of your body controlled by the sacral nerves.
Some recovery of feeling and movement may return after the injury-how much depends on the level of injury, the strength of your muscles, and whether the injury is complete or incomplete. Most recovery occurs within the first 6 months of the injury.
For the family and caregivers
After a traumatic SCI, your loved ones will often ask questions about the injury and what it means. Keep your answers short, simple, and honest. You cannot give a complete answer, because it's often hard to know how serious the injury is and how much you will recover. This typically is not known until swelling and bleeding are reduced and the doctors can find out where the spinal cord has been injured.
Moving into rehab
After emergency treatment and stabilization, you will move into rehab. A rehab center helps you adjust to life, both physically and emotionally. The goal of rehab is to help you be as independent as possible.
Your rehab depends on your level of injury. You may have to learn how to manage your bowel and bladder, walk with crutches, do breathing exercises, and move between a wheelchair and another location.