A spinal cord injury (SCI) is an injury to the spinal cord, the bundle of nerves that runs from the brain down through the spine and carries signals to and from the body. SCI can be caused by a variety of factors, including trauma, such as a car accident or fall, or diseases, such as cancer, or degenerative conditions such as spinal stenosis. Symptoms of SCI may include loss of sensation or movement, paralysis, and changes in bowel or bladder function. Treatment for a spinal cord injury may include surgery to repair any damage to the spinal cord, rehabilitation to help the patient regain function, and medications to manage pain and other symptoms.
What is a Spinal Cord Injury?
A spinal cord injury (SCI) is an injury to the spinal cord, the bundle of nerves that runs from the brain down through the spine and carries signals to and from the body. The spinal cord is responsible for transmitting messages between the brain and the rest of the body, allowing us to move, feel, and sense our surroundings.
SCI can be classified as either complete or incomplete, depending on the extent of the damage to the spinal cord. In a complete SCI, all signals from the brain to the body are cut off, resulting in paralysis below the site of the injury. In an incomplete SCI, some signals may still be able to pass through the damaged area, resulting in some level of function below the site of the injury.
Causes of Spinal Cord Injury
A spinal cord injury is a serious and often catastrophic injury that occurs when the spinal cord is damaged, either partially or completely. It is most often caused by trauma, but other conditions such as degenerative changes and cancer can cause damage to the spinal cord.
Spinal cord injuries can be caused by a variety of factors, including:
- Falls: Falls are a common cause of spinal cord injuries, especially among older adults. A fall from a height or a slip and fall accident can cause the spine to bend or twist in an unnatural way, leading to damage to the spinal cord.
- Car accidents: Car accidents are a leading cause of spinal cord injuries. The impact of a car crash can cause the spine to be subjected to excessive force, leading to damage to the spinal cord.
- Sports injuries: Sports injuries, such as diving accidents or collisions during contact sports, can lead to spinal cord injuries.
- Violence: Spinal cord injuries can also be caused by acts of violence, such as gunshots or stabbings.
- Degenerative conditions: Certain degenerative conditions, such as spinal stenosis or disc herniation, can cause the spine to narrow and compress and damage the spinal cord.
- Tumors: Abnormal growths into the spinal canal can lead to compression and damage of the spinal cord
Symptoms of Spinal Cord Injury
Spinal cord injuries can cause a wide range of symptoms, depending on the location and extent of the damage to the spinal cord. Common symptoms of a spinal cord injury include:
- Loss of sensation or movement: The spinal cord is responsible for transmitting signals between the brain and the rest of the body, so an injury to the spinal cord can cause a loss of sensation or movement in the affected area. This may include numbness, tingling, or a loss of feeling in the hands, feet, or other parts of the body.
- Pain: Spinal cord injuries can cause pain in the affected area or in other parts of the body.
- Difficulty breathing: In some cases, a spinal cord injury can cause difficulty breathing or problems with lung function.
- Sexual dysfunction: A spinal cord injury can affect sexual function and may cause changes in sexual sensation or ability to achieve or maintain an erection.
- Bowel or bladder control: A spinal cord injury can also cause problems with bowel or bladder control.
Paraplegia is a type of paralysis that affects the lower half of the body, including the legs and sometimes the lower part of the torso.
Quadriplegia, also known as tetraplegia, is a type of paralysis that affects all four limbs and the torso.
The difference in the extent of paralysis is usually caused by the location of the injury on the spinal cord. If the spinal cord is damaged at a high level, closer to the brain, it can result in quadriplegia. If the spinal cord is damaged at a lower level, it can result in paraplegia.
Diagnosis of Spinal Cord Injury
Spinal cord injuries are typically diagnosed based on a combination of a history, physical examination, and imaging tests.
History and Physical Examination
To diagnose a spinal cord injury, a clinician will ask about the details of the injury and assess for symptoms that suggest a spinal cord injury. They will also perform a physical examination to evaluate for signs of spinal cord injury such as:
- Loss of sensation: The spinal cord is responsible for transmitting signals between the brain and the rest of the body. If the spinal cord is damaged, it can disrupt these signals, leading to loss of sensation.
- Weakness or paralysis: Depending on the location of the injury, a spinal cord injury can cause weakness or paralysis in the legs, arms, or both.
- Changes in reflexes: Reflexes are automatic responses to stimuli. A healthcare provider may assess reflexes in the affected area to help diagnose a spinal cord injury.
Imaging Studies
Imaging studies are typically used to help diagnose a spinal cord injury and assess the severity of the injury. Below are common imaging tests that are used to evaluate a spine injury. MRI is the best test to assess the spinal cord itself.
- X-rays: X-rays are a type of imaging test that uses radiation to create detailed images of the bones in the spine. X-rays can help to identify fractures or other abnormalities in the spine that may be causing or contributing to a spinal cord injury.
- CT scans: CT (computed tomography) scans are a type of imaging test that uses a combination of X-rays and computer technology to create detailed, cross-sectional images of the spine. CT scans can help to identify fractures, dislocations, or other abnormalities in the spine that may be causing or contributing to a spinal cord injury.
- MRI: MRI (magnetic resonance imaging) scans are a type of imaging test that uses a combination of magnets and radio waves to create detailed images of the spine. MRI scans can help to identify damage to the spinal cord, as well as other abnormalities in the spine that may be causing or contributing to a spinal cord injury.
Treatment of Spinal Cord Injury
Treatment for a spinal cord injury typically involves a combination of surgical, medical, and rehabilitative approaches, depending on the severity of the injury and the specific symptoms being experienced. Below are some common treatments for spinal cord injuries:
- Surgery: Surgery may be necessary to stabilize the spine, repair fractures or dislocations, or remove debris or other objects that may be pressing on the spinal cord.
- Medications: Medications may be used to manage pain, inflammation, and other symptoms associated with a spinal cord injury.
- Rehabilitation: Rehabilitation is a crucial part of treatment for spinal cord injuries and may involve physical therapy, occupational therapy, and other therapies to help the patient regain function and independence.
- Assistive devices: Assistive devices, such as wheelchairs, braces, and other mobility aids, can help patients with spinal cord injuries to maintain mobility and independence.
There are several newer therapies being developed for the treatment of spinal cord injuries. Here are a few examples:
- Stem cell therapy: Stem cells are cells that have the ability to develop into different types of cells in the body. Some researchers are studying the use of stem cells to repair or regenerate damaged tissue in the spinal cord.
- Electrical stimulation: Electrical stimulation involves the use of low-voltage electrical currents to stimulate the nerves and muscles in the body. Some studies have shown that electrical stimulation may help to improve function and reduce the risk of complications after a spinal cord injury.
- Epidural electrical stimulation: Epidural electrical stimulation involves the use of electrodes placed on the spinal cord to stimulate the nerves and muscles. Some studies have shown that epidural electrical stimulation may help to improve bladder control, bowel function, and other symptoms after a spinal cord injury.
It is important to note that these therapies are still being researched and are not yet widely available.
Prognosis of Spinal Cord Injury
In some cases, people with spinal cord injuries may be able to recover some or all of their lost function with rehabilitation and other treatments. However, spinal cord injuries can also lead to long-term disability, depending on the location and extent of the injury There are several factors that can influence the prognosis for a spinal cord injury, including:
- Location of the injury: The location of the injury on the spinal cord can impact the prognosis. In general, injuries higher up on the spinal cord are more likely to result in greater disability, while injuries lower on the spinal cord may be less severe.
- Severity of the injury: The severity of the injury, as well as the extent of the damage to the spinal cord, can also impact the prognosis. In general, more severe injuries are more likely to result in greater disability.
- Age: Age can also play a role in the prognosis for a spinal cord injury. In general, younger people may be more likely to recover more function after a spinal cord injury, compared to older people.
- Overall health: The overall health of the individual can also impact the prognosis for a spinal cord injury. People who are in good physical and mental health before the injury are more likely to have a better prognosis than those who are not.
- Timing of treatment: The timing of treatment can also be a factor in the prognosis for a spinal cord injury. Prompt treatment can help to reduce the risk of complications and improve the chances of recovery.
It is important to note that the prognosis for spinal cord injuries can vary widely, and it is difficult to predict the specific outcomes for an individual. It is important to work with a healthcare team to develop a personalized treatment plan and manage the symptoms and complications of a spinal cord injury.
Sources
Shabani, Saman et al. “Diagnostic Imaging in Spinal Cord Injury.” Neurosurgery clinics of North America vol. 32,3 (2021): 323-331. doi:10.1016/j.nec.2021.03.004
Cadotte, David W, and Michael G Fehlings. “Spinal cord injury: a systematic review of current treatment options.” Clinical orthopaedics and related research vol. 469,3 (2011): 732-41. doi:10.1007/s11999-010-1674-0
Burns, Anthony S et al. “Clinical diagnosis and prognosis following spinal cord injury.” Handbook of clinical neurology vol. 109 (2012): 47-62. doi:10.1016/B978-0-444-52137-8.00003-6
