The spinal cord is a bundle of nerves that carry signals between the brain and the rest of the body for movement and sensation. It is protected by the vertebrae and any traumatic injury resulting in a bruise or tear to the spinal cord is referred to as an acute spinal cord injury (SCI). The condition occurs when the nerves' axons in the spinal cord are damaged, resulting in the loss of motor and sensory function below the injury level. In some severe cases it can even lead to permanent disability.
Types of SCI
There are two types of SCI. The first type is a complete injury, which occurs when there is no feeling or movement below the level of injury. Below the injury there are no neural pathways which prevents signals from the brain from travelling down. Likewise, signals below the injury will not be able to reach the brain. This type of injury can cause both paralysis and loss of sensation below the level of injury and can occur at any level of the spinal cord.
The second type is incomplete injury. It allows for some function below the level of the injury, like more movement in one limb compared to the other or more function on one side than the other. This type of SCI leaves some neural pathways unaffected.
Causes
Spinal Cord Injuries result from damage to the spinal cord or the vertebrae. Most of them are trauma injuries, as listed below. These can happen from a sudden trauma blow to the spine, which can fracture, dislocate, crush, or compress one or more of the vertebrae.
Examples include:
Birth injuries (typically in the neck area)
Falls
Car accidents
Sports injuries (cause about 10% of SCIs)
Diving accidents
Trampoline accidents
Acts of violence like gunshot or stab wounds (About 12% of spinal cord injuries result from violent encounters)
Infections that form an abscess on the spinal cord
Arthritis, cancer, inflammation, infections or disk degeneration of the spine
Symptoms
Symptoms depend on the severity and location of the SCI. One of the first symptoms a person may experience after the injury is spinal shock. This causes a loss of feeling, muscle movement, and reflexes below the level of injury and lasts from several hours to several weeks.
Location
Injury to C2 or C3 (the second and third vertebrae in the spinal column) affects the respiratory muscles and the ability to breathe.
Injury to the lumbar vertebrae affects the nerve and muscle control of the bladder, bowel, and legs.
Another prominent symptom is the loss of motor and sensory function. Types of these are:
Quadriplegia (quad means 4) is a loss of movement and feeling in all four limbs (arms and legs). It often occurs due to injury at T1 or above and affects the chest muscles.
Paraplegia (para here means side by side) is the loss of function in the legs and lower body. It often results from injuries at T1 or below.
Triplegia is a loss of movement and feeling in one arm and both legs. It often results from incomplete SCI.
Generally, the higher the level of spinal cord injury, the more severe the symptoms.
Other common symptoms of acute spinal cord injury may include:
Muscle weakness or paralysis in the trunk, arms, or legs
Loss of feeling in the chest, arms, or legs
Muscle spasticity
Pneumonia
Breathing problems
Digestive problems
Loss of bowel and bladder function
Sexual problems
Circulatory problems: Unstable blood pressure (hypotension), abnormal heart rhythms (arrhythmias), prolonged heart rate (bradycardia), and blood clots that may appear after injury.
Body temperature disruptions, especially low body temperature (hypothermia).
Some may develop neurogenic pain, numbness, or an intense burning or stinging sensation.
Depression due to lifestyle changes after the injury.
Treatments
An SCI is always rushed to the emergency centre as it is a trauma injury. There the patient is treated for infections, which can become deathly if not cared for fast enough. Restoring blood flow is also a lifesaving priority.
Additionally, surgery can relieve pressure on the spinal cord and repair damages related to surrounding injuries pressing on it. For example, if the back bones (vertebrae) were moved out of position, surgery may be used to fix them. Support devices like splints, braces, or halos may keep the area around the SCI stable, allowing the patient to move around with them.
Other measures can include neuroprotective treatments, which are medications or other treatment approaches that limit or prevent damage after an initial injury. Alternatively, neurodegenerative treatments help damaged spinal cord or nerve tissue regenerate and repair itself.
Injuries between C1 and C4 can stop breathing entirely or cause severe breathing problems, as the nerves in this region cause the diaphragm to move and the lungs to expand. People may require temporary or permanent help breathing, such as a breathing tube. Some people may be treated with medicines called steroids, which help reduce the swelling and inflammation around the spinal cord.
Patients with limited mobility can develop weight loss and muscle thinning after a SCI. A dietitian can help them sustain a healthy weight, and physical and occupational therapists can help develop a fitness and exercise program. Moreover additional care will also be needed in the long term. This can include physical or occupational therapy, speech therapy, mental healthcare, and in-home care and support.
Most importantly, rehabilitation (rehab) should be initiated during the early stages of treatment to ensure the individual can achieve the highest possible level of function and independence.
Diagnostic tests may include:
Blood tests
X-ray
A computed tomography scan (CT or CAT scan) is an imaging test that uses X-rays and computer technology to produce a detailed image of any body part. It is more detailed than general X-rays.
Magnetic resonance imaging (MRI) uses large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body.
Risk factors
Factors that increase the risk of spinal cord injuries include being male, especially between the ages of 16 and 30 or 65 and older. Alcohol use and engaging in risky behaviours such as diving into shallow water or not wearing safety gear during sports can also contribute to the risk. Additionally, having certain diseases that affect the joints or bones can make individuals more susceptible to spinal cord damage from minor injuries.
Works Cited
Bennett, J., M Das, J. and Emmady, P.D. (2020). Spinal Cord Injuries. [online] PubMed. Available at: https://www.ncbi.nlm.nih.gov/books/NBK560721/.
Cedars Sinai (n.d.). Articles. [online] Cedars-Sinai. Available at: https://www.cedars-sinai.org/health-library/diseases-and-conditions/a/acute-spinal-cord-injury-1.html.
Cleveland Clinic (n.d.). Spinal Cord Injury: Types, Symptoms, Causes & Treatment. [online] Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/diseases/12098-spinal-cord-injury#symptoms-and-causes.
FlintRehab (2020). Types of Spinal Cord Injury: Based on Severity, Levels, & Score. [online] Flint Rehab. Available at: https://www.flintrehab.com/types-of-spinal-cord-injury/.
John Hopkins (n.d.). Acute Spinal Cord Injury. [online] www.hopkinsmedicine.org. Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/acute-spinal-cord-injury/
Loma Linda University Health (n.d.). Spinal Cord Injury | Loma Linda University Health. [online] lluh.org. Available at: https://lluh.org/conditions/spinal-cord-injury [Accessed 27 Mar. 2024].
Mayo Clinic (2021). Spinal cord injury - Symptoms and causes. [online] Mayo Clinic. Available at: https://www.mayoclinic.org/diseases-conditions/spinal-cord-injury/symptoms-causes/syc-20377890.
National Institute of Neurological Disorders and Stroke (2022). Spinal cord injury. [online] www.ninds.nih.gov. Available at: https://www.ninds.nih.gov/health-information/disorders/spinal-cord-injury.
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