Spinal Cord Injury

The main symptom of an SCI is a loss of movement and feeling below the level of injury. Currently, the proper way to identify the injury is as a complete or incomplete lesion. A complete lesion identifies a complete loss of motor and sensory function below the level of the injury. Incomplete lesions involve only partial loss of motor and sensory function below the injury. Trauma to the cervical region resulting in impairment or loss of motor or sensory function is now called tetraplegia, previously quadriplegia. Injuries to the neck affect the functioning of both the legs and arms. 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.

Below the level of injury, the person will lose:

• bowel, bladder, and sexual function
• feeling
• movement
• position sense, or awareness of where the body is

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

Spinal cord trauma can be caused by:

• fractures to the vertebrae
• injuries that cause the vertebrae to move out of alignment
• penetrating injuries such as stabbing or gunshot
• severe stretching of the spine

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:

• motor vehicle accidents (44%)
• acts of violence (24%)
• falls (22%)
• sports (8%)
• other reasons (2%)

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.

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

• driving defensively and using seat belts
• following sports safety guidelines for children, adolescents, and adults
• jumping, rather than diving, into water
• limiting use of medicines that lower blood-clotting ability, such as aspirin
• not driving after drinking alcohol

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.

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.

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

Without proper treatment, many complications can occur.

• People with an SCI are at high risk for bedsores because they lack sensation and movement below the injury level.
• Kidney infections and kidney stones may result from a loss of bladder control.
• Respiratory problems, such as pneumonia, are sometimes seen when the injuries involve the neck.
• People with quadriplegia may have trouble controlling body temperature, blood pressure, and heart rate.

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 individuals and 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.