Spinal Cord Injury – Causes, Types, Signs and symptoms

Spinal Cord Injury

Also called: SCI

Summary

A spinal cord injury (SCI) results when any type of trauma damages nervous tissue of the spinal cord. These nerves are responsible for carrying signals between the brain and the rest of the body. Serious spinal cord injuries can result in permanent, partial or complete paralysis.

The spinal cord runs from the base of the brain down to the small of the back. Ring-shaped bones called vertebrae form the spine, which surrounds the spinal cord and protects it from injury. When these bones are broken or otherwise damaged, they can cause injury to the neurons and axons (nerve fibers) of the spinal cord. These nerve cells are part of the central nervous system and do not regenerate after they are injured. Such injuries can cause varying levels of paralysis.

Spinal cord injuries occur most often in the neck and lower back. The location of the injury on the spine determines how much the transmission of nerve signals to the brain is interrupted. In general, the higher up the spinal cord a person is injured, the more severe the injury is likely to be. Spinal cord injuries are divided into two types:

  • Incomplete injury. People with these injuries retain some motor or sensory function below the level of the injury. One side of the body may be more affected than the other.

  • Complete injury. Involves a total lack of sensory or motor function below the level of the injury. In most cases, both sides of the body are equally affected.

In most cases, SCIs result from a sudden and significant trauma to the spine. This most often occurs as a result of automobile accidents, acts of violence (e.g., gunshot wounds), accidental falls and injuries sustained during sports activities (especially diving accidents). In younger adults, automobile accidents are the leading cause of SCIs. In older adults, accidental falls most often cause SCIs. Men sustain SCIs more often than women.  

More than 200,000 Americans are living with SCIs, according to the National Institute of Neurological Disorders and Stroke (NINDS). Each year, more than 10,000 new cases of SCI occur, two-thirds of which strike people under 30.

An injury to the spinal cord can cause a variety of symptoms. Patients often experience an intense stinging sensation caused by damage to nerve fibers in the spinal cord. Loss of movement, loss of sensation (e.g., ability to feel heat, cold and touch) and loss of bodily functions (e.g., bladder and bowel control) also are typical symptoms of an SCI.

People who are not medical experts should be extremely careful when trying to provide first aid to a person who may have sustained an SCI. It is especially crucial not to move the affected person. Doing so can result in worsened permanent damage and other complications.

After the patient is brought to an emergency room, a physician will carefully inspect the body to look for signs of an SCI. Imaging tests also help reveal the extent of a patient’s injuries. Various treatments are available for people who have experienced an SCI, including neck and spine bracing, medications, surgery, physical therapy and mental health counseling.

While spinal cord injuries cannot always be prevented, people can take steps to reduce their risk of experiencing such trauma. These measures include driving safely, using care around firearms and wearing protective equipment when participating in sports.  

Research continues into ways to help patients to regain movement ability following SCIs. This includes nerve regeneration research and electrical stimulation devices that may help restore lost motor or sensory functions.

About spinal cord injury

A spinal cord injury (SCI) typically involves a sudden trauma to the spine that either fractures or dislocates vertebrae (ring-shaped bones of the spine). When these injuries occur, bone fragments, portions of disc material or damaged ligaments can cause bruising or tearing of the nervous tissue of the spinal cord. This can result in crushed or destroyed neurons (nerve cells) and axons (nerve fibers).

Neurons and axons of the spinal cord help coordinate movement and bodily functions and allow sensations to be felt. Neurons carry signals between the brain and the rest of the body. Axons help conduct outgoing signals from one neuron to other nerve, muscle or gland cells in the body. Axons also release neurotransmitters that affect these cells.

Injury to the spinal cord can result in impaired movement and sensation in the body. The extent of damage to neurons and axons after an SCI largely determines the severity of impairment a person experiences. The damage done to axons is responsible for most problems associated with SCIs.

The spinal cord is part of the central nervous system (CNS), which also contains the brain. The spinal cord does not extend the entire length of the spine. Instead, the length of the spinal cord is about 17 inches (43 centimeters) in women and 18 inches (45 centimeters) in men. The spinal cord begins at the base of the brain and ends in the lower back. The bony parts of the spine continue farther downward to what is known as the “tailbone.”  

The spine is made up of different segments: cervical (neck area), thoracic (upper back), lumbar (lower back), sacral (area near the pelvic bones) and coccygeal (base of spine, also known as the tailbone). There are a different number of bony vertebrae in each segment. The number changes from infancy to adulthood as some of the bones fuse together. Vertebrae surround the spinal cord and protect it from injury. The upper segments control areas of the upper body and lower segments control functioning of the lower parts of the body. The type of impairment sustained depends on where along the spinal cord the injury occurs, and on the type and severity of the injury.

Damage to the area continues even after the initial injury. Injuries often cause swelling of the spinal cord and surrounding areas. Bleeding and fluid accumulation may also occur. After trauma to the spine, nerve cells and axons in the spinal cord below the site of injury can slowly deteriorate and die. This disrupts the communication channel between the brain and body, inhibiting movement, sensation and bodily functions.

When communications throughout the body are cut off due to SCI, the patient’s blood pressure is likely to drop. This can lead to spinal shock, a condition that disables parts of the spine that were not injured. The results can include paralysis that passes after several hours to days.

SCIs occur most often in the neck and lower back. In general, the higher up the spinal cord a person is injured, the more severe the injury is likely to be. For example, an injury at the level of the neck typically causes paralysis to both the upper and lower body, while an injury lower in the back may cause paralysis that is limited to the waist and below.

The nerves of the CNS do not regenerate after they are injured – unlike nerves elsewhere in the body. As a result, patients who experience damage to nervous tissue of the CNS may develop varying levels of paralysis. Paralysis can result from a complete severing of the patient’s spinal cord, although most SCIs do not completely sever the spinal cord.

The severity of damage affects a patient’s long-term prognosis. Some patients recover completely, while others may be paralyzed for life. People who suffer an SCI may not experience paralysis if they are treated promptly and the bones are stabilized and allowed to heal. Nonetheless, people with spinal cord injuries often experience lifelong disability.  

More than 200,000 Americans are living with SCIs, according to the National Institute of Neurological Disorders and Stroke (NINDS). Each year, more than 10,000 new cases of SCI occur, two-thirds of which strike people under 30.

Some patients with SCIs develop autonomic dysreflexia, episodes in which the blood vessels remain constricted. This can result in elevated blood pressure, which puts the patient at risk for stroke.

Other complications of SCIs may include:

  • Bladder and bowel dysfunction
  • Chronic pain
  • Pressure sores (bed sores)
  • Urinary tract infections
  • Increased risk of respiratory and heart problems
  • Deep vein thrombosis (blood clot deep within a muscle)
  • Pulmonary embolism (blood clot that lodges in the lungs)
  • Inability to sweat below the level of injury
  • Infertility in men
  • Reduced control of body temperature
  • Sexual dysfunction
  • Spasticity
  • Weight loss or weight gain

Although SCIs remain a serious threat to a person’s long-term health, overall management has nonetheless improved in recent time. Until recent decades, patients with SCIs often died within a few weeks of injury due to infections and other related complications. Today, proper and prompt treatment allows many people with these injuries to survive and to lead much fuller lives than in the past.

Types and differences of spinal cord injury

Spinal cord injuries (SCIs) are usually divided into two categories:

  • Incomplete injury. Involves injuries that do not completely prohibit the spinal cord from conveying messages between the brain and the rest of the body. People with these injuries retain some motor or sensory function below the level of the injury. They may be able to move one side of the body more fully than the other side. This type of SCI includes syndromes such as:

    • Central cord syndrome. Usually affects motor control and sensory function of the hands and upper extremities, compared to the lower extremities.

    • Brown-Sequard syndrome. An injury may result in loss of sensation on one side of the body but weakness or paralysis on the other side.

    • Anterior cord syndrome. Involves loss of movement, but retaining sense of the body’s position.

  • Complete injury. Involves a total lack of sensory or motor function below the level of the injury. In most cases, both sides of the body are equally affected. Patients may have paralysis in just the lower part of the body (paraplegia) or in all four limbs (quadriplegia). Despite its name, a complete spinal injury rarely involves a complete cutting of the spinal cord.

Risk factors and causes of spinal cord injury

Spinal cord injuries (SCIs) occur as the result of a sudden and significant trauma to the spine. SCIs most often occur as a result of the following:

  • Automobile accidents
  • Acts of violence (e.g., gunshot wounds)
  • Falls
  • Injuries sustained during sports and other activities (especially diving)

The most common causes of SCIs vary, depending on age. For people under the age of 65, automobile accidents cause most SCIs. In adults 65 and older, accidental falls are the primary cause of SCIs.

SCIs may also result from conditions such as arthritis, blood vessel problems or bleeding, cancer, infections, inflammation, and spinal disc degeneration.

Men are much more likely to experience SCIs than women. According to the U.S. Centers for Disease Control and Prevention (CDC), more people between the ages of 15 and 29 experience SCIs than any other age group.

Signs and symptoms of spinal cord injury

An injury to the spinal cord may cause various symptoms. Patients often experience an intense stinging sensation caused by damage to axons (nerve fibers) in the spinal cord. Loss of movement and a loss of sensation (e.g., ability to feel heat, cold and touch) are also typical symptoms of spinal cord injuries (SCIs).

Other symptoms include:

  • Loss of bowel or bladder control
  • Exaggerated reflexes or spasms
  • Changes in sexual function or sensitivity
  • Breathing difficulties
  • Chronic coughing or need to clear secretions from the lungs

A person who experiences an SCI should not be moved by anyone other than a medical professional immediately after the injury. In some cases, the signs of an SCI are not obvious. However, in other cases, certain symptoms may indicate a person has just experienced an SCI. These include:

  • Severe pain in the neck or back
  • Inability or unwillingness to move the neck
  • Feelings of weakness, numbness or paralysis
  • Inability to control the limb, bowel or bladder
  • Ongoing change in a person’s level of consciousness
  • Twisted neck or back

Diagnosis and treatment of spinal cord injury

People who are not medical experts should be extremely careful when trying to provide first aid to a person who may have experienced a spinal cord injury (SCI). It is crucial not to move the affected person. Doing so can result in permanent paralysis and other complications. For more information about how to detect whether or not a patient has experienced an SCI, see Signs and Symptoms.

People are urged to call 911 if they are with someone who may have suffered an SCI. The injured person should be kept still with heavy towels on both sides of the neck. Or, the injured person’s head and neck should be held in place to prevent movement. If cardiopulmonary resuscitation (CPR) is necessary, it should be performed as normal except the patient’s head should not be tilted back to open the airway.

After an injured person is brought to an emergency room, a physician will carefully inspect the body to look for signs of an SCI. The physician will ask about how the injury occurred and will test for sensory or motor function.

Imaging tests such as x-rays, magnetic resonance imaging (MRI) or computed axial tomography (CAT) scans likely will be performed to look for damage to the spine. An imaging test called myelography (x-rays of the spine taken after an injection of contrast dye) sometimes can help identify the condition of nervous tissue of the spinal cord.

Prompt professional emergency care can help limit some of the damage caused by an injury to the spinal cord. Certain corticosteroid medications administered within the first eight hours following injury appear to reduce damage to a patient’s nervous tissue. 

A few days after the injury, a neurological examination and more imaging tests may be completed. This can provide a physician additional information about the extent of the injury.

Various treatments are available for patients with SCIs. Neck & spine bracing with traction can help stabilize the spine and bring it into alignment during healing. This may be accomplished by using metal braces to hold the skull in place. A rigid neck collar also can be used for this purpose.

In many cases, SCIs can cause respiratory problems. One-third of patients with injuries to the neck area require medical support to help them breathe, according to the National Institute of Neurological Disorders and Stroke (NINDS). Devices such as a respirator or diaphragmatic pacemaker can aid breathing.

Surgery may be required in some cases to remove fragments that are compressing the spine, to stabilize the spine to prevent future pain or deformity, or to facilitate mobilization of the patient for physical therapy or other activities.

Patients may remain in the hospital for anywhere from several days to weeks or months, depending on the nature and extent of their injury. After the patient has been released, physical therapy may be suggested to help rehabilitate the patient.

Recovery from SCIs may begin within a week of injury. Most of the recovery takes place in the first year. Most physicians consider impairment that remains 12 to 24 months after the injury to most likely be permanent. In some cases, patients will need a wheelchair to get around or computer devices to help them with their daily activities.

SCIs are often life-changing events that may present significant emotional challenges to the patient. Patients may wish to participate in mental health counseling for emotional and social support.

Prevention methods for spinal cord injury

While spinal cord injuries (SCI) cannot always be prevented, people can take steps to reduce the risk of experiencing such injuries.

Tips to prevent automobile accidents that can cause SCI include:

  • Drive safely

  • Always wear a seatbelt

  • Keep young children in the back seat to avoid air bag injuries

  • Do not drive while impaired by alcohol or drugs

  • Avoid riding with drivers who are under the influence of alcohol or drugs

  • Avoid distractions (e.g., cell phone use, eating) while driving a car

Tips to prevent acts of violence that can cause SCI include:

  • Use care around firearms

  • Keep firearms unloaded and locked away when not in use

  • Store bullets separately from firearms

  • Receive proper training on how to use a firearm

  • Keep children away from firearms

Tips to prevent accidental falls that can cause SCI include:

  • Use nonslip assistance where possible. This includes using stair handrails, nonslip shoes, grab bars and nonslip mats in the shower and tub.

  • Use safety gates at stairway entries. Safety gates placed at the top and bottom of stairways can help prevent young children from tumbling down a set of stairs.

  • Install window guards where appropriate. In homes above the first floor, or those with two or three stories, window guards can prevent accidental falls and possible spinal cord injuries.

  • Avoid certain medications if possible. Some medications may increase a person’s risk of falling if they have side effects that may make a person more likely to lose their balance.

Tips to prevent spinal cord injuries that may occur during sports and other activities include:

  • Wear appropriate protective equipment when physically active. This includes helmets or headgear during certain sports (e.g., football, baseball, hockey) and activities (e.g., bicycling, skating, skateboarding, horseback riding).

  • Avoid head-first type moves. This includes diving, tackling or sliding into base. When diving, it is important to have first positively identified the depth of the water before diving into it. Entering water feet first is safer than diving headfirst.

  • Use spotters. Ask a friend to spot you while doing any type of physical activity that may put you at risk of serious injury. This includes while working out with weights at the gym, or performing new gymnastic routines.

In addition, immediate and appropriate medical attention can help reduce the damage caused by an SCI. Bystanders should never attempt to move a person who appears to have suffered an SCI. Emergency medical personnel should be contacted immediately.

Ongoing research regarding spinal cord injury

Research continues into ways to help patients to regain movement ability following spinal cord injuries (SCIs). This includes research on how to promote nerve cell transplantation and allow nerve cells of the central nervous system (CNS) to regenerate.

Devices known as neural prostheses are among the most promising new developments in treating SCIs. These devices electrically stimulate CNS nerves to restore lost motor or sensory functions. They usually involve surgery to implant the device inside the body. Many of these devices are still being tested (e.g., prostheses to control bladder function and allow people to stand).

Medications are being developed to reduce damage due to SCI. These medications aim to reduce the death of nerve cells following SCI and promote nerve regeneration.

Questions for your doctor on spinal cord injury

Preparing questions in advance can help patients have more meaningful discussions with healthcare professionals regarding their condition. Patients may wish to ask their doctor the following questions related to spinal cord injury:

  1. What is the extent of damage caused by my spinal cord injury?

  2. Do I have any underlying medical condition that is responsible for my injury?

  3. Is this damage likely to be temporary or permanent?

  4. What are my treatment options?

  5. What are the risks of these treatments?

  6. Will I require surgery?

  7. How long will I be required to stay in the hospital?

  8. Can you estimate a length of time necessary for recovery?

  9. Where can I find information about support groups for those with spinal cord injuries?

  10. Where can I learn more about installing devices that can help me with day-to-day activities?
Scroll to Top