Spinal Cord Injury

What is an acute spinal cord injury?

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The spinal cord is a bundle of nerves that carries messages between the brain and the rest of the body.

Acute spinal cord injury (SCI) is due to a traumatic injury that can either result in a bruise (also called a contusion), a partial tear, or a complete tear (called a transection) in the spinal cord. SCI is more common in men and young adults.

There are about 12,000 new cases of SCI each year. The number of people in the U.S. in 2008 living with a spinal cord injury was approximately 259,000.

SCI results in a decreased or absence of movement, sensation, and body organ function below the level of the injury. The most common sites of injury are the cervical and thoracic areas. SCI is a common cause of permanent disability and death in children and adults.

Anatomy of the spine

The spine consists of 33 vertebrae, including the following:

7 cervical (neck)
12 thoracic (upper back)
5 lumbar (lower back)
5 sacral* (sacrum--located within the pelvis)
4 coccygeal* (coccyx--located within the pelvis)

* By adulthood, the five sacral vertebrae fuse to form one bone, and the four coccygeal vertebrae fuse to form one bone.

These vertebrae function to stabilize the spine and protect the spinal cord. In general, the higher in the spinal column the injury occurs, the more dysfunction a person will have.

Injury to the vertebrae does not always mean the spinal cord has been damaged. Likewise, damage to the spinal cord itself can occur without fractures or dislocations of the vertebrae.

What are the types of SCI?

SCI can be divided into two main types of injury:

Complete injury. Complete injury means that there is no function below the level of the injury--either sensation and movement--and both sides of the body are equally affected. Complete injuries can occur at any level of the spinal cord.
Incomplete injury. Incomplete injury means that there is some function below the level of the injury--movement in one limb more than the other, feeling in parts of the body, or more function on one side of the body than the other. Incomplete injuries can occur at any level of the spinal cord.

What causes an acute spinal cord injury?

There are many causes of SCI. The more common injuries occur when the area of the spine or neck is bent or compressed, as in the following:

Birth injuries, which usually affect the spinal cord in the neck area
Falls
Motor vehicle accidents. These can be either when a person is riding as a passenger in the car or is struck as a pedestrian.
Sports injuries
Diving accidents
Trampoline accidents
Violence. This involves penetrating injuries that pierce the cord, such as gunshots and stab wounds.

What are the symptoms of an acute spinal cord injury?

Illustration of acute spinal cord injuries that would result either in quadriplegia or paraplegia

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Symptoms vary depending on the severity and location of the SCI. At first, the patient may experience spinal shock, which causes loss of feeling, muscle movement, and reflexes below the level of injury. Spinal shock usually lasts from several hours to several weeks. As the period of shock subsides, other symptoms appear, depending on the location of the injury.

Generally, the higher up the level of the injury to the spinal cord, the more severe the symptoms. For example, an injury at C2 or C3 (the second and third vertebrae in the spinal column), affects the respiratory muscles and the ability to breathe. A lower injury, in the lumbar vertebrae, may affect nerve and muscle control to the bladder, bowel, and legs.

SCI is classified according to the person's type of loss of motor and sensory function. The following are the main types of classifications:

Quadriplegia (quad means four). This involves loss of movement and sensation in all four limbs (arms and legs). It usually occurs as a result of injury at T1 or above. Quadriplegia also affects the chest muscles and injuries at C4 or above require a mechanical breathing machine (ventilator).
Paraplegia (para means two like parts). This involves loss of movement and sensation in the lower half of the body (right and left legs). It usually occurs as a result of injuries at T1 or below.
Triplegia (tri means three). This involves the loss of movement and sensation in one arm and both legs and usually results from incomplete SCI.

The following are the most common symptoms of acute spinal cord injuries. However, each individual may experience symptoms differently. Symptoms may include:

Muscle weakness or paralysis in the trunk, arms or legs
Loss of feeling in the trunk, arms, or legs
Muscle spasticity
Breathing problems
Problems with heart rate and blood pressure
Digestive problems
Loss of bowel and bladder function
Sexual dysfunction

The symptoms of SCI may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

Rehabilitation potential with SCI

The following chart is a comparison of the specific level of SCI and the resulting rehabilitation potential. This chart is a guide, with general information only; impairments and rehabilitation potential can vary depending on the type and severity of SCI. Always consult your doctor for more specific information based on your individual medical condition and injury.

Level of injury	Possible impairment	Rehabilitation potential
C2 - C3	Usually fatal as a result of inability to breathe	Totally dependent for all care
C4	Quadriplegia and breathing difficulty	Dependent for all cares; usually needs a ventilator
C-5	Quadriplegia with some shoulder and elbow function	May be able to feed self using assistive devices; usually can breathe without a ventilator, but may need other types of respiratory support
C6	Quadriplegia with shoulder, elbow, and some wrist function	May be able to propel a wheelchair inside on smooth surfaces; may be able to help feed, groom, and dress self; dependent on others for transfers
C7	Quadriplegia with shoulder, elbow, wrist, and some hand function	May be able to propel a wheelchair outside, transfer self, and drive a car with special adaptions; may be able to help with bowel and bladder programs
C8	Quadriplegia with normal arm function; hand weakness	May be able to propel a wheelchair outside, transfer self, and drive a car with special adaptions; may be able to help with bowel and bladder programs
T1 - T6	Paraplegia with loss of function below mid-chest; full control of arms	Independent with self-care and in wheelchair; able to be employed full time
T6 - T12	Paraplegia with loss of function below the waist; good control of torso	Good sitting balance; greater ability for operation of a wheelchair and athletic activities
L1 - L5	Paraplegia with varying degrees of muscle involvement in the legs	May be able to walk short distances with braces and assistive devices

Spinal cord injury rehabilitation

Rehabilitation of the patient with a SCI begins during the acute treatment phase. As the patient's condition improves, a more extensive rehabilitation program is often begun.

The success of rehabilitation depends on many variables, including the following:

Level and severity of the SCI
Type and degree of resulting impairments and disabilities
Overall health of the patient
Family support

It is important to focus on maximizing the patient's capabilities at home and in the community. Positive reinforcement helps recovery by improving self-esteem and promoting independence.

The goal of SCI rehabilitation is to help the patient return to the highest level of function and independence possible, while improving the overall quality of life--physically, emotionally, and socially.

Areas covered in spinal cord injury rehabilitation programs may include:

Patient need	Example
Self-care skills, including activities of daily living (ADLs)	Feeding, grooming, bathing, dressing, toileting, and sexual functioning
Physical care	Support of heart and lung function, nutritional needs, and skin care
Mobility skills	Walking, transfers, and self-propelling a wheelchair
Respiratory care	Ventilator care, if needed; breathing treatments and exercises to promote lung function
Communication skills	Speech, writing, and alternative methods of communication
Socialization skills	Interacting with others at home and within the community
Vocational training	Work-related skills
Pain and muscle spasticity (increased muscle tone) management	Medications and alternative methods of managing pain and spasticity
Psychological counseling	Identifying problems and solutions for thinking, behavioral, and emotional issues
Family support	Assistance with adapting to lifestyle changes, financial concerns, and discharge planning
Education	Patient and family education and training about SCI, home care needs, and adaptive techniques

The spinal cord injury rehabilitation team

The spinal cord injury rehabilitation team revolves around the patient and family and helps set short-and long-term treatment goals for recovery. Many skilled professionals are part of the spinal cord injury rehabilitation team, including any or all of the following: