What Is It?
The spinal cord carries nerve signals from the brain to the rest of the body. Trauma to the spinal cord can result from a number of injuries: about half occur after motor vehicle accidents; followed by falls; gunshot wounds or other violence; and sports-related injuries. The average age at injury is 42 years, and approximately 80% of those affected are male. Up to one-quarter of cases occur after significant alcohol ingestion. Pre-existing disease in the spine can make spinal cord trauma more likely. For example, complications of rheumatoid arthritis or osteoporosis may lead to spinal cord damage.
Most spinal cord injuries occur in the area of the neck called the cervical region. Trauma can result from bruising to the spinal cord itself, loss of blood flow to the cord or cuts in the cord. Spinal cord injuries are serious and can cause diminished strength, coordination and sensation as well as other functions, such as bladder control.
The symptoms of spinal cord trauma vary and depend on the location and severity of the injury. Complete spinal cord trauma -- an injury that results in a total loss of sensation or the ability to move -- occurs at about the same level as the injury. For example, a person injured in the middle of the neck will lack feeling and be unable to move below the middle of the neck. Almost one-half of all spinal cord injuries are complete. Complete injuries that take place in the upper neck can compromise breathing ability and require the person to use a mechanical ventilator. Injuries to the spinal cord in the neck or upper back may cause abnormalities in blood pressure, sweating and in regulating body temperature. In addition, loss of bladder and bowel control and increased muscle tone in the extremities (spasticity) may accompany spinal cord injury. Some of these symptoms may not be apparent immediately after the injury.
Injuries to a specific side of the spinal cord or its center will produce characteristic patterns of symptoms, such as weakness or paralysis of arms or legs, or one side of the body. In an injured person who is unconscious, the degree of neurological injury may be hard to assess, so doctors must have a high degree of suspicion that a spinal cord injury has taken place and take steps to protect the spinal cord. This usually is done by using a cervical collar to immobilize the neck or by strapping the person to a stiff backboard for transport.
The possibility of spinal cord trauma should be considered in anyone who has been in a severe automobile accident or who has experienced significant injury to the head or neck.
If you are conscious, you will be asked about neck pain and whether you can feel and move your arms and legs. Significant pain, bruising and swelling of the skin and tissues over the neck or back may raise the suspicion of a spinal cord injury. A physical examination may reveal loss of sensation, weakness, and abnormal reflexes.
You also will be assessed for whether you have other injuries that may be diverting attention from a neck injury, and for the presence of other signs of spinal cord injury. X-rays, computed tomography (CT) scans and magnetic resonance imaging (MRI) also may be used to evaluate your spine and the spinal cord.
A cervical collar to keep your neck immobilized often will be left in place until the results of tests are available. If a spinal cord injury is suspected, the collar may be left in place for at least several days, even if tests are negative, in case an injury does exist but hasn't been detected because of swelling or muscle spasm.
Complete spinal cord injuries are diagnosed when total loss of sensation and control occurs. Incomplete injuries cause variable amounts of sensory loss, weakness or paralysis, depending on the site of the injury.
How long the symptoms of spinal cord injury last depends on the nature and extent of the injury. Minor bruising may go away over time, although full recovery sometimes takes weeks or months. More serious injuries often will result in permanent loss of function. Strategies for helping nerve cells (neurons) recover after injury is an area of active research.
Preventing spinal cord injury requires preventing traumatic injury to the spinal column, especially the neck. The leading causes of spinal cord injury include automobile accidents, falls, sports, diving accidents and firearms. To prevent spinal cord injury:
- Always wear your seat belt.
- Don't drink and drive.
- Dive only in water at least 9 to 12 feet deep, with your arms in front of you. Never dive into water if you don't know its depth.
- Wear protective equipment when playing sports or engaging in any dangerous activity.
- Protect yourself against falls.
Emergency care, surgery (when necessary), rehabilitation and supportive care, including use of respirators, can help people with spinal cord injuries survive and make the most of their remaining neurologic function.
In the past, corticosteroids were often given just after the injury to reduce swelling around the injured spinal cord. While corticosteroid therapy remains an option, a number of guidelines have removed this treatment as a standard recommendation due to a lack of convincing evidence supporting its effectiveness and its potential to cause side effects.
Most treatment of spinal cord injuries involves a "wait and see" approach. If the injury is minor, only time will reveal the extent of recovery. For those with major injuries, a complete recovery is highly unlikely, and treatment consists of providing supportive care, teaching new skills and developing coping strategies.
Surgery sometimes is required to stabilize a damaged spine, to remove fragments of injured bone, discs, or foreign objects (such as bullets), to drain fluid or a blood clot that is pressing on the spinal cord.
Active areas of research include:
- cooling of the body temperature or cooling of the tissues near the spinal cord
- nerve-cell transplant
- hormones and growth factors that encourage nerve cell regeneration
- electrical stimulation
Some believe that stem cells hold promise in helping people with spinal cord trauma regenerate damaged nerve cells so that neurologic function can be regained.
When To Call a Professional
All cases of actual or possible spinal cord trauma should be evaluated by a doctor immediately.
Spinal cord trauma may heal over time without further problems, or it may result in permanent deficits, depending on the location and severity of the injury. Early recovery of at least some movement or sensation suggests that additional recovery is possible. Lost sensation or function lasting more than 6 months is unlikely to improve.
Christopher Reeve Paralysis Foundation
United Spinal Association
Think First National Injury Prevention Foundation