A spinal cord injury (SCI) is the damage done to the spinal cord that results in injury to a person and a loss of functionality in the body. What does recovery look like for a person facing such life-changing circumstances? This article explains the comprehensive medical, rehabilitative, and legal roadmap for patients with spinal cord injuries. You learn the types, symptoms, and causes of SCIs. Moreover, you learn how to seek damages and what research has for SCI treatment in the future.
An Overview of Spinal Cord Injury
What is a Spinal Cord Injury?
The spinal cord is a thick mass of nerves that transfers important messages between your brain and the rest of your body. This two-way communication of signals enables you to:
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Move your limbs
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Sense touch and temperature
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Regulate your body's automatic processes. For example, breathing and blood pressure
A spinal cord injury (SCI) is the damage that occurs in the spinal cord to form a roadblock. These nerve fibers are bruised, torn, or even cut in parts or altogether by the trauma, and the flow of information is interrupted. As a result, the functions of your body below the site of the damage, like your strength, sensation, and other systems, could be permanently changed.
The Prevalence of Spinal Cord Injuries
The United States has an estimated 18,000 people who sustain a new traumatic spinal cord injury annually, and it is estimated that there are about 300,000 individuals living with the condition.
Individuals of all walks of life experience these injuries, but most often they are experienced by males. The mean age at the time of injury is 43, when most individuals are career-oriented, family-oriented, and active.
Types of Spinal Cord Injuries
When making your first medical assessments, you will have your doctors refer to specific words describing your injury. The initial step in understanding your individual prognosis is to understand these classifications. Physicians classify SCIs in two main ways:
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Spine location
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Severity or completeness
Depending on the place of the injury, it affects different parts of your body. Sustaining an injury up high on the spinal cord involves a larger section of your body. Scientists separate the spine into four major parts, which are:
- Tetraplegia/quadriplegia—A cervical injury, or injury in your neck, usually causes tetraplegia, or quadriplegia. This implies that your arms, hands, trunk, and legs are partially paralyzed.
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Paraplegia—A blow to the lower back, in the thoracic (upper back), lumbar (lower back), or sacral (pelvic area) area causes paraplegia. This type of paralysis involves your trunk and legs but not your arms and hands.
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Complete injury—The extent of your injury informs the damage. A complete injury is one in which all the sensory and motor functions below the neurological level of injury are entirely lost. The superhighway roadblock in this instance is complete.
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Incomplete injury—An incomplete injury implies that there are still signals passing through. You still have some amount of motor movement or sensation below the site of injury. Recovery is more likely with an incomplete injury, and there is a formal grading system known as the ASIA Impairment Scale to help you accurately determine this level of injury and base your prognosis on it.
Spinal Cord Injuries Symptoms
The effects of your injury show throughout the core systems of your body, which can be divided into three major categories of symptoms.
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Sensory alterations—These symptoms involve the signals that are sent to your brain, like the ability to sense touch, pressure, temperature, and the position of your body in space. This could lead to loss of sensation, numbness, or tingling. Neuropathic pain, a complicated and frequently severe stinging or burning pain that occurs due to the damaged nerve fibers themselves, develops in many people.
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Motor symptoms—These are associated with the messages that your brain sends to your muscles. The greatest motor symptom is paralysis, or the loss of voluntary muscle movement. You might also have muscle weakness or spasticity, which is where your muscles are not controlled and are flexed or have exaggerated, jerky reflexes.
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Autonomic nervous system alterations—Your injury impacts your autonomic nervous system, which regulates the automatic functions that you do not consciously consider. You can have symptoms like:
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Losing voluntary control of your bowel and bladder
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Becoming unstable in your blood pressure and heart rate
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Having trouble controlling your body temperature
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Having trouble breathing and sexual dysfunction
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These symptoms need to be carefully managed throughout your life to ensure that your overall health is taken care of.
The Causes of Spinal Cord Injury
There are two primary forms of spinal cord injury, including:
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Traumatic Spinal Cord Injuries
The most common ones are traumatic SCIs, which are caused by an external physical force powerful enough to fracture, dislocate, or crush the vertebrae that surround your spinal cord. In case of damage to these bones, they may move out of position or even break, releasing bone fragments into the spinal canal. It can directly bruise, compress, or even cut the delicate nerve tissue of the spinal cord, causing an immediate interruption of its operation.
Common causes of such traumatic injuries are:
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Road Accidents—Car and motorcycle crashes are the most common causes of SCIs in the United States. These cause tremendous forces that can violently shake the spine. The abrupt loss of momentum may result in excessive bending (hyperflexion) or arching (hyperextension) of the neck and back, resulting in severe vertebral fractures and dislocations that tear the cord.
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Falls—A spinal fracture can be easily caused by a fall from a considerable height, for example, off a ladder or down a flight of stairs. Even a simple slip on an even surface can be sufficient to cause a compression fracture and damage the spinal cord in people with pre-existing conditions such as osteoporosis, which makes the bones weak.
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Acts of Violence—Penetrating injuries, which are most frequently a result of gunshot wounds or stabbing, can result in devastating and direct SCI. A bullet or a knife may cut the spinal cord directly, and the injury may be complete and permanent, unlike injuries caused by a fall or crash, where the secondary cause of the cord damage is often bone fragments.
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Sports and Recreational Injuries—High-impact athletic activities like swimming down into shallow water and then diving headfirst to form an axial loading force that runs directly down the spine, bursting a vertebra. Also, in sports such as football, when tackling is done with the head down, the injury can be severe to the cervical spine.
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Non-Traumatic Spinal Cord Injuries
Not every spinal cord injury is accidental. A significant number of them develop over time as a consequence of a disease. The injury to the spinal cord in such situations may be slower, yet the functional loss may be equally significant. The major non-traumatic causes are:
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Degenerative Spine Conditions—Aging or wear and tear may result in degenerative changes such as spinal stenosis (narrowing of the spinal canal), severe arthritis with bone spurs, or large herniated disks. These conditions creep into the area where the spinal cord is located and compress it, slowly choking off its blood supply, resulting in neurological damage.
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Spinal Tumors—Tumors may be cancerous (malignant) or non-cancerous (benign) and develop either in the vertebrae or directly on the spinal cord itself. When a tumor grows, it exerts direct pressure on the delicate nerve tissue and interferes with its functioning as a sending and receiving unit.
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Infections—An infection may develop an abscess (a pool of pus) either around the spinal cord (an epidural abscess) or in the vertebrae themselves (osteomyelitis). Inflammation, swelling, and pressure of the abscess may easily squeeze the spinal cord and lead to irreversible damage unless timely treatment is provided.
Acute Surgical and Medical Intervention
During the first hours of traumatic spinal cord injury, two things are of immediate concern:
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To avoid additional harm to your spinal cord
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To provide the most favorable conditions for your body to start healing
It is a race against time, and a high level of precision in stabilization, speedy diagnosis, and, in most instances, urgent surgical decisions characterizes this acute stage of care.
Emergency Stabilization and Diagnosis in the Hospital
Your attention starts at the accident scene. The emergency medical staff is trained to identify the symptoms of a possible SCI and will instantly stabilize your spine by using a stiff neck collar and a backboard. This is necessary to avoid movement that may aggravate the injury.
Upon arrival in the emergency room, the emergency room staff will perform a comprehensive neurological examination to determine your movement and sensation. Hospitals use sophisticated imaging to have a clear image of the damage.
A CT scan will give a fast and detailed picture of your spine bones, and we can tell about fractures or dislocations instantly. Next, an MRI scan provides us with a complex image of the spinal cord itself, showing any bruising, swelling, or compression of the tissue surrounding it.
Decompression and Stabilization Using Surgery
A spinal cord injury surgery is not a spinal cord injury cure that will cure paralysis. A broken spinal cord cannot yet be fixed. Nonetheless, surgery is a critical intervention procedure that has two objectives:
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Decompression. When the bone, a herniated disk, or a blood clot is pressing against your spinal cord, surgery is done to take that pressure off. Decompression of this compression can help to avoid secondary damage and can increase your likelihood of neurological recovery.
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Stabilization. In case your spine has become unstable due to the injury, the surgeon applies medical-grade tools such as rods, screws, and plates to stabilize the vertebrae. This produces a powerful, internal support that cushions your spinal cord against additional damage and gives it a solid base to heal and rehabilitate in the future.
Spinal Cord Surgery Recovery
Upon stabilization of your medical condition, you will move to the next stage, called rehabilitation. This is an active, intensive, and collaborative process to restore your strength, regain independence, and redefine your future. It is in specialized rehabilitation that you learn the skills and develop the resilience needed to thrive.
Meet Your Multi-Disciplinary Rehabilitation Team
A team of specialists will lead you through the process of recovery, and each of them will bring their own experience to your treatment. This interdisciplinary team is headed by a neurointerventional surgeon and a medical physician specializing in physical medicine and rehabilitation, who coordinates your general recovery strategy.
Your physical therapist will aim at maximizing your mobility, strength, and balance by means of specific exercises and mobility training. Meanwhile, your occupational therapist will assist you in retraining the fine motor skills required in your daily living activities, teaching you how to do things such as dressing, eating, and grooming, usually with the assistance of adaptive equipment.
A rehabilitation psychologist will assist you and your family to adjust emotionally and mentally to the changes that come with a life-altering injury. Also, you will be guided through the logistical maze of insurance, available housing, and other community services by a social worker or case manager so that you have the resources you need once you leave the hospital.
Rebuilding Skills and Strength
The essence of your recovery will be vigorous, functional, goal-oriented therapy. You will be taught how to move safely out of your wheelchair into a bed or a car, how to maneuver around your surroundings with your new mobility skills, and how to adjust your daily activities to make the most out of your independence. Over the last few years, extraordinary technological developments have changed this process.
You can also use Functional Electrical Stimulation (FES), which involves the use of small electrical pulses in the weak muscles to make them contract during exercises to enhance their strength and circulation. In other patients, robotic exoskeletons may be used to support them in standing and performing the actions of walking to retrain nerve conduits and keep bones strong.
These technologies are potent tools that, when utilized together with the skills of your therapy team, can enable you to reach a level of function and independence that was previously believed impossible.
A Guide to Your Long-term Health
The life of your spinal cord injury does not end when you leave the rehabilitation hospital. To stay healthy, you need to adopt a proactive and informed lifestyle for wellness. Learning to recognize and treat the possible secondary health conditions related to SCI, you will be able to avoid severe complications and save your quality of life in the years to come. This is how you get in charge of your long-term health.
Autonomic Dysreflexia
In people with an injury above the spine, it is of paramount importance that you and your caregivers are aware of a condition known as autonomic dysreflexia (AD). It is a health crisis marked by an acute and hazardous rise in blood pressure. It is the hyperirritation of your body to a painful or irritating stimulus below your level of injury, for example, a full bladder due to a blocked catheter, a bowel impaction, or even a tight piece of clothing.
The symptoms include:
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Pounding headache
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Flushed skin
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Sweating above your level of injury
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Anxiety
The correct answer is to sit up and assist in reducing your blood pressure and then quickly identify and eliminate the stimulus that is causing the response.
Respiratory Health
The muscles that enable you to breathe and cough can also be weakened, and this makes you more susceptible to lung infections such as pneumonia, depending on the severity of your injury. To maintain the health of your lungs, it is essential to be proactive and take regular breathing exercises, keep abreast of vaccinations, and learn how to assist coughing.
Managing Bladder, Bowel, Skin, and Pain
Establishing regular daily habits is the basis of your long-term health. Since your injury has disrupted the signals that govern your bladder and bowel, you will be required to adhere to a strict management program. This usually includes an established catheterization schedule to empty your bladder and a regular bowel program to avoid accidents and constipation. These programs are essential to prevent urinary tract infections and preserve your dignity and confidence.
Your skin should also be taken good care of. Your skin cannot sense when it is being overstrained without normal sensation, so severe pressure sores may develop. You need to adhere to a schedule of frequent pressure reliefs. For example, alternate your weight every 15-30 minutes when sitting and check your skin daily to identify any redness before it degenerates.
Also, you will be dealing with spasticity and neuropathic pain daily. Stretching and range-of-motion exercises are also helpful in managing muscle tightness, and your doctor may prescribe drugs to manage more serious spasms. Neuropathic pain needs a multimodal approach, and your medical team will collaborate with you to identify the best combination of treatments to ensure that you are comfortable.
Locate a Neuro-Interventional Surgeon Near Me
A spinal cord injury (SCI) is severe damage to the nerve bundle that connects your brain and your body and results in the permanent alteration of sensation, strength, and functioning below the point of damage. The effects of an SCI, such as tetraplegia or paraplegia, are determined by the location and severity of the injury caused primarily by trauma, such as accidents or falls.
SCI treatment involves surgical stabilization followed by intensive rehabilitation to maximize independence. Although there is no absolute cure, surgery and adjustment measures can help people live a productive life.
At LAMIS (Los Angeles Minimally Invasive Spine) Institute, our neuro-interventional surgeons, rehabilitation specialists, and support staff can assist you throughout the phases of SCI recovery. Our goal is to maximize your function, health, and quality of life. Call us today at 310-734-6088.
