Spinal Cord Injury

Overview

What is a spinal cord injury?

The spinal cord relays messages between the brain and the rest of the body. Layers of tissue called meninges and a column of vertebrae (spinal bones) surround and protect the spinal cord. Most spinal cord injuries come from a sudden, traumatic blow to the vertebrae. The fractured (broken) bones then damage the spinal cord and its nerves. In rare cases, an injury can completely sever, or split, the spinal cord.

How does a spinal cord injury affect the body?

The body loses many essential functions if an injury means nerves can’t communicate with the brain. A damaged spinal cord can affect:

  • Bladder and bowel (intestinal) function.
  • Breathing.
  • Heart rate.
  • Metabolism, or the body’s process of converting food into energy.
  • Muscle movement.
  • Reflexes.
  • Sensations.

Is a spinal cord injury the same as a back injury?

A spinal cord injury isn’t the same as a back injury. Back injuries may damage bones or soft tissues in the spine, but they don’t affect the spinal cord.

What are the types of spinal cord injuries?

Spinal cord injuries can be complete or incomplete (partial):

  • Complete: A complete injury causes total paralysis (loss of function) below the level of the injury. It affects both sides of the body. A complete injury may cause paralysis of all four limbs (quadriplegia) or the lower half of the body (paraplegia).
  • Incomplete: After an incomplete injury, some function remains on one or both sides of the body. The body and brain can still communicate along certain pathways.

Symptoms and Causes

How do spinal cord injuries happen?

Some possible causes of spinal cord injuries (from most to least common) include:

  • Motor vehicle accidents.
  • Falls.
  • Gunshot wounds.
  • Sports injuries.
  • Surgical complications.

What are the symptoms of a spinal cord injury?

Spinal cord injury symptoms depend on the type (complete or incomplete) and location of the damage. Get immediate medical attention if you notice any of the following issues after an injury:

  • Weakness in the arms and or legs.
  • Decreased sensation in the arms and or legs.
  • Loss of bladder or bowel control.
  • Severe pain or pressure in the neck or back.
  • Unusual lumps along the spine.
  • Difficulty breathing.

Diagnosis and Tests

How is a spinal cord injury diagnosed?

In an emergency, a healthcare provider makes sure a spinal cord injury isn’t affecting your breathing or heart rate. Next, they’ll assess how well your nerves are working. The provider checks:

  • Motor function, or your ability to move parts of your body.
  • Sensory function, or your ability to feel touch.

Certain imaging tests can help diagnose a spinal cord injury:

  • CT scan, to see broken bones, blood clots or blood vessel damage.
  • MRI, to see the spinal cord or soft tissues.
  • X-ray, to show broken bones or dislocations (bones knocked out of place).

A healthcare provider may also use an electromyogram (EMG) to check electrical activity in muscles and nerve cells if there are co-exist peripheral nerve injury. (EMG is usually not necessary in a spinal cord injury.)

Management and Treatment

What is the immediate treatment for a spinal cord injury?

You may need emergency surgery for a spinal cord injury if there’s trauma to another area of the body. Surgery can also address spinal cord damage from broken bones, blood clots or damaged tissue.

Some research suggests that a corticosteroid injection may help spinal cord injuries. The medication should be given within eight hours after the injury occurs. This treatment may:

  • Improve blood flow.
  • Preserve nerve function.
  • Reduce inflammation.

What is the long-term treatment for a spinal cord injury?

Long-term goals of spinal cord injury treatment include:

  • Enhancing independence and quality of life.
  • Reducing the risk of chronic (ongoing) health conditions.
  • Restoring some nerve function in partial injuries.

Long-term complications of a spinal cord injury may include:

  • Inability to regulate blood pressure or body temperature.
  • Increased risk of heart or lung problems.
  • Loss of bladder or bowel control.
  • Paralysis in the arms or legs.
  • Persistent pain.
  • Spasticity, joint contracture.
  • Sexual dysfunction.

Will I need rehabilitation after a spinal cord injury?

Most people with a spinal cord injury will need some form of physical rehabilitation, or therapy. You may need inpatient (during a hospital stay) or outpatient (after a hospital stay) rehabilitation. A rehabilitation team can help you:

  • Learn to use assistive devices such as walkers or wheelchairs.
  • Regain strength and mobility in areas of the body with nerve function.
  • Recover the skills needed for activities of daily living (ADL), including dressing and using the toilet.

What are neural prostheses and how can they help a spinal cord injury?

Neural prostheses (artificial body parts) are a potential new treatment for spinal cord injuries. A neural prosthesis replaces lost nerve function like how an arm or leg prosthesis replaces a lost limb. An electrical device connects to nerves that are still functioning. You use those nerves to control the prosthesis, which helps you move immobile parts of your body.

Prevention

How can I prevent a spinal cord injury?

You can reduce your risk of a spinal cord injury by:

  • Avoiding fall hazards such as ladders.
  • Driving safely and wearing a seatbelt in motor vehicles.
  • Wearing appropriate protective gear during sports.

Outlook / Prognosis

Are spinal cord injuries permanent?

Complete spinal cord injuries are usually permanent. Incomplete spinal cord injuries may allow for some functional improvement over time.

Living With

When should I contact my healthcare provider about a spinal cord injury?

Contact your healthcare provider right away if you develop:

A note from Cleveland Clinic

Spinal cord injuries can have a profound effect on your life. If you’re dealing with a spinal cord injury, it’s important to have a strong support system. This support system may include your healthcare providers, family members, friends and community organizations. You can all work together to improve your health and quality of life.

Last reviewed by a Cleveland Clinic medical professional on 12/01/2020.

References

  • Akkus S, Sezer N, Ugurlu FG. Chronic Complications of Spinal Cord Injury. World Journal of Orthopedics. 2015;6:23-33. Accessed 11/30/2020.
  • American Association of Neurological Surgeons. Spinal Cord Injury. (https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Spinal-Cord-Injury) Accessed 11/30/2020.
  • Atresh S, Goss B, Schuetz M, Urquhart S, Van Middendorp JJ, Williams RP. Diagnosis and Prognosis of Traumatic Spinal Cord Injury. Global Spine Journal. 2011;1:1-8. Accessed 11/30/2020.
  • Bellon K, Bitterman B, Chen D, Klaas SJ, Kolakowsky-Hayner SA, McDowell S. Evidence-based Practice in Primary Prevention of Spinal Cord Injury. Topics in Spinal Cord Injury Rehabilitation. 2013;19:25-30. Accessed 11/30/2020.
  • Burns AS, Fehlings MG, Harrop JS, Hawryluk G, Kwon BK, Martin AR, Tetreault LA, Wilson JR. A Clinical Practice Guideline for the Management of Acute Spinal Cord Injury: Introduction, Rationale, and Scope. Global Spine Journal. 2017;73:845-945. Accessed 11/30/2020.
  • Chen Y, Devivo MJ, Tang Y, Vogel LC. Causes of Spinal Cord Injury. Topics in Spinal Cord Injury Rehabilitation. 2013;19:1-8. Accessed 11/30/2020.
  • Fakhoury M. Neural Prostheses for Restoring Functions Lost After Spinal Cord Injury. Neural Regeneration Research. 2015;10:1594-1595. Accessed 11/30/2020.
  • Merck Manual. Spinal Cord. (https://www.merckmanuals.com/home/brain,-spinal-cord,-and-nerve-disorders/biology-of-the-nervous-system/spinal-cord) Accessed 11/30/2020.
  • National Institute of Neurological Disorders and Stroke. Neurological Diagnostic Tests and Procedures Fact Sheet. (https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Neurological-Diagnostic-Tests-and-Procedures-Fact) Accessed 11/30/2020.
  • National Institute of Neurological Disorders and Stroke. Spinal Cord Injury Information Page. (https://www.ninds.nih.gov/disorders/all-disorders/spinal-cord-injury-information-page) Accessed 11/30/2020.

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