Spinal Cord Injury

The spinal cord sends messages between the brain and the body. Spinal cord injuries can disrupt those signals. Injuries may be caused by trauma, such as a fall, or by diseases, such as cancer or arthritis. Nerve cells in the spinal cord do not regrow. When there is a severe injury, paralysis or loss of function can occur below the injury. However, surgery, medicines, rehabilitation, and technology or equipment can help spinal cord injury sufferers still have a high quality of life. Learn more about spinal cord injury.

The spinal cord, which connects the brain to the rest of the body, is a long, fragile tube of nerves protected by back bones (vertebra) of the spine (spinal column).

This central nerve sends messages between the brain and different parts of the body. Spinal injuries can cause problems with those signals, resulting in loss of control for movement and some organ functions as well as inability to feel various sensations.

Injury may result from damage to the spinal cord or vertebrae, ligaments, or discs of the spinal column. (Your doctor may refer to the vertebra and nerves in cervical, thoracic, lumbar, and sacral regions of the back.) Spinal cord injuries can be either:

• Traumatic. These usually happen as a result of a sudden blow that fractures or dislocates your spine.
• Nontraumatic. These injuries or pain can be caused by arthritis, osteoporosis, spinal stenosis (a narrowing of the spinal column), cancer, infections, or inflammation.

Damage from both traumatic and nontraumatic injuries affects the nerves around the injured site and impairs nerve signals from the muscles and nerves below the injury.

Injuries range from “incomplete” to “complete.” A tear or bruise on the spinal cord is an incomplete injury. Most spinal pain is due to an incomplete injury, with something out of place in the back, such as pieces of vertebra or disc tissue, pressing against nerves in the spinal cord. A complete injury means that the spinal cord is severed, so the brain can’t send or receive nerve signals below that point. This results in paralysis in areas below the injury point.

Nerve cells in the spinal cord do not regrow, so there is no way to reverse damage. Researchers are working to find treatments, such as medicines that could promote nerve cell regeneration or help remaining nerves function better after a spinal cord injury. For now, treatment focuses on helping people with spinal cord injury to live as productive and active lives as possible with the help of medicines, rehabilitation, and prosthetic or assistance devices.

Spinal cord injuries are medical emergencies, and you need immediate treatment. If you are experiencing sudden severe head, back, or neck pain, you should be evaluated for a spinal injury.

Other emergency signs and symptoms include problems with:

• Breathing
• Walking and maintaining balance
• Controlling bowel or bladder function (pooping and peeing)
• Weakness or inability to move any part of your body
• Being unable to feel or having numb, tingly hands, feet , fingers, or toes
• Severe back pain or pressure in the back, head, or neck
• Having your neck or back appear twisted in an odd position

If you have experienced trauma to your back or neck, you should assume you have a spinal injury — even if you don’t. Serious spinal injuries are not always apparent right away, so you should seek medical help before other problems (such as numbness or paralysis) potentially develop.

If you think someone has injured their neck or back, follow these precautions to ensure that the injury doesn’t get worse:

• Do not move the person, and make sure they stay still.
• Call 911.
• Keep the person’s head from moving by holding their head or bracing both sides of the head with rolled-up towels or blankets until emergency help arrives.
• As long as the head doesn’t move, do what you can to make the person comfortable, and provide basic first aid (such as stopping bleeding).

Spinal cord injuries are often the result of an accident, such as falls, motor vehicle accidents, sports injuries, and acts of violence. Injury can also come from diseases, such as cancer or arthritis.

Some injuries can be prevented, however, by taking care of your overall health and limiting involvement in impact or extreme sports. This includes avoiding alcohol as well as not engaging in risky behavior. Falls cause most injuries in adults older than 65, so older adults should also take safety measures to avoid potential falls.

Your doctor will do a physical exam to test for sensory function (how you perceive pain, temperature, touch, and pressure) as well as movement and strength. If the injury is the result of an accident, your doctor may ask these questions:

• When and how did the injury occur?
• Is the injury related to what you do for work?
• Do you have other medical conditions?
• Do you have a personal or family history of blood clots?

If you have neck pain or signs of weakness or nerve damage, your doctor may want to run further tests such as:

• X-rays, commonly taken when there has been trauma to the back. X-rays can show problems in the spinal column bones (vertebra), tumors, fractures, or degenerative conditions.
• A computerized tomography (CT) scan, which takes pictures that form a series of cross-sectional images so doctors can better see bone, disc, and other spinal problems.
• Magnetic resonance imaging (MRI), which helps to identify problems in the tissues, such as herniated discs or blood clots.

If there is swelling around your spinal cord, your doctor may want to examine you again a few days later after the swelling has gone down.

Emergency treatment for a traumatic spinal cord injury focuses on getting your breathing stable, keeping you from further injuring your spine or going into shock, and managing complications.

Once you are stable, your treatment will focus on rehabilitation. Depending on your injury, your rehabilitation team may include one or more of these types of specialists:

• Neurologist [noo-RALL-oh-jist], a specialist in nervous system disorders
• Physical medicine and rehabilitation physician (Physiatrist)
• Neurosurgeon [NOO-roh-SUR-jun], a specialist in spinal cord injuries
• Physical therapist
• Occupational therapist
• Rehabilitation nurse
• Rehabilitation psychologist
• Social worker
• Dietitian
• Recreation therapist

Treatments may include anything from surgery to repair your spine and medicines to manage some symptoms (such as helping with pain and inflammation, bladder and bowel control, or sexual function) to rehabilitation and education.

If you are having issues with body functions or sensation below an injured site on the spinal cord, your healthcare team will help you develop strategies to address the changes caused by the injury. This includes issues with bladder and bowel control, breathing and circulation, sexual health, skin sensation, and muscle tone.

Your team can also help you avoid muscle or joint pain from overusing certain muscle groups, nerve pain in those with an incomplete injury, and depression from coping with the changes spinal cord injury brings and living with pain.

Therapists will educate you on the effects of a spinal cord injury. They can help you develop skills and adapt to new ways to do your daily tasks, including the use of assistive equipment and technology to increase your quality of life.

Some spinal injuries can’t be prevented, since they’re due to aging or normal wear and tear on your back — or unavoidable accidents and trauma. However, you can prevent some spinal injuries by avoiding risky situations and practicing good back health habits.

Tips for lowering your risk of spinal cord injury

• Practice safe driving. Always wear a seat belt or motorcycle helmet to protect yourself in case of motor vehicle accident. Make sure everyone in your vehicle does as well. Never drive if you have been drinking alcohol or using other substances. Never text while driving.
• Protect yourself when playing sports. Avoid extreme sports. Always wear protective gear. Never dive into water headfirst unless you know it is at least 9 feet (3 meters) deep or lead with your head when playing contact sports.
• Make your home “fall-proof,” and practice ladder safety. Get rid of floor clutter, wear sturdy, non-slip footwear, and add lighting and handrails or grab bars to stairs and bathrooms.

Tips for good back health

• Use good posture. Be aware of your posture, especially when you are sitting or standing for long periods. Train yourself to stand, walk, sit, and lie in ways that place the least strain on supporting muscles and ligaments.
• Lift smart. Avoid heavy lifting when you can. When you can’t, use proper lifting techniques: Bend the legs, keep the back straight, and slowly stand while lifting the object.
• Get regular exercise to strengthen your back. Exercise regularly with both aerobic and core-strengthening exercises. Be sure to warm up by stretching your muscles first.
• Don’t smoke. If you smoke, make a plan to get the support you need to quit.
• Maintain a healthy weight. Follow your healthcare providers’ recommendations for diet and exercise as obesity can weaken your back.