Spinal cord trauma
Spinal cord trauma is damage to the spinal cord. It may result from direct injury to the cord itself or indirectly from disease of the surrounding bones, tissues, or blood vessels.
Spinal cord injury; Compression of spinal cord; SCI; Cord compression
The spinal cord contains the nerves that carry messages between your brain and body. The cord passes through your neck and back.
Spinal cord trauma can be caused by injuries to the spine, such as:
- Gunshot wounds
- Industrial accidents
- Motor vehicle accidents
- Sports injuries
A minor injury can damage the spinal cord if the spine is weakened, such as from rheumatoid arthritis or osteoporosis. Injury can also occur if the spinal canal protecting the spinal cord has become too narrow (spinal stenosis) due to the normal aging process.
Direct injury, such as bruises, can occur to the spinal cord if the bones or disks have been weakened. Fragments of bone (such as from broken vertebrae, which are the spine bones) or fragments of metal (such as from a traffic accident or gunshot) can damage the spinal cord.
Direct damage can occur if the spinal cord is pulled, pressed sideways, or compressed. This may occur if the head, neck, or back is twisted abnormally during an accident or intense chiropractic manipulation.
Bleeding, fluid buildup, and swelling can occur inside or outside the spinal cord (but within the spinal canal). The buildup of blood or fluid can press on the spinal cord and damage it.
Most spinal cord trauma happens to young, healthy individuals. Men ages 15 to 35 are most often affected. The death rate tends to be higher in young children with spinal injuries.
Risk factors include:
- Participating in risky physical activities
- Riding in high-speed vehicles
- Diving into shallow water
Older people with weakened bones (from osteoporosis) or persons with other medical problems (such as stroke) that make them more likely to fall may also have spinal cord injury.
Symptoms vary depending on the location of the injury. Spinal cord injury causes weakness and loss of feeling at, and below the injury. How severe symptoms are depends on whether the entire cord is severely injured (complete) or only partially injured (incomplete).
An injury at and below the first lumbar vertebra does not cause spinal cord injury. But it may cause cauda equina syndrome. This is an injury to the nerve roots in this area. This type of spinal cord injury is a medical emergency and needs surgery right away.
Injuries of the spinal cord at any level can cause:
- Increased muscle tone (spasticity)
- Loss of normal bowel and bladder control (may include constipation, incontinence, bladder spasms)
- Sensory changes
- Weakness, paralysis
CERVICAL (NECK) INJURIES
When spinal cord injuries are in the neck area, symptoms can affect the arms, legs, and middle of the body. The symptoms may occur on one or both sides of the body. Symptoms can also include breathing difficulties from paralysis of the breathing muscles, if the injury is high up in the neck.
THORACIC (CHEST LEVEL) INJURIES
When spinal injuries are at chest level, symptoms can affect the legs. Injuries to the cervical or high thoracic spinal cord may also result in blood pressure problems, abnormal sweating, and trouble maintaining normal body temperature.
LUMBAR SACRAL (LOWER BACK) INJURIES
When spinal injuries are at the lower back level, symptoms can affect one or both legs. Muscles that control the bowels and bladder can also be affected.
Exams and Tests
Spinal cord injury is a medical emergency that needs immediate medical attention.
The health care provider will perform a physical exam, including a brain and nervous system (neurological) exam. This will help identify the exact location of the injury, if it is not already known.
Some of the reflexes may be abnormal or missing. Once swelling goes down, some reflexes may slowly recover.
Tests that may be ordered include:
- CT scan or MRI of the spine
- Myelogram (an x-ray of the spine after injecting dye)
- Spine x-rays
- Electromyography (EMG)
- Nerve conduction studies
A spinal cord injury needs to be treated right away. The time between the injury and treatment can affect the outcome.
Medicines called corticosteroids are sometimes used to reduce swelling that may damage the spinal cord.
If spinal cord pressure is caused by a growth that can be removed or reduced before the spinal nerves are completely destroyed, paralysis may improve.
Surgery may be needed to:
- Realign the spinal bones (vertebrae)
- Remove fluid or tissue that presses on the spinal cord (decompression laminectomy)
- Remove bone fragments, disk fragments, or foreign objects
- Fuse broken spinal bones or place spinal braces
Bedrest may be needed to allow the bones of the spine to heal.
Spinal traction may be recommended. This can help keep the spine from moving. The skull may be held in place with tongs. These are metal braces placed in the skull and attached to weights or to a harness on the body (halo vest). You may need to wear the spine braces for many months.
The health care team will also tell you what to do for muscle spasms and bowel and bladder dysfunction. They will also teach you how to care for your skin and protect it from pressure sores.
You will probably need physical therapy, occupational therapy, and other rehabilitation after the injury has healed. Rehabilitation will help you cope with the disability from your spinal cord injury.
Seek out organizations for additional information on spinal cord injuries. They can provide support as you recover.
How well a person does depends on the level of injury. Injuries near the top of the spine lead to more disability than injuries low in the spine.
Paralysis and loss of sensation of part of the body are common. This includes total paralysis or numbness, and loss of movement and feeling. Death is possible, especially if there is paralysis of the breathing muscles.
A person who recovers some movement or feeling within 1 week usually has a good chance of recovering more function, although this may take 6 months or more. Losses that remain after 6 months are more likely to be permanent.
Routine bowel care often takes one hour or more each day. Most people with spinal cord injury must perform bladder catheterization regularly.
The home will usually need to be modified.
Most people with a spinal cord injury are in a wheelchair, or need assistive devices to get around.
The following are possible complications of a spinal cord injury:
- Blood pressure changes - can be extreme (autonomic hyperreflexia)
- Increased risk of injury to numb areas of the body
- Increased risk of urinary tract infections
- Long-term kidney disease
- Loss of bladder control
- Loss of bowel control
- Loss of feeling
- Loss of sexual function (male impotence)
- Paralysis of breathing muscles
- Paralysis (paraplegia, quadriplegia)
- Pressure sores
- Problems due to not being able to move, such as deep vein thrombosis, lung infections, skin breakdown, and muscle stiffness
People living at home with spinal cord injury should do the following to prevent complications:
- Get lung (pulmonary) care each day (if they need it).
- Follow all instructions for bladder care to avoid infections and damage to the kidneys.
- Follow all instructions for routine wound care to avoid pressure sores.
- Keep immunizations up to date.
- Maintain routine health visits with their doctor.
When to Contact a Medical Professional
Call your health care provider if you have a back or neck injury. Call 911 if you lose movement or feeling. This is a medical emergency!
Managing a spinal cord injury begins at the site of an accident. Trained paramedics immobilize the injured spine to prevent further nervous system damage.
Someone who may have a spinal cord injury should not be moved unless he or she is in immediate danger.
Proper safety practices during work and play can prevent many spinal cord injuries. Use proper protective equipment for any activity in which an injury is possible.
- Diving into shallow water is a major cause of spinal cord trauma. Check water depth before diving, and look for rocks or other possible objects in the way.
- Football and sledding can often involve sharp blows or abnormal twisting and bending of the back or neck, which can cause spinal cord injury. Before sledding down a hill, check the area for obstacles. Use the right techniques and equipment when playing football or other contact sports.
- Defensive driving and wearing a seat belt reduces the risk of serious injury if there is a car accident.
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Ling GSF. Traumatic brain injury and spinal cord injury. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 406.
Shih P, Fessler RG. Trauma of the nervous system: spinal cord trauma. In: Daroff RB, Fenichel GM, Jankovic I, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 50C.
Reviewed By: Luc Jasmin, MD, PhD, FRCS (C), FACS, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, CA; Department of Surgery at Ashland Community Hospital, Ashland, OR; Department of Surgery at Cheyenne Regional Medical Center, Cheyenne, WY; Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.