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Spinal cord trauma
Definition
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.
Alternative Names
Spinal cord injury; Compression of spinal cord; SCI; Cord compression
Causes
Spinal cord trauma can be caused by a number of injuries to the spine, including:
- Assault
- Falls
- Gunshot wounds
- Industrial accidents
- Motor vehicle accidents
- Sports injuries (particularly diving into shallow water)
A minor injury can cause spinal cord injury if the spine is weakened (such as from rheumatoid arthritis or osteoporosis) or if the spinal canal protecting the spinal cord has become too narrow (spinal stenosis) due to the normal aging process.
Direct injury, such as cuts, can occur to the spinal cord, especially if the bones or the disks have been weakened. Fragments of bone (for example, from broken vertebrae, which are the spine bones) or fragments of metal (such as from a traffic accident or gunshot) can cut or damage the spinal cord.
Direct damage can also occur if the spinal cord is pulled, pressed sideways, or compressed. This may occur if the head, neck, or back are 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 - 35 are most commonly affected. The death rate tends to be higher in young children with spinal injuries.
Risk factors include:
- Participating in risky physical activities
- Not wearing protective gear during work or play
- Diving into shallow water
Older people with weakened spines (from osteoporosis) may be more likely to have a spinal cord injury. Patients who have other medical problems (stroke or prostate cancer, for example) that make them more likely to fall may also be more susceptible.
Symptoms
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).
Injuries at and below the first lumbar vertebra do not cause spinal cord injury. However, they may cause "cauda equina syndrome" -- injury to the nerve roots in this area. This type of spinal cord injury is a medical emergency and needs immediate surgery.
Injuries at any level can cause:
- Increased muscle tone (spasticity)
- Loss of normal bowel and bladder control (may include constipation, incontinence, bladder spasms)
- Numbness
- Sensory changes
- Pain
- Weakness, paralysis
CERVICAL (NECK) INJURIES
When spinal cord injuries occur 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 occur 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 occur at the lower back level, symptoms can affect one or both legs, as well as the muscles that control the bowels and bladder.
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.
The following tests may be ordered:
- CT scan or MRI of the spine
- Myelogram (an x-ray of the spine after injecting dye)
- Somatosensory evoked potential (SSEP) testing or magnetic stimulation
- Spine x-rays
Treatment
A spinal cord injury is a medical emergency that needs to be treated right away. The time between the injury and treatment can affect the outcome.
Corticosteroids, such as dexamethasone or methylprednisolone, are 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 your spinal nerves are completely destroyed, paralysis may improve. Ideally, corticosteroids should begin as soon as possible after the injury.
Surgery may be needed to:
- 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 (metal braces placed in the skull and attached to traction weights or to a harness on the body). You may need to wear the spine braces for a long time.
The health care team will also provide information on muscle spasms, care of the skin, and bowel and bladder dysfunction. Your skin will be protected against pressure sores.
You will probably need physical therapy, occupational therapy, and other rehabilitation therapies after the injury has healed. Rehabilitation will help you cope with the disability from your spinal cord injury.
Muscle spasticity can be relieved with medications taken by mouth or injected into the spinal canal. Botox injections into the muscles may also be helpful. Painkillers (analgesics), muscle relaxers, and physical therapy are used to help control pain.
See also:
Support Groups
For organizations that provide support and additional information, see spinal injury resources.
Outlook (Prognosis)
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.
Possible Complications
The following are possible complications of a spinal cord injury:
- Blood pressure changes - can be extreme (autonomic hyperreflexia)
- Chronic kidney disease
- Complications of immobility:
- Deep vein thrombosis
- Lung infections
- Skin breakdown
- Muscle contractures
- Increased risk of injury to numb areas of the body
- Increased risk of urinary tract infections
- Loss of bladder control
- Loss of bowel control
- Loss of feeling
- Loss of sexual function (male impotence)
- Muscle spasticity
- Pain
- Paralysis of breathing muscles
- Paralysis (paraplegia, quadriplegia)
- Pressure sores
- Shock
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.
Prevention
Proper safety practices during work and recreation 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 the depth of water 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. Use caution when sledding and inspect the area for obstacles. Use appropriate techniques and equipment when playing football or other contact sports.
- Falls while climbing at work or during recreation can cause spinal cord injuries. Defensive driving and wearing seat belts greatly reduces the risk of serious injury if there is an automobile accident.
References
Gupta MC, Benson DR, Keenen TL. Initial evaluation and emergency treatment of the spine-injured patient. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, Krettek C, eds. Skeletal Trauma. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 25.
Ling GSF. Traumatic brain injury and spinal cord injury. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 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: Saunders Elsevier; 2012:chap 50C.
Edgerton VR, Roy RR. A new age for rehabilitation. Eur J Phys Rehabil Med. 2012;48(1):99-109.
Reviewed By: Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
