Spinal Cord Injuries

What is a Spinal Cord Injury?

A spinal cord injury (SCI) occurs when the spinal cord is damaged. The spinal cord is a bundle of nerves and nerve fibres that allows the brain to communicate with the rest of the body.

An SCI interrupts nerve signals below the level of injury. The damage may result in temporary or permanent changes in sensation, movement, strength, and bodily functions.

Types of Spinal Cord Injuries

The spine consists of four regions:

• Cervical

• Thoracic

• Lumbar

• Sacral

Spinal cord injuries can be classified as either incomplete or complete

1. Incomplete SCI

An incomplete SCI means the spinal cord can still send some messages to and from the brain. There is some preservation of sensation, function, and muscle control below the level of injury.

2. Complete SCI

A complete SCI means the spinal cord is unable to communicate with the brain below the level of injury. There is a complete loss of muscle control, sensation, and function below the injury site.

Incomplete and complete SCIs can result in different forms of paralysis:

1. Tetraplegia/Quadriplegia

   Occurs when the injury affects the neck region. Sensation and movement in the arms, hands, trunk, legs, and pelvic organs may be affected.

   
   

2. Paraplegia

   Sensation and movement in all or parts of the trunk, legs, and pelvic organs are affected.

   
   

3. Triplegia

   Sensation and movement in one arm and both legs are affected.

   
   

Symptoms

Symptoms depend on which nerve signals are affected. There are three main types of signals: sensory, motor, and autonomic.

1. Sensory Signals

These signals carry information to the brain, such as touch (tactile) and body-position awareness (proprioception).

• Symptoms may include:

• Pain

• Numbness

• Tingling

2. Motor Signals

These signals travel from the brain to the muscles.

Symptoms may include:

• Muscle weakness

• Paralysis

• Spasticity

• Difficulty breathing

3. Autonomic Signals

These are automatic body functions that occur without conscious thought. Symptoms may include:

• Heart rate irregularities

• Bladder and bowel incontinence

• Blood pressure changes

• Temperature regulation difficulties

Possible Complications

• Autonomic dysreflexia

• Spinal (neurogenic) shock

• Neuropathic (nerve) pain

• Breathing difficulties

• Pneumonia

• Pressure sores

• Sexual dysfunction

• Changes in muscle tone

• Depression

Causes

Spinal cord injuries may be caused by traumatic or non-traumatic events.

1. Traumatic Causes

Examples include:

• Motor vehicle accidents

• Falls

• Sports injuries

• Violence-related injuries

2. Non-Traumatic Causes

Examples include:

• Spinal tumours

• Infections affecting the spinal cord or causing swelling

• Congenital spinal conditions, such as spina bifida

• Diseases such as osteopenia, osteoporosis, or cancer

• Autoimmune or inflammatory conditions such as Guillain-Barré syndrome and multiple sclerosis

• Genetic conditions

Diagnosis and Testing

Diagnosis may involve:

1. Imaging scans such as MRI, CT scans, and X-rays

2. Neurological examinations

3. Physical examinations and clinical evaluations

4. Diagnostic tests such as nerve conduction studies

Management and Treatment

Early treatment in the emergency setting focuses on:

• Maintaining breathing

• Preventing shock

• Immobilising the spinal column

• Avoiding further complications

Additional treatment may include:

• Surgery

• Medication

• Traction

• Supportive devices such as splints and braces

Long-term rehabilitation may involve:

• Physiotherapy

• Occupational therapy

• Speech therapy

• Psychological support

• Social work services

• In-home care and support

Physiotherapy

Physiotherapy aims to maintain and strengthen muscle function while redeveloping motor skills. Treatment focuses on improving independence, quality of life, mobility, and respiratory function.

The ASIA (American Spinal Injury Association) assessment is commonly used by physiotherapists to evaluate motor and sensory function, as well as the severity of the injury.

Prognosis

Recovery and long-term outcomes depend on many factors, including the severity and location of the injury, the timing of intervention, and the individual’s overall health. Every person’s journey and prognosis will be different.

“Never let anyone tell you that you cannot do something just because of your spinal cord injury. It’s sometimes just a matter of figuring out how to do it in a new way. Above all, never give up.” — Ryan