Filed under: Brain & Nervous System
A spinal cord injury — damage to any part of the spinal cord or nerves at the end of the spinal canal — often causes permanent changes in strength, sensation and other body functions below the site of the injury. If you've recently experienced a spinal cord injury, it might seem like every aspect of your life will be affected.
Many scientists are optimistic that advances in research will someday make the repair of spinal cord injuries possible. Research studies are ongoing around the world. In the meantime, treatments and rehabilitation allow many people with a spinal cord injury to lead productive, independent lives.
Your ability to control your limbs after spinal cord injury depends on two factors: the place of the injury along your spinal cord and the severity of injury to the spinal cord. The lowest normal part of your spinal cord is referred to as the neurological level of your injury. The severity of the injury is often called "the completeness" and is classified as either:
Additionally, paralysis from a spinal cord injury may be referred to as:
Your health care team will perform a series of tests to determine the neurological level and completeness of your injury.
Spinal cord injuries of any kind may result in one or more of the following signs and symptoms:
Emergency signs and symptoms
Emergency signs and symptoms of spinal cord injury after an accident may include:
When to see a doctor
Anyone who experiences significant trauma to his or her head or neck needs immediate medical evaluation for the possibility of a spinal injury. In fact, it's safest to assume that trauma victims have a spinal injury until proven otherwise because:
If you suspect that someone has a back or neck injury:
Spinal cord injuries result from damage to the vertebrae, ligaments or disks of the spinal column or to the spinal cord itself. A traumatic spinal cord injury may stem from a sudden, traumatic blow to your spine that fractures, dislocates, crushes or compresses one or more of your vertebrae. It also may result from a gunshot or knife wound that penetrates and cuts your spinal cord. Additional damage usually occurs over days or weeks because of bleeding, swelling, inflammation and fluid accumulation in and around your spinal cord.
A nontraumatic spinal cord injury may be caused by arthritis, cancer, inflammation, infections, or disk degeneration of the spine.
Your brain and central nervous system
The central nervous system comprises the brain and spinal cord. The spinal cord, made of soft tissue and surrounded by bones (vertebrae), extends downward from the base of your brain and is made up of nerve cells and groups of nerves called tracts, which go to different parts of your body. The lower end of your spinal cord stops a little above your waist in the region called the conus medullaris. Below this region is a group of nerve roots called the cauda equina.
Tracts in your spinal cord carry messages between the brain and the rest of the body. Motor tracts carry signals from the brain to control muscle movement. Sensory tracts carry signals from body parts to the brain relating to heat, cold, pressure, pain and the position of your limbs.
Damage to nerve fibers
Whether the cause is traumatic or nontraumatic, the damage affects the nerve fibers passing through the injured area and may impair part or all of your corresponding muscles and nerves below the injury site. A chest (thoracic) or lower back (lumbar) injury can affect your torso, legs, bowel and bladder control, and sexual function. In addition, a neck (cervical) injury affects movements of your arms and, possibly, your ability to breathe.
Common causes of spinal cord injury
The most common causes of spinal cord injuries in the United States are:
Although a spinal cord injury is usually the result of an accident and can happen to anyone, certain factors may predispose you to a higher risk of sustaining a spinal cord injury, including:
At first, changes in the way your body functions may be overwhelming. However, your rehabilitation team will help you develop the strategies you need to address the changes caused by the spinal cord injury. Areas often affected include:
Sexual health. Sexuality, fertility and sexual function may be affected by spinal cord injury. Men may notice changes in erection and ejaculation; women may notice changes in lubrication. A spinal cord injury may cause decreased or absent sensation and movement below the level of injury, but a person may notice a heightened sensitivity in areas above the level of injury. Doctors, urologists and fertility specialists who specialize in spinal cord injury can offer options for sexual functioning and fertility.
There's usually no physical change in women with a spinal cord injury that inhibits sexual intercourse or pregnancy. Most women with a spinal cord injury can experience labor, have a normal delivery and breast-feed.
Traumatic spinal cord injuries are emergencies, and the person who's injured may not be able to participate in his or her care in the beginning. A number of specialists will be involved in stabilizing the condition, including a doctor who specializes in nervous system disorders (neurologist) and a surgeon who specializes in spinal cord injuries and other nervous system problems (neurosurgeon), among others. The rehabilitation team, which will include a variety of specialists, will be led by a doctor who specializes in spinal cord injury.
If you have a possible spinal cord injury or you accompany someone who's had a spinal cord injury and can't provide the necessary information, here are some things you can do to facilitate care.
What you can do
For a spinal cord injury, some basic questions to ask the doctor include:
Don't hesitate to ask any other questions you have.
What to expect from the doctor
Your doctor is likely to ask questions, including:
In the emergency room, a doctor may be able to rule out a spinal cord injury by careful inspection, testing for sensory function and movement, and asking some questions about the accident. But if the injured person complains of neck pain, isn't fully awake, or has obvious signs of weakness or neurological injury, emergency diagnostic tests may be needed.
These tests may include:
A few days after injury, when some of the swelling may have subsided, your doctor will conduct a neurological exam to determine the level and completeness of your injury. This involves testing your muscle strength and your ability to sense light touch and a pinprick.
Unfortunately, there's no way to reverse damage to the spinal cord. But, researchers are continually working on new treatments, including prostheses and medications that may promote nerve cell regeneration or improve the function of the nerves that remain after a spinal cord injury.
In the meantime, spinal cord injury treatment focuses on preventing further injury and empowering people with a spinal cord injury to return to an active and productive life.
Urgent medical attention is critical to minimize the effects of any head or neck trauma. So treatment for a spinal cord injury often begins at the scene of the accident.
Emergency personnel typically immobilize the spine as gently and quickly as possible using a rigid neck collar and a rigid carrying board, which they'll use to transport you to the hospital.
Early (acute) stages of treatment
In the emergency room, doctors focus on:
You may be sedated so that you don't move and sustain more damage while undergoing diagnostic tests for spinal cord injury.
If you do have a spinal cord injury, you'll usually be admitted to the intensive care unit for treatment. You may even be transferred to a regional spine injury center that has a team of neurosurgeons, orthopedic surgeons, spinal cord medicine specialists, psychologists, nurses, therapists and social workers with expertise in spinal cord injury.
After the initial injury or disease stabilizes, doctors turn their attention to preventing secondary problems that may arise, such as deconditioning, muscle contractures, pressure ulcers, bowel and bladder issues, respiratory infections, and blood clots.
The length of your hospitalization depends on your condition and the medical issues you're facing. Once you're well enough to participate in therapies and treatment, you may transfer to a rehabilitation facility.
Rehabilitation. Rehabilitation team members will begin to work with you while you're in the early stages of recovery. Your team may include a physical therapist, occupational therapist, rehabilitation nurse, rehabilitation psychologist, social worker, dietitian, recreation therapist and a doctor who specializes in physical medicine (physiatrist) or spinal cord injuries.
During the initial stages of rehabilitation, therapists usually emphasize maintenance and strengthening of existing muscle function, redeveloping fine motor skills and learning adaptive techniques to accomplish day-to-day tasks. You'll be educated on the effects of a spinal cord injury and how to prevent complications, and you'll be given advice on rebuilding your life and increasing your quality of life. You'll be taught many new skills. and you'll use equipment and technology that can help you live on your own as much as possible. You'll be encouraged to resume your favorite hobbies, participate in social and fitness activities, and return to school or the workplace.
Medications. Medications may be used to manage some of the effects of spinal cord injury. These include medications to control pain and muscle spasticity, as well as medications that can improve bladder control, bowel control and sexual functioning.
New technologies. Inventive medical devices can help people with a spinal cord injury become more independent and more mobile. Some devices may also restore function. These include:
Prognosis and recovery
Your doctor may not be able to give you a prognosis right away. Recovery, if it occurs, typically starts a week to six months after an injury. However, some people experience small improvements for up to one year or longer.
An accident that results in paralysis is a life-changing event. Suddenly having a disability can be frightening and confusing, and adapting is no easy task. You may wonder how your spinal cord injury will affect your everyday activities, job, relationships and long-term happiness.
Recovery from such an event takes time, but many people who are paralyzed move on to lead productive and fulfilling lives. It's essential to stay motivated and get the support you need.
If you're newly injured, you and your family will likely experience a period of mourning and grief. Although the grieving process is different for everyone, it's common to experience denial or disbelief, followed by sadness, anger, bargaining and, finally, acceptance.
The grieving process is a common, healthy part of your recovery. It's natural — and important — to grieve the loss of the way you were. But it's also necessary to set new goals and find a way to move forward with your life.
You'll probably have concerns about how your injury will affect your lifestyle, your financial situation and your relationships. Grieving and emotional stress are normal and common. However, if your grief and sadness are affecting your care, causing you to isolate yourself from others, or prompting you to abuse alcohol or other drugs, you may want to consider talking to a social worker, psychologist or psychiatrist. Or, you might find a support group of people with spinal cord injuries helpful. Talking with others who understand what you're going through can be encouraging, and members of the group may have good advice on adapting areas of your home or work space to better accommodate your current needs. Ask your doctor or rehabilitation specialist if there are any support groups in your area.
One of the best ways to regain control of your life is to educate yourself about your injury and your options for reclaiming an independent life. A range of driving equipment and vehicle modifications is available today. The same is true of home modification products. Ramps, wider doors, special sinks, grab bars and easy-to-turn doorknobs make it possible for you to live more autonomously.
Because the costs of a spinal cord injury can be overwhelming, you may want to find out if you're eligible for economic assistance or support services from the state or federal government or from charitable organizations. Your rehabilitation team can help you identify resources in your area.
Talking about your disability
Your friends and family may respond to your disability in different ways. Some may be uncomfortable and unsure if they're saying or doing the right thing.
Being educated about your spinal cord injury and willing to educate others is helpful. Children are naturally curious and sometimes adjust rather quickly if their questions are answered in a clear, straightforward way. Adults can also benefit from learning the facts. Explain the effects of your injury and what your family and friends can do to help. At the same time, don't hesitate to tell friends and loved ones when they're helping too much. Although it may be uncomfortable at first, talking about your injury often strengthens your relationships with family and friends.
Dealing with intimacy, sexuality and sexual activity
Your spinal cord injury may affect your body's response to sexual stimuli. However, you're a sexual being with sexual desires. A fulfilling emotional and physical relationship is possible, but requires communication, experimentation and patience. A professional counselor can help you and your partner communicate your needs and feelings. Your doctor can provide the medical information you need regarding sexual health. You can have a satisfying future complete with intimacy and sexual pleasure.
By nature, a spinal cord injury has a sudden impact on your life and the lives of those closest to you. When you first hear your diagnosis, you may start making a mental list of all of the things you can't do anymore. However, as you learn more about your injury and your treatment options, you may be surprised by all you can do.
Thanks to new technologies, treatments and devices, people with a spinal cord injury play basketball and participate in track meets. They paint and take photographs. They get married, have and raise children, and have rewarding jobs.
Today, advances in stem cell research and nerve cell regeneration give hope for a greater recovery for people with spinal cord injuries. At the same time, new medications are being investigated for people with long-standing spinal cord injuries. No one knows when new treatments will be available, but you can remain hopeful about the future of spinal cord research while living your life to the fullest today.
Following this advice may reduce your risk of a spinal cord injury:
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