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Your Spinal Cord Injury:
The Medical Facts

 

David L. Goldin, J.D., M.B.A.

 

© 2005-2016

 

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Spinal cord injury disconnects the brain from the body below the injury site. Almost everybody knows that spinal cord injury causes paralysis, but many are not aware that the spinal cord also controls the bladder and bowel, sexual function, blood pressure, skin blood flow, sweating, and temperature regulation. Together, the brain and spinal cord make up the central nervous system. The spinal cord itself is the largest bundle of nerves in the body carrying nerve impulses, both motor and sensory, to and from the brain to the rest of the body.

Approximately 450,000 people live with spinal cord injury (SCI) in the United States. There are about 10,000 to 11,000 new SCI￿s each year, the great majority (82%) involving males between the ages of 16 and 30. Spinal cord injuries result from motor vehicle accidents (36%), violence (29%), and falls (21%). Quadriplegia is slightly more common than paraplegia.

The spinal cord is about 18 inches in length extending from the base of the brain down the middle of the back to the area of the waist. The spinal cord sits within the spinal column (back bones or vertebrae) and is divided into cervical, thoracic and lumbar regions. There are eight vertebrae in the neck, C-1 to C-7; 12 vertebrae in the chest, T-1 to T-12; five vertebrae in the lower back, L-1 to L-5; and the sacral vertebrae, S-1 to S-5, fused to make up the sacrum, running from the pelvis to the end of the spinal column. Here is a picture of the spinal column.

In most spinal cord injuries, vertebrae come into contact with the spinal cord causing it to become bruised or swollen. The damage begins at the moment of injury when displaced bone fragments, disc material or ligaments bruise or tear the spinal cord tissue. Like brain injuries, continued deterioration or tissue damage may occur in the hours and days immediately following a SCI as a result of chemical and cellular responses that contribute to further tissue damage, including inflammation, free radicals and swelling. A ￿complete￿ injury means there is no function below the level of the injury; no sensation and no voluntary movement. Both sides of the body are equally affected. An ￿incomplete￿ injury means there is some functioning below the primary level of the injury. 

Emergency management of an acute SCI requires the patient to receive high intravenous doses of a steroid (methylprednisone) within eight hours of the injury. If the spinal cord is compressed by bone or disc, every effort should be made to decompress the cord as soon as possible. This may be recommended by your physician, even for incomplete spinal cord injuries.

The level of the injury is most helpful in predicting what parts of the body might be affected by paralysis and loss of function, remembering that with incomplete injuries there will be some variation in these prognoses. The Spinal Cord Injury Information Network provides a useful table describing the level of the injury, liabilities and functional goals. See table at "Spinal Cord Injury Information Network." The table describes the realistic expectation of activities the person with SCI eventually should be able to do with this level of injury.

In addition to the limitation of abilities caused by a spinal cord injury, there are various potential medical complications accompanying this terrible injury. These include abnormal sensations and neuropathic pain, spasticity and spasms, atrophy, bladder paralysis, bowel constipation and incontinence, bed sores, difficulty maintaining body temperature causing abnormal sweating patterns, lowered blood pressure (hypotension), along with an increased susceptibility to respiratory and heart problems which may be life threatening.

Success and recovery depends on how well these chronic conditions and complications are handled on a day-to-day basis. Neuro-circuits in the spinal cord may turn off when they are not being used. Effective rehabilitation is essential to achieve the best recovery. This is the topic of my article which follows: ￿Your Spinal Cord Injury: Hope and Recovery.￿

 

 

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