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Spinal Cord Injury
MayoClinic.com
Definition
In 1995, actor Christopher Reeve fell off
a horse and severely damaged his spinal cord, leaving him paralyzed from the
neck down. From then until his death in 2004, the silver screen Superman became
the most famous face of spinal cord injury.
Most spinal cord injury causes permanent
disability or loss of movement (paralysis) and sensation below the site of the
injury. Paralysis that involves the majority of the body, including the arms and
legs, is called quadriplegia or tetraplegia. When a spinal cord injury affects
only the lower body, the condition is called paraplegia.
Christopher Reeve's celebrity and advocacy
raised national interest, awareness and research funding for spinal cord injury.
Many scientists are optimistic that important advances will occur to make the
repair of injured spinal cords a reachable goal. In the meantime, treatments and
rehabilitation allow many people with spinal cord injury to lead productive,
independent lives.
Symptoms
Spinal cord injury symptoms depend on two
factors:
 | The
location of the injury.
In general, injuries
that are higher in your spinal cord produce more paralysis. For example, a
spinal cord injury at the neck level may cause paralysis in both arms and legs
and make it impossible to breathe without a respirator, while a lower injury
may affect only your legs and lower parts of your body. |
| The
severity of the injury. Spinal cord injuries
are classified as partial or complete, depending on how much of the cord width
is damaged. In a
partial spinal cord injury, which may also be called an incomplete
injury, the spinal cord is able to convey some messages to or from your brain.
So people with partial spinal cord injury retain some sensation and possibly
some motor function below the affected area.
A complete spinal cord injury
is defined by total or near-total loss of motor function and sensation below
the area of injury. However, even in a complete injury, the spinal cord is
almost never completely cut in half. Doctors use the term "complete" to
describe a large amount of damage to the spinal cord. It's a key distinction
because many people with partial spinal cord injuries are able to experience
significant recovery, while those with complete injuries are not. |
Spinal cord injuries of any kind may
result in one or more of the following signs and symptoms:
| Pain or an intense stinging sensation
caused by damage to the nerve fibers in your spinal cord |
| Loss of movement |
| Loss of sensation, including the
ability to feel heat, cold and touch |
| Loss of bowel or bladder control
|
| Exaggerated reflex activities or spasms
|
| Changes in sexual function, sexual
sensitivity and fertility |
| Difficulty breathing, coughing or
clearing secretions from your lungs |
Causes
Your brain and central
nervous system
Together, your spinal cord and your brain make up your central nervous system,
which controls most of the functions of your body. Your spinal cord runs
approximately 15 to 17 inches from the base of your brain to your waist and is
composed of long nerve fibers that carry messages to and from your brain.
These nerve fibers feed into nerve roots
that emerge between your vertebrae — the 33 bones that surround your spinal cord
and make up your backbone. There, the nerve fibers organize into peripheral
nerves that extend to the rest of your body.
Injury may be traumatic or
nontraumatic
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 may also 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.
Nontraumatic spinal cord injury may be
caused by arthritis, cancer, blood vessel problems or bleeding, inflammation or
infections, or disk degeneration of the spine.
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. Spinal injuries occur
most frequently in the neck (cervical) and lower back (thoracic and lumbar)
areas. A thoracic or lumbar injury can affect leg, bowel and bladder control,
and sexual function. A cervical injury may affect breathing as well as movements
of your upper and lower limbs.
The spinal cord ends at the lower border
of the first vertebra in your lower back — known as a lumbar vertebra. So
injuries below this vertebra actually don't involve the spinal cord. However, an
injury to this part of your back or pelvis may damage nerve roots in the area
and may cause some loss of function in the legs, as well as difficulty with
bowel and bladder control and sexual function.
Common causes of spinal cord
injury
The most common causes of spinal cord injury in the United States are:
| Motor
vehicle accidents. Auto and motorcycle
accidents are the leading cause of spinal cord injuries, accounting for almost
50 percent of new spinal cord injuries each year. |
| Acts
of violence. About 15 percent of spinal cord
injuries result from violent encounters, often involving gunshot and knife
wounds. |
|
Falls. Spinal cord injury after age 65 is most
often caused by a fall. Overall, falls make up approximately 22 percent of
spinal cord injuries. |
|
Sports and recreation injuries. Athletic
activities such as impact sports and diving in shallow water cause about 8
percent of spinal cord injuries. |
|
Diseases. Cancer, infections, arthritis and
inflammation of the spinal cord also cause spinal cord injuries each year. |
Risk factors
Although a spinal cord injury is usually
the result of an unexpected accident that can happen to anyone, some groups of
people have a higher risk of sustaining a spinal cord injury. These include:
| Men.
Spinal cord injury affects a disproportionate amount of men. In fact, women
account for only about 20 percent of spinal cord injuries in the United
States. |
| Young
adults and seniors. People are most often
injured between ages 16 and 30. But there is another peak in people older than
60. Motor vehicle crashes are the leading cause of spinal cord injury for
young people, while falls cause most injuries in older adults. However, in
some cities, acts of violence — such as gunshot wounds, stabbings and assaults
— are a major cause of spinal cord injury. |
|
People who are active in sports. Sports and
recreational activities cause 8 percent of the 11,000 spinal cord injuries in
the United States each year, although sports-related spinal cord injury is
becoming less common. High-risk athletic activities include football, rugby,
wrestling, gymnastics, diving, surfing, ice hockey and downhill skiing.
|
|
People with predisposing conditions. A
relatively minor injury can cause spinal cord injury in people with conditions
that affect their bones or joints, such as arthritis or osteoporosis. |
Complications
If you recently experienced a spinal cord
injury, it might seem like every aspect of life just became a lot more
complicated. After all, adapting to life with a disability — often in a
wheelchair — is no easy task.
You'll likely experience many thoughts and
emotions after the injury. And you'll likely have concerns about how your injury
will affect your lifestyle, your financial situation and your personal
relationships. Grieving and emotional stress are normal and common. However, if
your grief and sadness are affecting your personal care, causing you to isolate
yourself from others, or prompting you to abuse alcohol or other drugs, it's
time to seek help. People with spinal cord injury are at increased risk of
suicide, especially in the first 10 years following the injury.
Other complications of a spinal cord
injury may include:
|
Urinary tract problems. A spinal cord injury
that affects nerves that run to your bladder can cause urinary incontinence —
the inability to control the release of urine from your bladder. Loss of
bladder control increases your risk of urinary tract infections. It may also
cause kidney infection and kidney or bladder stones. Drinking plenty of clear
fluids and using a catheter — a thin, soft tube that you insert into your
urethra and bladder to drain your urine — several times a day may help.
|
| Bowel
management difficulties. After a spinal cord
injury, voluntary control of your bowels may be lost or impaired. This can
make it difficult for stool to move through your intestines, or it can result
in fecal incontinence — the inability to control your bowel movements. Eating
a high-fiber diet can help regulate your bowels. Medications and other
products are also available to manage waste elimination. |
|
Pressure sores. Sitting or lying in the same
position for a long period of time can cause pressure sores, which are also
called decubitus ulcers or bedsores. People with a spinal cord injury are
particularly susceptible to pressure sores because the injury reduces or
eliminates sensations, making it difficult to know when a sore is developing.
Changing positions frequently — with help, if needed — is the best way to
prevent these sores. |
| Deep
vein thrombosis and pulmonary embolism. Sitting
for long periods of time can decrease blood flow through your veins and cause
blood clots to form. These blood clots can develop in a vein deep within a
muscle (deep vein thrombosis), and they can lead to a blocked pulmonary artery
in your lungs (pulmonary embolism). Large clots that block blood flow can be
fatal, so people with spinal cord injury may need devices or medications to
try to prevent clotting. |
| Lung
and breathing problems. It's more difficult to
breathe and cough with weakened abdominal and chest muscles, so people with
cervical and thoracic spinal cord injury may develop pneumonia or other lung
problems. Medications and therapy can treat these problems. In some instances,
people with spinal cord injury may also need a yearly flu shot or other
immunizations. |
|
Autonomic dysreflexia. Spinal cord injury above
the middle of your chest may cause a condition called autonomic dysreflexia.
This dangerous condition occurs when an irritation or pain below the level of
the injury sends a signal that fails to reach your brain, producing a reflex
action that can constrict blood vessels. The result is a rise in blood
pressure and a drop in heart rate that can result in stroke or seizure.
Changing positions or eliminating the cause of the irritation — which can be
something as simple as a full bladder or tight clothes — can help.
|
|
Spasticity. Some people with spinal cord injury
develop muscle spasms and jumping of their arms and legs. Unfortunately, this
doesn't mean that they're recovering. These exaggerated reflexes occur because
some of the nerves in the lower spinal cord become more sensitive after injury
and cause muscle contractions. However, because of the spinal cord injury, the
brain can no longer send signals to the lower nerves to regulate the
contractions. Medical treatments may be needed if spasms become severe.
|
|
Weight control issues. After a spinal cord
injury, weight loss and muscle atrophy are common. But the change in lifestyle
and activities may eventually cause weight gain, which can make it difficult
for you to lift yourself — or be lifted — from place to place and put you at
risk of heart disease and other problems. It's a good idea to develop an
exercise and diet plan with assistance from a dietitian and rehabilitation
therapist. |
|
Sexual dysfunction. Many men with a spinal cord
injury still have erections, even men with little sensation in the genital
area. But the erections may not be firm enough or last long enough for sexual
activity. Fertility also can be affected. Ninety percent of men with a spinal
cord injury aren't able to ejaculate during intercourse. However, this doesn't
mean that men with a spinal cord injury can't be sexually active or father a
child. Doctors, urologists and fertility specialists who specialize in spinal
cord injury can offer options for better sexual functioning and fertility.
Women with a spinal cord injury also may
benefit from seeing a doctor about changes in their sexuality and fertility.
There's usually no physical change in women with a spinal cord injury that
inhibits sexual intercourse or pregnancy. But women may lose the ability to
produce vaginal lubrication or experience orgasm, and many experience changes
in body image that affect sexuality. In addition, any pregnancy will likely be
considered high risk. It's important to talk with a doctor before becoming
pregnant. |
| Pain.
You may experience pain as a result of damage to your spinal cord or other
parts of your body during your accident. It's possible to feel pain in areas
of your body where there's little or no sensation. You may also experience
pain from overusing muscles in one part of your body. For example, many people
develop shoulder tendinitis from manually operating a wheelchair for a long
period of time. Any kind of pain can have a negative impact on daily living.
Medications and modified activities can help manage pain. |
| New
injuries. Having a spinal cord injury makes you
susceptible to injury of any part of your body that has impaired sensation.
You may even receive a burn or cut without realizing it. Take steps to prevent
new injuries and to inspect your body for any cuts or sores that need medical
attention. |
Coping and support
An accident that results in paralysis is a
life-changing event. The sudden presence of disability can be frightening and
confusing. You may wonder how 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. The will to live in humans is amazingly strong, and the creativity with
which many affected people lead their lives is great. It's essential to stay
motivated and get the support you need.
Grieving
If you're newly injured, you and your family will likely experience a period of
mourning and grief that's similar to the period after the death of a loved one.
Although the grieving process is different for everyone, it's common to
experience denial or disbelief, then 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.
Taking control
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 wide 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 assert your autonomy.
Because the costs of a spinal cord injury
can be overwhelming, you may want to find out if you are 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 unfazed by your injury. Others may be uncomfortable and unsure if they
are saying or doing the right thing. And some may have a difficult time
adjusting to the change. They may grieve for the loss of the way your life was
before the accident. They may be scared about the financial challenges and
stress that are sure to arise. Or they may be nervous about their new role as
caregiver.
Educating people about your disability is
often the best solution. 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
Many men and women with a spinal cord injury wonder if they can maintain a
romantic, intimate relationship with a partner. The answer is yes.
However, people with a spinal cord injury
often need to address physical and emotional changes that can affect sexuality.
You may need medical treatments or medications to have sexual intercourse. In
some cases, intercourse may not be possible and you and your partner may need to
explore and experiment with different ways to be romantic and intimate. A
professional counselor can help you and your partner communicate your needs and
feelings so that you're more comfortable talking about sex and discovering what
is fulfilling for both of you.
Taking care of yourself
As you adjust to your disability, allow yourself time to rest and time to
process your thoughts and feelings about your disability. This is also a good
time to concentrate on eating a healthy diet and reducing stress.
Good nutrition will help you build enough
strength to fully participate in daily activities. A balanced diet will also
help you fight infections and maintain proper body weight. Plus, it will help
maintain regular bladder and bowel functioning and assist in preventing pressure
ulcers.
Looking ahead
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 at
all of the things 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, 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 a
spinal cord injury. Several experimental treatments are being tested around the
world. At the same time, new medications are being developed for people with
long-standing spinal cord injuries. No one knows exactly when new treatments
will become available, but you can remain hopeful about the future of spinal
cord research, while living your life to the fullest today.
MayoClinic.com
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