What is a SCI

The Electronic Directory for People with Spinal Cord Injury

"Because no one should cope with a Spinal Cord Injury (SCI) alone"

What is a Spinal cord

The spinal cord is the body's superhighway via which all forms of information moves between the human nervous system (peripheral) and the human brain. A spinal boney column constructed of small bones -- vertebrae -- shields the sensitive spinal cord. In men, the spinal cord extends up to 45 cm while it stretches till 43 cm in women.

What is Spinal Cord Injury

Spinal Cord Injury (SCI) is damage to the spinal cord that results in a loss of function such as mobility and/or feeling. In order for the loss of function to occur, the spinal cord does not have to be completely severed. In most individuals with SCI, the spinal cord is intact, but it's the damage to it that results in the loss of functioning.

The most common causes of damage to the spinal cord are:

	Trauma such as automobile accidents, falls, gunshots, diving accidents, war injuries, etc.
	Tumor such as meningiomas, ependymomas, astrocytomas, and metastatic cancer.
	Ischemia resulting from occlusion of spinal blood vessels, including dissecting aortic aneurisms, emboli, arteriosclerosis.
	Developmental disorders, such as spina bifida, meningomyolcoele, and other.
	Neurodegenerative diseases, such as Friedreich's ataxia, spinocerebellar ataxia, etc.
	Demyelinative diseases, such as Multiple Sclerosis.
	Transverse myelitis, resulting from spinal cord stroke, inflammation, or other causes.
	Vascular malformations, such as arteriovenous malformation (AVM), dural arteriovenous fistula (AVF), spinal hemangioma, cavernous angioma and aneurysm.

Traumatic spinal cord injury is classified into five types by the American Spinal Injury Association (ASIA) and the International Spinal Cord Injury Classification System.

	A indicates a "complete" spinal cord injury where no motor or sensory function is preserved in the sacral segments S4-S5. A complete injury is one in which there is some neurological level below which there is no motor or sensory function. Since the S4-S5 segment is the lower segmental, absence of motor and sensory function indicates "complete" spinal cord injury.
	B indicates an "incomplete" spinal cord injury where sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5. This is typically a transient phase and if the person recovers any motor function below the neurological level, that person essentially becomes a motor incomplete, i.e. ASIA C or D.
	C indicates an "incomplete" spinal cord injury where motor function is preserved below the neurological level and more than half of key muscles below the neurological level have a muscle grade of less than 3.
	D indicates an "incomplete" spinal cord injury where motor function is preserved below the neurological level and at least half of the key muscles below the neurological level have a muscle grade of 3 or more.
	E indicates "normal" where motor and sensory scores are normal. Note that it is possible to have spinal cord injury and neurological deficit with completely normal motor and sensory scores.

The Effects of Spinal Cord Injury

The exact effects of a spinal cord injury vary according to the type and level injury, and can be organized into two types:

In a complete injury, there is no function below the "neurological" level, defined as the lowest level that has intact neurological function. If a person has some level below which there is no motor and sensory function, the injury is said to be "complete". Recent evidence suggest that less than 5% of people with "complete" spinal cord injury recover locomotion.

A person with an incomplete injury retains some sensation or movement below the level of the injury. The lowest spinal cord level is S4-5, representing the anal sphincter and peri-anal sensation. So, if a person is able to contract the anal sphincter voluntarily or is able to feel peri-anal pinprick or touch, the injury is said to be "incomplete". Recent evidence suggest that over 95% of people with "incomplete" spinal cord injury recover some locomotory ability.

In addition to a loss of sensation and motor function below the point of injury, individuals with spinal cord injuries will often experience other complications of spinal cord injury:

	Bowel and bladder function is regulated by the sacral region of the spine, so it is very common to experience dysfunction of the bowel and bladder, including infections of the bladder, and anal incontinence.
	Sexual function is also associated with the sacral region, and is often affected.
	Injuries of the C-1, C-2 will often result in a loss of breathing, necessitating mechanical ventilators or phrenic nerve pacing.
	Inability or reduced ability to regulate heart rate, blood pressure), sweating and hence body temperature.
	Spasticity (increased reflexes and stiffness of the limbs).
	Neuropathic pain.
	Autonomic dysreflexia or abnormal increases in blood pressure, sweating, and other autonomic responses to pain or sensory disturbances.
	Atrophy of muscle.
	Osteoporosis (loss of calcium) and bone degeneration.
	Gallbladder and renal stones.

The Location of the Injury

Knowing the exact level of the injury on the spinal cord is important when predicting what parts of the body might be affected by paralysis and loss of function.

Below is a list of typical effects of spinal cord injury by location. Please keep in mind that while the prognosis of complete injuries are predictable, incomplete injuries are very variable and may differ from the descriptions below.

Cervical (neck) injuries usually result in full or partial tetraplegia. Depending on the exact location of the injury, one with a spinal cord injury at the cervical level may retain some amount of function as detailed below, but are otherwise completely paralyzed.

	C3 vertebrae and above : Typically lose diaphragm function and require a ventilator to breathe.
	C4 : May have some use of biceps and shoulders, but weaker
	C5 : May retain the use of shoulders and biceps, but not of the wrists or hands.
	C6 : Generally retain some wrist control, but no hand function.
	C7 and T1 : Can usually straighten their arms but still may have dexterity problems with the hand and fingers. C7 is generally the level for functional independence.

Thoracic injuries

Injuries at the thoracic level and below result in paraplegia. The hands, arms, head, and breathing are usually not affected.

	T1 to T8 : Most often have control of the hands, but lack control of the abdominal muscles so control of the trunk is difficult or impossible. Effects are less severe the lower the injury.
	T9 to T12 : Allows good trunk and abdominal muscle control, and sitting balance is very good.

Lumbar and Sacral injuries

The effect of injuries to the lumbar or sacral region of the spinal canal are decreased control of the legs and hips, urinary system, and anus.

The exact effects of a spinal cord injury vary according to the type and level injury, and can be organized into two types:

In addition to a loss of sensation and motor function below the point of injury, individuals with spinal cord injuries will often experience other complications of spinal cord injury:

	Bowel and bladder function is regulated by the sacral region of the spine, so it is very common to experience dysfunction of the bowel and bladder, including infections of the bladder, and anal incontinence.
	Sexual function is also associated with the sacral region, and is often affected.
	Injuries of the C-1, C-2 will often result in a loss of breathing, necessitating mechanical ventilators or phrenic nerve pacing.
	Inability or reduced ability to regulate heart rate, blood pressure), sweating and hence body temperature.
	Spasticity (increased reflexes and stiffness of the limbs).
	Neuropathic pain.
	Autonomic dysreflexia or abnormal increases in blood pressure, sweating, and other autonomic responses to pain or sensory disturbances.
	Atrophy of muscle.
	Osteoporosis (loss of calcium) and bone degeneration.
	Gallbladder and renal stones.
	Pressure sores from sitting in one position for too long without a correct pressure cushion

Treatment

Treatment for acute traumatic spinal cord injuries have consisted of giving high dose methylprednisolone if the injury occurred within 8 hours. The recommendation is primarily based on the National Acute Spinal Cord Injury Studies (NASCIS) II and III. Some of the claims of the studies have been challenged as being from faulty interpretation of the data.

Breakthrough medical research shows stem cell transplants could have the potential to help or cure paralysis caused by spinal injury. Stem cells are primal cells found in all multi-cellular organisms. They can be made to differentiate into a range of specialized cells including nerve cells, which can be transplanted into the body.

Cure

Currently there is no cure for SCI. There are many researchers attacking this problem, and there have been many advances in the lab. Many of the most exciting advances have resulted in a decrease in damage at the time of the injury. Steroid drugs such as methylprednisolone reduce swelling, which is a common cause of secondary damage at the time of injury. The experimental drug Sygen®appears to reduce loss of function, although the mechanism is not completely understood.

Amount of people with SCI

Approximately 450,000 people live with SCI in the US. There are about 8,000 new SCIs every year; the majority of them (82%) involve males between the ages of 16-30. These injuries result from motor vehicle accidents (42%), violence (24%), or falls (22%). Quadriplegia is slightly more common than paraplegia. Source

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This web site was designed and is maintained by Silas S. Slade