Description

A spinal cord injury (SCI) is damage to the tight bundle of cells and nerves that sends and receives signals from the brain to and from the rest of the body. SCI can be caused by direct injury to the spinal cord itself or from damage to the tissue and bones (vertebrae) that surround the spinal cord. This damage can result in temporary or permanent changes in sensation, movement, strength, and body functions below the site of injury. Some injuries that cause little or no cell death may allow for an almost complete recovery while those that occur higher on the spinal cord and are more serious can cause paralysis in most of the body.  Motor vehicle accidents and catastrophic falls are the most common causes of SCI in the United States.

An incomplete injury means the spinal cord is still able to trasnmit some messages to and from the brain to the rest of the body.  A complete injury means there is no nerve communication and motor function (voluntary movement) below the site where the trauma occurred.

A spinal cord injury can cause one or more symptoms including:

  • Numbness, tingling, or a loss of or changes in sensation in the hands and feet.
  • Paralysis that may happen immediately or develop over time as swelling and bleeding affects the spinal cord.
  • Pain or pressure in head, neck, or back.
  • Loss of movement.
  • Weakness or inability to move any part of the body.
  • Unnatural positions of the spine or head.
  • Loss of bladder and bowel control.
  • Problems walking.
  • Difficulty breathing.
  • Changes in sexual function.

Treatment

Immediate treatment at the accident scene includes putting the person on a backboard with a special collar around the neck to prevent further damage to the spinal cord.  Treatment at a trauma center may include realigning the spine and surgery to remove any bone fragments or other objects that might press on the spinal column. Rehabilitative care may include breathing assistance using a machine that produces forced air, treatment for any respiratory or circulatory problems, pain medications, and learning new ways to address bladder and bowel problems.  A rehabilitation team will assess the individual's needs and create a rehabilitation program that combines plysical and other therapies with skill-building activities, training, and counseling to aid recovery and provide social and emotional support, as well as to increase independence and quality of life.

Prognosis

Retention of movement depends on the type of injury and where it occurs along the spine.  Loss of nerve function occurs below the level of injury.   An injury higher on the spinal cord can cause paralysis in most of the body and affect all limbs (called tetraplegia or quadriplegia).  A lower injury to the spinal cord may cause paralysis affecting the legs and lower body (called paraplegia).  People who survive a spinal cord injury will most likely have medical complications such as chronic pain and bladder and bowel dysfunction, along with an increased susceptibility to respiratory and heart problems. Successful recovery depends upon how well these chronic conditions are handled day to day.

Research

Scientists at the National Institute of Neurological Disorders and Stroke (NINDS) and those at other institutes at the National Institutes of Health (NIH) conduct and fund research to better understand SCI and how to treat it.   Current research on SCI focuses on advancing our understanding of four key principles of spinal cord repair: Neuroprotection—preventing cell death and protecting surviving nerve cells from further damage, such as drugs to reduce nerve cell death and controlled lowering of the body’s core temperature to reduce cell and blood vessel damage and improve functional outcome. Repair and regeneration—encouraging the spinal cord’s intrinsic ability to self-repair and stimulating the regrowth of nerve cell projections (axons) and targeting their connections appropriately, including cell transplants, natural growth-promoting substances, and bioengineered growth scaffolds that allow axons to bridge across the injury site and rebuild neural circuits. Cell-based therapies—replacing damaged nerve or support cells with other cell types, including stem cells, to regenerate neuronal growth and create new cell connections. Retraining central nervous system circuits to restore body functions and form new nerve connections and pathways following injury or cell death (called neuroplasticity) through techniques including rehabilitation, electrical stimulation, robot-assisted training, and brain-computer interface technology that may help with voluntary muscle movement and coordination. Basic spinal cord function research studies how the normal spinal cord develops, processes sensory information, controls movement, and generates rhythmic patterns (like walking and breathing). Research on injury mechanisms focuses on what causes immediate harm and on the cascade of helpful and harmful bodily reactions that protect from or contribute to damage in the hours and days following a spinal cord injury.  Neural engineering strategies also offer ways to restore communication and independence.   Information from the National Library of Medicine’s MedlinePlus Spinal Cord Injuries