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Spinal cord injury:- What is a spinal cord injury? A spinal cord injury (SCI) is damage to the spinal cord—the bundle of nerves and nerve fibers that sends and receives signals from the brain. The spinal cord extends from the lower part of the brain down through the lower back. Direct injury to the spinal cord itself or damage to the tissue and bones (vertebrae) that surround the spinal cord can cause an SCI. This damage can cause temporary or permanent changes in feeling, movement, strength, and body functions below the point where the injury happens. Spinal cord injury symptoms The symptoms of spinal cord injuries depend on the part of the spinal cord that is damaged and how much damage there is. SCIs to upper parts of the spinal cord affect more of the body than injuries lower down. An injury to the upper part of the spinal cord can cause paralysis in most of the body and affect all limbs (tetraplegia or quadriplegia). An injury that happens lower down the spinal cord may only affect a person’s lower body and legs (paraplegia). Paralysis can happen immediately upon injury (primary damage) or develop over time from bleeding and swelling in the spinal cord and cell death (secondary damage). An SCI can damage a few, many, or almost all of the nerve fibers that cross the site of injury. If the injury causes little or no nerve cell death, a person can make an almost complete recovery. An SCI can cause one or more symptoms, including: Numbness, tingling, or a loss of (or changes in) sensation in hands and feet Paralysis (loss of movement) Pain or pressure in the head, neck, or back Weakness in any part of the body Unnatural or uncomfortable positions of the spine or head Loss of bladder and bowel control Problems with walking Difficulty breathing Changes in sexual function What causes an acute SCI? Many things can cause SCI. The more common injuries occur when the area of the spine or neck is bent or compressed, as in the following: Falls Motor vehicle accidents, such as cars, motorcycles, and being struck when walking Sports injuries Diving accidents Trampoline accidents Violence, such as gunshot or stab wounds Infections that form a collection of pus (abscess) on the spinal cord Birth injuries. These typically affect the spinal cord in the neck area. Who is at risk for acute SCI? Some people are at higher risk for SCI than others. Those at higher risk are people ages 16 to 30 or older than age 65. tThe majority of people who suffer SCIs are male. Non-Hispanic whites are at higher risk for SCI than any other ethnic group. Types of spinal cord injury An SCI can be either complete or incomplete: An incomplete injury means the spinal cord is still able to send some messages to or from the brain. People still have some feeling, function, and muscle control below the site of their injury. A complete injury means that there is no nerve communication below the injury site. People lose muscle control, feeling, or function below the injury. Anatomy of the spinal cord The spinal cord is a soft, cylindrical column of tightly bundled cells (nerve cells and glia), nerve fibers that transmit nerve signals (called axons), and blood vessels. It sends and receives information between the brain and the rest of the body. Millions of nerve cells in the spinal cord coordinate complex patterns of movements, such as rhythmic breathing and walking. The spinal cord extends from the brain to the lower back through a canal in the center of the vertebrae. Like the brain, the spinal cord has three layers of tissue for protection—and cerebrospinal fluid (CSF) surrounds it to act as a cushion against shock or injury. Other types of nerve cells sit just outside the spinal cord and send information to and from the brain. Doctors refer to these nerve cells based on their location: Cervical spinal nerves (known as C1 to C7) in the neck control signals to the back of the head, the neck and shoulders, the arms and hands, and the diaphragm. Thoracic spinal nerves (known as T1 to T12) in the upper mid-back control signals to the chest muscles, some muscles of the back, and many organ systems. Lumbar spinal nerves (known as L1 to L5) in the lower mid-back control signals to the lower parts of the abdomen and the back, the buttocks, some parts of the external genital organs, and parts of the legs. Sacral spinal nerves (known as S1 to S5) in the lower back control signals to the thighs and lower parts of the legs, the feet, most of the external genital organs, and the area around the anus. Who is more likely to get a spinal cord injury? Motor vehicle accidents and serious falls are the most common causes of SCI in the U.S. Other causes include: Acts of violence (mostly gunshot wounds and assaults) Sports injuries Medical or surgical injuries Industrial or workplace accidents Diseases Conditions that can damage the spinal cord Risk factors for an SCI include age (either being between ages 16 and 30, or after age 65 for dangerous falls), alcohol use, or not wearing proper gear—such as a seat belt or protective sports equipment. What are the symptoms of an acute SCI? Symptoms of an acute SCI can vary widely. The location of the injury on the spinal cord determines what part of the body is affected. And how bad the symptoms are. Your spine may be in shock right after a spinal cord injury. This causes loss or decrease in feeling, muscle movement, and reflexes. It will be easier for your healthcare provider to find out the extent of injuries as swelling eases. Generally, the higher up the level of the injury is to the spinal cord, the more severe the symptoms. For example, an injury to the neck, the first and second vertebrae in the spinal column (C1, C2), or the midcervical vertebrae (C3, C4, and C5) affects the respiratory muscles and the ability to breathe. A lower injury, in the lumbar vertebrae, may affect nerve and muscle control to the bladder, bowel, and legs, and sexual function. Quadriplegia is loss of function in both arms and both legs. Paraplegia is loss of function in the legs and lower body. The extent of the damage to the spinal cord determines whether the injury is complete or incomplete. A complete injury means that there is no movement or feeling below the level of the injury. An incomplete injury means that there is still some degree of feeling or movement below the level of the injury. These are the most common symptoms of acute spinal cord injuries: Muscle weakness Loss of voluntary muscle movement in the chest, arms, or legs Breathing problems Loss of feeling in the chest, arms, or legs Loss of bowel and bladder function The symptoms of SCI may look like other health conditions or problems. How are acute SCIs diagnosed? Acute SCI is a medical emergency. Emergency evaluation is needed anytime there is a suspected injury to the spinal cord. The effects of an SCI may not be clear at first. A full health evaluation and tests are needed. During the exam, the healthcare provider will ask about your health history and how the injury occurred. A spinal cord injury can cause ongoing nerve problems. These will need more medical follow-up. Sometimes, surgery is needed to stabilize the spinal cord after acute SCI. Diagnostic tests may include: Blood tests X-ray. This test uses invisible electromagnetic energy beams to make images of internal tissues, bones, and organs onto film. CT scan. An imaging test that uses X-rays and computer technology to make detailed images of the body. A CT scan shows images of any part of the body. This includes the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays. MRI scan. This test uses large magnets, radio waves, and a computer to make detailed images of organs and structures within the body. This is done without using X-rays. Treating spinal cord injuries At an accident scene, if SCI is suspected, emergency personnel will place a rigid collar around the neck and carefully place the person on a backboard to prevent further damage to the spinal cord. They may use sedatives to relax the person and prevent movement. Emergency responders may also insert a breathing tube if there are problems breathing and the body isn't receiving enough oxygen from the lungs. Doctors are now able to predict with reasonable accuracy the likely long-term outcome of an SCI. This helps people experiencing spinal cord injuries to set achievable goals for themselves and gives families and loved ones a realistic set of expectations for the future. Immediate treatment at the trauma center or emergency room may include: Realigning the spine using a rigid brace or mechanical force, which is usually done as soon as possible to stabilize the spine and prevent additional damage. Surgery to remove any fractured bones or other objects that are pressing on the spinal column. Spinal decompression surgery to relieve pressure within the spinal column may also be necessary in the days after injury. Results of neurosurgical studies show that, in some cases, earlier surgery is connected to better functional recovery. An SCI may result in the following problems, which require treatment: Breathing problems. About one-third of people with an SCI will need temporary or permanent help with breathing and may require a breathing tube. Any injury to the spinal cord between the C1-C4 segments can stop breathing as the nerves in this region cause the diaphragm to move and the lungs to expand. People with an SCI may need special training with breathing and swallowing. Their caregivers may need training as well. Pneumonia. Breathing complications are the leading cause of death in people with an SCI, commonly as a result of pneumonia. People using a ventilator to help with breathing, are at increased risk of developing pneumonia. The person will need careful monitoring and antibiotic treatment if symptoms of pneumonia appear. Ways to prevent pneumonia include clearing the throat and taking precautions to avoid food and liquids being sucked into the lungs (aspiration). Circulatory (blood flow) problems. Changes in circulation can lead to unstable blood pressure, abnormal heart rhythms (arrhythmias), and blood clots that may appear days after injury. The injured person will need careful monitoring for each of these common issues after an SCI. People with spinal cord injuries are at increased risk for blood clots because blood flow can slow or stop in the large veins in the legs. Anticoagulant drugs and compression stockings to increase blood flow in the lower legs and feet can reduce the risk for blood clots. Stiffness and changes in muscle tone. Reflexes may become exaggerated over time, causing muscle stiffness and an increase in muscle tone (spasticity) that may require special treatment. Muscles below the injury site may weaken when people don’t use them. Autonomic dysreflexia. Autonomic dysreflexia is a life-threatening reflex action that primarily affects those with injuries to the neck or upper back. Symptoms may include flushing or sweating, a pounding headache, anxiety, sudden increase in blood pressure, vision changes, or goose bumps on the arms and legs. If possible, the person needs to stay in a sitting position to keep blood flowing to the legs and feet, which helps reduce blood pressure. Pressure sores (also known as pressure ulcers). Pressure sores are areas of skin that have broken down because of continuous pressure on the skin and reduced blood flow to the area. People with paraplegia and tetraplegia are at risk for pressure sores. To prevent pressure sores, they change their position regularly, either on their own or with the help of assistive devices or a caregiver. Pain. Some people with an SCI develop neurogenic pain—an intense burning or stinging sensation. This pain may be constant or may come and go. Many things can trigger it—and some people may even feel pain in parts of the body that have otherwise lost sensation. Treatments for chronic pain include medicines, spinal or brain electrical stimulation, and surgery. But none of these treatments are completely effective at relieving neurogenic pain long term. Bladder and bowel problems. People may need to use a catheter to empty their bladder and learn new ways to empty their bowels. The person may need to change their diet. Sexual function. Depending on the severity and location of the injury, and the person’s recovery after the injury, their sexual function and fertility may be affected. A urologist and other specialists can suggest different options to support sexual functioning and health. Depression. Many people living with an SCI may develop depression due to lifestyle changes after the injury. Therapy and medicine can help treat depression and other mental health conditions. Spinal cord injury rehabilitation Rehabilitation programs for people with an SCI combine physical therapies with skill-building activities. They also have counseling designed to provide social and emotional support and increase the person’s independence and quality of life. A doctor specializing in physical medicine and rehabilitation usually leads the rehabilitation team. The team may include social workers, physical and occupational therapists, recreational therapists, rehabilitation nurses, rehabilitation psychologists, vocational counselors, nutritionists, a case worker, and other specialists. The first phase of rehabilitation after injury usually focuses on regaining communication skills and leg and arm strength. Adaptive or assistive devices may help people with an SCI to regain independence and improve mobility and quality of life. They can also help with communication skills, such as writing, typing, and using the telephone. Depending on how serious the injury is, the person may need: Braces A wheelchair Electronic stimulators Assisted training with walking Neural prosthetics (assistive devices that may stimulate the nerves to restore lost functions) Computer adaptations and other computer-assisted technology Rehabilitation for an SCI can include: Physical therapy, which are exercise programs that strengthen muscles. Occupational therapy, which helps redevelop fine motor skills. People with an SCI may need help regaining skills to perform activities for daily living—such as getting in and out of a bed, personal hygiene, eating, and using the toilet. The person may learn how to cope with spasticity, autonomic dysreflexia, and neurogenic pain as part of their occupational therapy. Vocational rehabilitation, which is identifying basic work skills and physical and cognitive capabilities that can support paid work. Through this process, the person and their team can identify potential, accessible workplaces and any assistive equipment they will need.. Educational training, which can help the person develop skills for a new line of work that may be less dependent upon a person’s physical abilities. People with an SCI are encouraged to participate in activities that provide a sense of satisfaction and self-esteem, such as educational classes, hobbies, special interest groups, and family and community events. Recreation therapy, which encourages people with an SCI to participate in sports, arts, or other leisure activities that they can do with their new level of mobility. This can help people achieve a balanced lifestyle that provides opportunities for socialization and self-expression. Living with an acute SCIs Physical therapy will likely be a very important part of your rehabilitation. In this treatment, specialists will work with you to prevent muscle wasting and shortening (contractures), and to help you retrain other muscles to aid in mobility and movement. Another type of therapy is occupational therapy. It helps you learn new ways of doing everyday tasks in spite of your new physical limitations. A traumatic event that results in a SCI is devastating to both you and your family. The healthcare team will help educate your family after your hospital stay and rehabilitation on how to help care for you at home. They will also help you understand the specific problems that need medical attention right away. You will need frequent medical evaluations and testing after your hospital stay and rehabilitation to keep track of your progress. It’s important to focus on maximizing your capabilities at home and in the community. You may feel sad or depressed after your injury. If this happens to you or a loved one, your healthcare provider may recommend that you see a mental health professional. Antidepressants and talk therapy (psychotherapy) can help treat depression. When should I call my healthcare provider? Depending on the severity of the injury, some people might recover some of their lost function, but others might continue to have long-term problems. Be sure to talk with your healthcare provider about when you would need to call them. Your healthcare provider will likely advise you to call them if any problems you are having become worse, including weakness, numbness or other changes in sensation, or changes in bladder or bowel control. People who have serious long-term effects from a spinal cord injury can also develop a number of other complications. Your healthcare provider might advise you to call them if you have problems, such as: Skin sores or infections Trouble breathing Fever, cough, or other signs of infection Severe headache Not urinating regularly or having severe diarrhea or constipation Severe muscle cramps or spasms Increasing pain Sudden blood pressure changes Key points about acute SCIs An acute spinal cord injury is caused by trauma to the spinal cord. It's a medical emergency that needs to be treated right away. The severity of symptoms (such as weakness, paralysis, and loss of feeling) depends on how badly the spinal cord is damaged and where on the cord the injury occurs. Damage to the cord in the middle of the back might affect only the legs, whereas damage to the spinal cord in the neck might also affect the arms and even the breathing muscles. Treatment might include surgery, medicine, and other treatments as needed. Some people might recover some function over time, but others might continue to have long-term problems. Physical and occupational therapy can help you adapt to new ways of doing things. What are the latest updates on spinal cord injury? Current research on spinal cord injuries focuses on advancing our understanding of the four key principles of spinal cord repair: Neuroprotection. Preventing cell death and protecting surviving nerve cells from further damage improves functional outcome. This includes using medicines to reduce nerve cell death and lower the body's core temperature. Repair and regeneration. Encouraging the spinal cord to self-repair and stimulating the regrowth of nerve fibers can help people regain function. These efforts include exploring cell transplants, growth-promoting substances, and bioengineered growth scaffolds. Cell-based therapies. Replacing damaged nerve or support cells with other cell types, including stem cells, jumpstarts nerve cell growth and creates new cell connections. Neuroplasticity. Retraining central nervous system circuits to restore body functions and form new nerve connections and pathways may help with voluntary muscle movement and coordination. These techniques happen after injury or cell death. They include rehabilitation, electrical stimulation, robot-assisted training, and brain-computer interface technology..

Key Specification Spinal cord injury

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