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Spinal cord injury (SCI)

Signs and symptoms

The signs and symptoms of a spinal cord injury depend on two factors:

• The location of the injury. In general, injuries that are higher in the 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 the legs and lower parts of the 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. With a partial spinal cord injury, the spinal cord is able to convey some messages to or from the brain. So people with partial spinal cord injury retain some sensation and possibly some motor function below the affected area. A complete injury is defined by complete 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.

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 the 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 the lungs

Emergency signs and symptoms of spinal cord injury after a head injury or accident may include:

•  Fading in and out of consciousness

•  Extreme back pain or pressure in the neck, head or back

•  Weakness, incoordination or paralysis in any part of the body

• Numbness, tingling or loss of sensation in the hands, fingers, feet or toes

•  Loss of bladder or bowel control

• Difficulty with balance and walking

• Impaired breathing after injury

• An oddly positioned or twisted neck or back

• back pain

Causes

Together, your spinal cord and your brain make up your central nervous system, which controls most of the functions of your body. The 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.

A 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 may occur over days or weeks because of bleeding, swelling, inflammation and fluid accumulation in and around your spinal cord.

This trauma and 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 most common causes of spinal cord injury are:

• Motor vehicle accidents. Auto and motorcycle accidents are the leading cause of spinal cord injuries, accounting for approximately 40 percent of new spinal cord injuries each year.

• Acts of violence. About a quarter of spinal cord injuries result from violent encounters, often involving guns and knifes.

• Falls. Spinal cord injury after age 65 is often caused by a fall. Overall, falls make up 22 percent of spinal cord injuries.

• Sports and recreation injuries. Athletic activities such as impact sports and diving in shallow water cause up to 10 percent of spinal cord injuries.

• Diseases. Cancer, infections, arthritis and inflammation of the spinal cord also cause spinal cord injuries each year. The exact number isn't known.

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 18 percent of spinal cord injuries.

• Young adults and seniors. More than half the people living with a spinal cord injury were injured between the ages of 16 and 30. However, research shows an increase in the number of people who are at least 61 years old at the time of injury. Motor vehicle crashes are the leading cause of spinal cord injury for people under age 65, while falls cause most injuries in older adults.

• People who are active in sports. 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.

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