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Living with a Spinal Cord Injury/Disorder

What is a Spinal Cord Injury?

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Spinal cord injury occurs when there is any damage to the spinal cord that blocks communication between the brain and the body. After a spinal cord injury, a person’s sensory, motor and reflex messages are affected and may not be able to get past the damage in the spinal cord. In general, the higher on the spinal cord the injury occurs, the more dysfunction the person will experience. Injuries are referred to as complete or incomplete, based on whether any movement and sensation occurs at or below the level of injury.

The most important – and sometimes frustrating – thing to know is that each person’s recovery from spinal cord injury is different.

There are approximately 17,000 new spinal cord injuries in the United States each year. Vehicle crashes are currently the leading cause of injury, followed by falls, acts of violence (primarily gunshot wounds), and sports/recreation activities.

The Spinal Cord Nerves & Injury Levels Defined

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The spinal cord is our largest nerve and the pathway for messages traveling between the brain and the rest of the body. The spinal column is divided into four sections, from which 31 pairs of nerves emerge and extend to the various parts of the body. The top portion of the spinal column is the cervical area, which has seven cervical vertebrae (identified as C-1 through C-7) from which eight pairs of cervical nerves emerge.

 

Next is the thoracic area, which includes the chest area and has twelve thoracic vertebrae (identified as T-1 through T-12), from which 12 pairs of thoracic nerves emerge. The lower back section is the lumbar area, with five lumbar vertebrae (L-1 through L-5) and five pairs of lumbar nerves; and the bottom section the, sacral area, has five vertebrae (S-1 through S-5) and five pairs of sacral nerves.

The bones in the sacral section, however, are actually fused together into one bone. At the very tip of the column, the coccyx, there is one pair of coccygeal nerves. In most spinal cord injuries, the backbones, ligaments, or disc material pinch the cord, causing it to become bruised or swollen. Sometimes the injury may tear the spinal cord and/or its nerve fibers. An infection or a disease can result in similar damage.

 

After a spinal cord injury, all the nerves above the level of injury keep working normally. At the level of injury, messages are blocked from being transmitted from above that level to below the level of injury. Depending on the level of injury, damage to the spinal cord can result in paralysis of the muscles used for breathing; paralysis and/or loss of feeling in all or some of the trunk, arms, and legs; weakness; numbness; loss of bowel and bladder control; and numerous secondary conditions including respiratory problems, pressure sores, and sometimes fatal spikes in blood pressure.

Levels of Spinal Cord Injuries

Vertebrae are grouped into sections. The higher the injury on the spinal cord, the more dysfunction can occur.

High-Cervical Nerves (C1 – C4)

  • Most severe of the spinal cord injury levels

  • Paralysis in arms, hands, trunk and legs

  • Patient may not be able to breathe on his or her own, cough, or control bowel or bladder movements.

  • Ability to speak is sometimes impaired or reduced.

  • When all four limbs are affected, this is called tetraplegia or quadriplegia.

  • Requires complete assistance with activities of daily living, such as eating, dressing, bathing, and getting in or out of bed

  • May be able to use powered wheelchairs with special controls to move around on their own

  • Will not be able to drive a car on their own

  • Requires 24-hour-a-day personal care

Low-Cervical Nerves (C5 – C8)

  • Corresponding nerves control arms and hands.

  • A person with this level of injury may be able to breathe on their own and speak normally.

C5 Injury

  • Person can raise his or her arms and bend elbows.

  • Likely to have some or total paralysis of wrists, hands, trunk and legs

  • Can speak and use diaphragm, but breathing will be weakened

  • Will need assistance with most activities of daily living, but once in a power wheelchair, can move from one place to another independently

C6 Injury

  • Nerves affect wrist extension.

  • Paralysis in hands, trunk and legs, typically

  • Should be able to bend wrists back

  • Can speak and use diaphragm, but breathing will be weakened

  • Can move in and out of wheelchair and bed with assistive equipment

  • May also be able to drive an adapted vehicle

  • Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment

C7 Injury

  • Nerves control elbow extension and some finger extension.

  • Most can straighten their arm and have normal movement of their shoulders.

  • Can do most activities of daily living by themselves, but may need assistance with more difficult tasks

  • May also be able to drive an adapted vehicle

  • Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment

C8 Injury

  • Nerves control some hand movement.

  • Should be able to grasp and release objects

  • Can do most activities of daily living by themselves, but may need assistance with more difficult tasks

  • May also be able to drive an adapted vehicle

  • Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment

Thoracic Nerves (T1 – T5)

Thoracic vertebrae are located in the mid-back.

  • Corresponding nerves affect muscles, upper chest, mid-back and abdominal muscles.

  • Arm and hand function is usually normal.

  • Injuries usually affect the trunk and legs(also known as paraplegia).

  • Most likely use a manual wheelchair

  • Can learn to drive a modified car

  • Can stand in a standing frame, while others may walk with braces

Thoracic Nerves (T6 – T12)

  • Nerves affect muscles of the trunk (abdominal and back muscles) depending on the level of injury.

  • Usually results in paraplegia

  • Normal upper-body movement

  • Fair to good ability to control and balance trunk while in the seated position

  • Should be able to cough productively (if abdominal muscles are intact)

  • Little or no voluntary control of bowel or bladder but can manage on their own with special equipment

  • Most likely use a manual wheelchair

  • Can learn to drive a modified car

  • Some can stand in a standing frame, while others may walk with braces.

Lumbar Nerves (L1 – L5)

  • Injuries generally result in some loss of function in the hips and legs.

  • Little or no voluntary control of bowel or bladder, but can manage on their own with special equipment

  • Depending on strength in the legs, may need a wheelchair and may also walk with braces

Sacral Nerves (S1 – S5)

  • Injuries generally result in some loss of function in the hips and legs.

  • Little or no voluntary control of bowel or bladder, but can manage on their own with special equipment

  • Most likely will be able to walk

Types of Spinal Cord Injuries

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Charles Scott Sr. & Jr.

Incomplete Spinal Cord Injuries

With incomplete injuries, the cord is only partially severed, allowing the injured person to retain some function. In these cases, the degree of function depends on the extent of the injuries.

Complete Spinal Cord Injuries

By contrast, complete injuries occur when the spinal cord is fully severed, eliminating function. Though, with treatment and physical therapy, it may be possible to regain some function.

Incomplete spinal cord injuries are increasingly common, thanks in part to better treatment and increased knowledge about how to respond—and how not to respond—to a suspected spinal cord injury. These injuries now account for more than 60% of spinal cord injuries, which means we're making real progress toward better treatment and better outcomes.

Some of the most common types of incomplete or partial spinal cord injuries include:

Anterior Cord Syndrome

This type of injury, to the front of the spinal cord, damages the motor and sensory pathways in the spinal cord. You may retain some sensation, but struggle with movement.

 

Central Cord Syndrome

This injury is an injury to the center of the cord, and damages nerves that carry signals from the brain to the spinal cord. Loss of fine motor skills, paralysis of the arms, and partial impairment—usually less pronounced—in the legs are common. Some survivors also suffer a loss of bowel or bladder control, or lose the ability to sexually function.

 

Brown-Sequard Syndrome

This variety of injury is the product of damage to one side of the spinal cord. The injury may be more pronounced on one side of the body; for instance, movement may be impossible on the right side, but may be fully retained on the left. The degree to which Brown-Sequard patients are injured greatly varies from patient to patient.

Knowing the location of your injury and whether or not the injury is complete can help you begin researching your prognosis and asking your doctor intelligent questions. Doctors assign different labels to spinal cord injuries depending upon the nature of those injuries. The most common types of spinal cord injuries include:

 

Tetraplegia

These injuries, which are the result of damage to the cervical spinal cord, are typically the most severe, producing varying degrees of paralysis of all limbs. Sometimes known as quadriplegia, tetraplegia eliminates your ability to move below the site of the injury, and may produce difficulties with bladder and bowel control, respiration, and other routine functions. The higher up on the cervical spinal cord the injury is, the more severe symptoms will likely be.

 

Paraplegia

This occurs when sensation and movement are removed from the lower half of the body, including the legs. These injuries are the product of damage to the thoracic spinal cord. As with cervical spinal cord injuries, injuries are typically more severe when they are closer to the top vertebra.

 

Triplegia

Triplegia causes loss of sensation and movement in one arm and both legs, and is typically the product of an incomplete spinal cord injury.

Injuries below the lumbar spinal cord do not typically produce symptoms of paralysis or loss of sensation. They can, however, produce nerve pain, reduce function in some areas of the body, and necessitate several surgeries to regain function. Injuries to the sacral spinal cord, for instance, can interfere with bowel and bladder function, cause sexual problems, and produce weakness in the hips or legs. In vary rare cases, sacral spinal cord injury survivors suffer temporary or partial paralysis.

Spinal Cord Injury Complications

The level of injury and the type of injury (incomplete or complete), usually will determine the extent of functional loss or disability that the individual will experience. Complications are numerous and often vary from individual to individual. Complications related to spinal cord injury will most often occur in multiples (bladder, bowel, skin, movement, etc.) further creating any number of resulting complications.

Upper Extremities
The loss of use of upper extremity function can vary greatly depending on the level of injury and type of injury (complete or incomplete). The higher the level of injury, the less upper extremity function there is. The lower level (paraplegic) injury may experience no deficits at all while the tetraplegic/quadriplegic injury may suffer complete loss of use. Not being able to use arms and/or hands can create great difficulties for someone with a spinal cord injury. It may mean hiring a care provider to help with activities of daily living such as cooking, bathing, dressing, grooming, shopping and taking medications. It also precludes the use of a manual wheelchair and creates dependency for mobility on another person (wheelchair pusher) or the use of a costly powered wheelchair that is difficult to transport and due to its mechanical nature, much more prone to breakdowns and expensive repairs.

 

Lower Extremities
As in all things spinal cord injury, the higher the level of injury, the less function that will be retained. Lower extremity functions such as walking, running, climbing, are almost always impaired or completely lost after injury at any cord level. A number of complications will arise that are related to not being able to stand and/or walk. Most SCI will experience atrophy (the loss of muscle bulk) as well as osteoporosis (decrease in bone density) which will place the individual at much higher risk for breaks and fractures. The inability to stand can also increase the risk of pressure sores to areas of the body such as buttocks, lower back and thighs since weight can not be relieved on these areas as a preventative measure. Acquisition of joint contractures, a condition where joints of the leg become rigidly locked in a certain position making it difficult at times to sit in a wheelchair properly, perform transfers to and from wheelchair, chairs, and cars, or get close to objects such as tables, doorknobs, and counters.

 

Skin
Loss of skin sensation below the level of injury. The individual may not feel and therefore not respond to prolonged pressure on the skin or damaging/painful levels of hot or cold. Without this protective mechanism an individual is more susceptible to pressure sores (damage to the skin and or underlying flesh), serious burns and issues related to exposure to cold.

 

Circulation
Circulatory complications may range from low blood pressure to swelling of the extremities creating higher at risk situations for developing blood clots and pulmonary embolus. A life threatening circulation complication for SCI is rise in blood pressure known as autonomic dysreflexia or autonomic hyperreflexia.

 

Bladder
The bladder stores urine as always. However, because of the the injury to the spinal cord, the individual may not be able to willfully void the bladder, control the flow of urine or even sense that they need to void. This loss of bladder control can increase the risk of urinary tract infections (UTI) and increase the risk of developing kidney infections and kidney stones. Use of an in-dwelling or external urinary catheter is often necessary to facilitate personal urinary care.

 

Bowel
After an injury loss of control of bowel movements is often the case and it becomes difficult or impossible to empty one’s bowels. This condition is known as neurogenic bowel. It is a lack of nervous control (caused by a spinal cord injury or disease) that prevents the bowel from functioning correctly. The lack of function results in fecal incontinence, chronic constipation, or both. Bowel training (during rehab) can help regulate bowel movements but often a care provider is needed to complete the bowel maintenance process.

 

Respiratory
The higher level injuries, tetraplegia/quadriplegia can cause difficulties in breathing and coughing since the injury may have impacted on muscles (abdominal, diaphragm, chest muscles) that assist in breathing. At the higher levels of injury, impaired breathing may be so profound that the individual may need to be placed either temporarily or permanently on a respirator. This complication brings with it a greater risk of respiratory infection and pneumonia.

 

Sexuality
Sexual function and fertility can be affected after a spinal cord injury (SCI) in both men and women. Men may notice changes in erection and ejaculation; women may notice changes in lubrication and the ability to reach an orgasm. Very few men with complete SCI have ejaculations even though they may obtain an erection. Women however are able to get pregnant after a spinal cord injury. It is critical that individuals with a SCI contact urologists and fertility specialists who specialize in and are experienced with SCI.

What is a Spinal Cord Disorder?

Spinal cord disorders or diseases can cause permanent and irreparable cord problems. These disorders usually are a result of some condition outside of the spinal cord.

Mutiple Sclerosis (MS)

Multiple sclerosis (MS) is a chronic, progressive, degenerative disorder that affects nerve fibers in the brain and spinal cord. Surrounding and insulating nerve fibers is a fatty substance known as myelin, which facilitates the conduction of nerve impulse transmissions. MS is characterized by intermittent damage to myelin in a process known as “demyelination” caused by the destruction of specialized cells oligodendrocytes that form myelin. Demyelination causes scarring and hardening (sclerosis) of nerve fibers, usually in the spinal cord, brain stem, and optic nerves, which slows nerve impulses and results in weakness, numbness, pain, and vision loss.

Amyotrophic Lateral Sclerosis (ALS)

Amyotrophic lateral sclerosis (ALS), sometimes called Lou Gehrig’s disease, is a rapidly progressive, invariably fatal neurological disease that attacks the nerve cells (neurons) responsible for controlling voluntary muscles. The disease belongs to a group of disorders known as motor neuron diseases, which are characterized by the gradual degeneration and death of motor neurons. The cause of ALS is not known, and scientists do not yet know why ALS strikes some people and not others, but it occurs throughout the world with no racial, ethnic, or socioeconomic boundaries. ALS affects as many as 30,000 Americans, with 5,600 new cases diagnosed in the U.S. each year.

Post-Polio

Polio—also known as poliomyelitis—is a contagious viral disease that attacks the central nervous system and can cause temporary or permanent paralysis and weakness. While the disease has been virtually conquered in many areas of the world through vaccines, some survivors of childhood polio have been experiencing a new syndrome called “post-polio” that typically emerges 25 to 30 years after the initial attack.

Spina Bifida

Spina bifida is the most common neural tube defect. In the developing vertebrate nervous system, the neural tube is the precursor of the central nervous system. Neural tube defects result from the failure of the spine to close properly during the first month of pregnancy. Worldwide incidence of spina bifida is 1–2 cases per 1,000 births, but certain populations have a significantly greater risk

Transverse Myelitis

Transverse myelitis (TM) is a neurologic syndrome caused by inflammation of the spinal cord. TM occurs in both adults and children and is uncommon, but not rare. Conservative estimates of incidence per year vary from 1 to 5 per million population. The term myelitis is a nonspecific term for inflammation of the spinal cord; transverse refers to involvement across one level of the spinal cord. TM often develops in the setting of viral and bacterial infections, especially those which may be associated with a rash, such as rubella, influenza, or mumps. Approximately one third of patients with TM report flu-like symptoms prior to the onset of neurologic symptoms.

Syringomyelia

Syringomyelia (sear-IN-go-my-EEL-ya) is a disorder in which a cyst forms within the spinal cord. This cyst, called a syrinx, expands and elongates over time, destroying the center of the spinal cord. Since the spinal cord connects the brain to nerves in the extremities, this damage results in pain, weakness, and stiffness in the back, shoulders, arms, or legs. Other symptoms may include headaches and a loss of the ability to feel extremes of hot or cold, especially in the hands. Signs of the disorder tend to develop slowly. If not treated surgically, syringomyelia often leads to progressive weakness in the arms and legs, loss of hand sensation, and chronic, severe pain. In most cases, the disorder is related to a congenital abnormality of the brain called a Chiari I malformation.

Brown-Sequard Syndrome (BSS)

Brown-Sequard Syndrome (BSS) is a rare neurological condition that creates a lesion in the spinal cord. Contrary to conventional spinal cord injury that leaves most victims paralyzed on both sides of their body, Brown-Sequard syndrome results in weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side. Brown-Sequard may be caused by a spinal cord tumor, trauma or puncture wound ot the back or neck, obstruction of a blood vessels, infectious or inflammatory diseases such as tuberculosis, or multiple sclerosis.

Cauda Equina Syndrome

Cauda Equina Syndrome is a serious debilitating condition caused by compression of the nerves in the lower spinal canal. If left untreated Cauda Equina Syndrome can lead to permanent loss of bowel and bladder control as well as paralysis of the legs.