What happens if you have one?
You’re out working in your yard and decide that you need to trim some branches off one of the trees. You grab your ladder, climb up to the right spot, and get to work. The next you know, you wake up in the hospital to find that it’s several days later, and the doctor tells you that you have a spinal cord injury from falling off the ladder. What does this mean for you at the moment? What does it mean for your future?
Definition
A spinal cord injury is when there’s damage to any part of the spinal cord or nerves at the end of the spinal cord. It can involve the vertebrae (bones of your spinal column), ligaments, discs of the spinal column, or the spinal cord itself. Typically, the cause of a spinal cord injury is a traumatic injury, like car accidents, falls, acts of violence, and sports/recreation. Sometimes, nontraumatic things, such as arthritis, cancer, inflammation, infections, or disc degeneration, can cause a spinal cord injury. While anyone is at risk for an accident, certain factors can elevate your chances of developing a spinal cord injury, including being male, being between the ages of 16 – 30, being 65 or older, alcohol use, engaging in risky behavior, or having certain medical conditions (ex. osteoporosis).
To understand what happens during a spinal cord injury, we need to first look at the structure of your central nervous system, which is made up of the brain and spinal cord. The spinal cord has soft tissue that’s surrounded by bones. It extends down from the base of your brain and stops a little above your waist. Below this region is a group of nerve roots called the cauda equina. The entire structure contains nerve cells and groups of nerves called tracts, which go to different parts of your body. These tracts carry messages between your brain and your body. There are different types of tracts. Motor tracts carry signals from your brain to control muscle movement, whereas sensory tracts carry signals from body parts to your brain relating to heat, cold, pressure, pain, and the position of your limbs.
Regardless of the cause, any damage that affects the nerve fibers passing through an injured area can impair part or all of the muscles and nerves below the injury site. Your ability to control your limbs after a spinal cord injury depends on where the injury occurred and its severity. The lowest part of your spinal cord that remains undamaged after an injury is called the neurological level of your injury. The severity of the injury is often referred to as “completeness.” If all feeling (sensory) and all ability to control movement (motor function) are lost below the injury area, it’s called complete. If you have some motor or sensory function below the affected area, it’s incomplete. It’s critical to note that there are varying degrees of incomplete injury.
A chest (thoracic) or lower back (lumbar) injury can affect your torso, legs, bowel and bladder control, and sexual function. A neck (cervical) injury involves the same areas and affects movements of your arms and, possibly, your ability to breathe. Paralysis from a spinal cord injury is defined in two ways. Tetraplegia, or quadriplegia, means that your arms, hands, trunk, legs, and pelvic organs are all affected by your spinal cord injury. Paraplegia is when paralysis affects all or part of the trunk, legs, and pelvic organs.
Emergency signs of a spinal cord injury after an accident include extreme back pain, intense pressure in your neck/head/back, weakness/incoordination/paralysis in any part of your body, numbness/tingling/loss of sensation in your hands/fingers/feet/toes, loss of bladder/bowel control, difficulty with balance and walking, impaired breathing after injury, or an oddly positioned or twisted neck or back. Other common symptoms of a spinal cord injury are loss of movement, loss of or altered sensation (ex. decreased ability to feel heat/cold/touch), exaggerated reflex activities (spasms), changes in sexual function/sensitivity/fertility, pain/intense stinging sensation caused by damage to the nerve fibers in your spinal cord, and difficulty breathing/coughing/clearing secretions from your lungs. After the initial injury, you must worry about additional impairment over the next several days to weeks from bleeding, swelling, inflammation, and fluid accumulation in the affected area.
Several complications can arise from a spinal cord injury. A significant one is the ability to control your bladder. While it will continue to store urine made in your kidneys, your brain might not control your bladder as well because the message carrier (the spinal cord) has been injured. This increases your risk of urinary tract infections (UTIs), kidney infections, and kidney or bladder stones. Similarly, although your stomach and intestines work as before your injury, control of your bowel movements is often altered. Another issue is you might have lost some or all skin sensations in the area below the level of your injury. This means you’re not aware of certain things, such as prolonged pressure in one place, making you more susceptible to pressure sores. A spinal cord injury can also impact your circulatory system. Problems can include low blood pressure when you rise (orthostatic hypotension), swelling of your extremities, and a higher chance of developing blood clots (ex. deep vein thrombosis or a pulmonary embolus). Another issue is a potentially life-threatening rise in blood pressure (autonomic dysreflexia). Your injury might make it more difficult to breathe and cough if your abdominal and chest muscles are affected. This can increase the risk of pneumonia or other lung problems. After a spinal cord injury, there’s a heightened risk of osteoporosis and fractures below the level of damage. Some individuals have muscle tone problems. The first is uncontrolled tightening or motion in the muscles (spasticity). The second is soft and limp muscles lacking muscle tone (flaccidity). It’s vital to note that weight loss and muscle wasting (atrophy) are frequently seen after a spinal cord injury. Further, limited mobility can lead to a more sedentary lifestyle, putting you at risk of obesity, cardiovascular disease, and diabetes. Often sexual health is impacted with men noticing changes in erection and ejaculation and women experiencing changes in lubrication. Unfortunately, pain is common and results from the overuse of particular muscle groups or nerve pain (especially if the person has an incomplete injury). Given all of the changes that occur after a spinal cord injury, it’s not surprising that many people have depression.
Treatment
Anyone with significant trauma to the head or neck needs immediate medical evaluation for a spinal injury. It’s safest to assume that trauma victims have a spinal injury until proven otherwise for various reasons. Sometimes, a severe spinal injury isn’t always immediately apparent, which means if the person is moved, a more severe injury may occur. Also, numbness or paralysis might come on gradually. So, if you suspect that someone has a back or neck injury, don’t move them, keep them still, and call 911. Also, place heavy towels on both sides of the neck or hold the head and neck to prevent them from moving until emergency personnel arrives. You can provide basic first aid, such as stopping bleeding and making the person comfortable, without moving the head or neck. The time between injury and treatment can be critical in determining the extent and severity of complications and the possible extent of expected recovery. The goal of spinal cord injury treatment is to prevent further injury and empower people with a spinal cord injury to return to an active and productive life.
Since it’s critical to minimize the effects of head or neck trauma, treatment begins at the accident scene. Emergency personnel typically immobilize the spine as gently and quickly as possible using a rigid neck collar and a rigid carrying board. Once in the emergency room, doctors concentrate on maintaining your ability to breathe, preventing shock, and immobilizing your neck to prevent further spinal cord damage. You’ll usually be admitted to the intensive care unit for treatment. Another option is to be transferred to a regional spine injury center that has a team of experts focused on spinal cord injury treatment. It’s essential to keep in mind that your doctor might not be able to give you a prognosis right away. The rate and level of recovery relate to the injury’s severity and location. The fastest recovery rate is often seen in the first six months, but some people make small improvements for up to 1 to 2 years.
Methylprednisolone (Solu-Medrol) is a medication that used to be given intravenously (IV) because it was thought to help reduce swelling. However, recent research has shown that the potential side effects, like blood clots and pneumonia, outweigh the benefits, so methylprednisolone is no longer recommended after a spinal cord injury.
Often, you’ll need some form of immobilization device, such as neck collars or braces, to stabilize or align your spine. You might require surgery if there are fragments of bones, foreign objects, herniated discs, or fractured vertebrae that are compressing the spine. In some cases, surgery is done to stabilize the spine.
After your condition stabilizes, doctors turn their attention to preventing secondary problems—the potential complications. The length of your hospital stay depends on your condition and the medical issues you face. You’ll be transferred to a rehabilitation facility once you’re well enough to participate in therapies and treatment. Rehabilitation team members often include a physical therapist, an occupational therapist, a rehabilitation nurse, a rehabilitation psychologist, a social worker, a dietitian, a recreation therapist, and a doctor specializing in physical medicine (physiatrist). The costs of a spinal cord injury can be overwhelming. However, economic assistance or support services are available from the state or federal government or charitable organizations. Your rehabilitation team can help you identify resources in your area.
During the initial stages of rehabilitation, therapists usually emphasize maintaining and strengthening muscle function, redeveloping fine motor skills, and learning ways to adapt to do day-to-day tasks. You’ll also be educated on the long-term effects of a spinal cord injury and how to prevent complications. Not only will you be taught many new skills, but you’ll also use equipment and technologies that can help you live as independently as possible. Improved, lighter weight wheelchairs make it easier to be more mobile and more comfortable. Some wheelchairs can even climb stairs, travel over rough ground, and elevate a user to reach high places without help. With the invention of electronics, the ability to independently perform activities of daily living has increased dramatically. Many devices can be turned on or off by a switch or voice-controlled and computer-based remotes. A range of driving equipment, vehicle modifications, and home modification products (ex. ramps, wider doors, special sinks, grab bars and easy-to-turn doorknobs) make it possible for you to live more autonomously. Newer advances, such as electrical stimulation devices (or functional electrical stimulation systems), use electrical stimulators to control arm and leg muscles to allow people with spinal cord injuries to stand, walk, reach and grip. Medications can control pain, muscle spasticity, and improve bladder control, bowel control, and sexual functioning.
An accident that results in paralysis is a life-changing event that can leave you feeling frightened and confused. In addition, adapting is no easy task. If you’re newly injured, you and your family will likely experience a period of mourning. The grieving process is a normal, healthy part of your recovery and is different for everyone. It’s vital to grieve the loss of the way you were, but just as necessary, you need to set new goals and find ways to go forward. It’s important to resume your favorite hobbies, participate in social and fitness activities, and return to school or work. It’s vital to stay motivated and get the support you need.
If your grief affects your care, causing you to isolate yourself or prompting you to abuse alcohol or other drugs, you should talk to a social worker, psychologist, or psychiatrist. Another helpful option is to join a support group of people with spinal cord injuries. Talking with others who understand what you’re going through can be encouraging.
Part of regaining control of your life is to educate yourself about your injury. Often, friends and family members might be unsure about how to act around you. Being educated and willing to educate others can benefit all of you. Not only can you explain the effects of your injury, but you can also let others know what they can do to help. Don’t hesitate to tell friends and loved ones when they’re helping too much.
Even though a spinal cord injury might affect your body’s sexual responsiveness, you can have a fulfilling emotional and physical relationship. It’ll take communication, experimentation, and patience. A professional counselor can help you and your partner communicate your needs and feelings. Your doctor can provide the medical information you need regarding sexual health.
Prevention
While you can’t completely prevent a spinal cord injury from occurring, there are steps you can take to reduce your risk level. Since car accidents are responsible for over half of the new spinal cord injuries every year, the number one thing is to drive safely! Make sure to wear a seat belt every time you’re in a moving vehicle. Also, ensure that your children wear a seat belt or use an age- and weight-appropriate child safety seat. Remember, children under age 12 should always ride in the back seat. In addition, don’t drive while intoxicated or under the influence of drugs and don’t ride with a driver who’s impaired.
The next thing is to do everything possible to prevent falls. When trying to reach high-up items, use a step stool with a grab bar. Use the proper safety precautions when on a ladder. Make sure that stairways have handrails and put nonslip mats on tile floors and in the tub or shower. For young children, use safety gates to block stairs and install window guards.
When it comes to playing sports, always wear recommended safety gear. Also, avoid leading with your head in sports. This means don’t slide headfirst in baseball or don’t tackle using the top of your helmet in football. Always check water depth before diving. Don’t dive into a pool unless it’s 12 feet deep or deeper, never dive into an aboveground pool, and don’t dive into water if you don’t know how deep it is.
While there’s no way yet to reverse damage to the spinal cord, researchers are continually working on new treatments, including prostheses and medications, that might promote nerve cell regeneration or improve the function of the nerves that remain after a spinal cord injury. With advances in stem cell research and nerve cell regeneration, there’s hope for more significant recovery for people with spinal cord injuries in the future.
Suffering a spinal cord injury is shocking and overwhelming. While recovery takes time, many paralyzed people progress to lead productive and fulfilling lives. If you have any questions or concerns about spinal cord injuries, please speak with your doctor. If you would like more information, please visit the National Institute of Neurological Disorders and Stroke’s Spinal Cord Injury Information Page at https://www.ninds.nih.gov/Disorders/All-Disorders/Spinal-Cord-Injury-Information-Page#:~:text=Definition,that%20surround%20the%20spinal%20cord.