| Subject | Contents |
| Definition | Spinal cord trauma is damage to the spinal cord that results from direct injury to the spinal cord itself or indirectly by damage to the bones and soft tissues and vessels surrounding the spinal cord. |
| Alternative Names | Spinal cord compression; Spinal cord injury; Compression of spinal cord |
| Causes, incidence, and risk factors | Damage to the spinal cord affects all nervous function that is controlled at and below the level of the injury, including muscle control (strength) and sensation. More than 30 bones make up the spine. These bones (vertebrae) and the cushions between the vertebrae (discs) allow the back to bend while protecting the spinal cord from injury. Spinal cord trauma is caused by motor vehicle accidents, falls, sports injuries (particularly diving into shallow water), industrial accidents, gunshot wounds, assault, and other injuries. A seemingly minor injury can cause spinal cord trauma if the spine is weakened (such as from rheumatoid arthritis or osteoporosis ). Direct injury such as cuts can occur to the spinal cord, particularly if the bones or the discs are damaged. Fragments of bone (from fractured vertebrae for example) or fragments of metal (such as from a traffic accident) can transect (cut) or damage the spinal cord. Direct damage can also occur if the spinal cord is pulled, pressed sideways, or compressed. This may occur if the head, neck, or back are twisted abnormally during an accident or injury. Bleeding, or fluid accumulation and swelling, can occur within the spinal cord or outside the spinal cord but within the spinal canal. The accumulation of blood or fluid can compress the spinal cord and damage it. A mild injury (such as " whiplash ") may resolve when swelling is reduced. Severe injury (such as occurs from fractures , dislocations, or cutting of the spinal cord) usually results in permanent damage to the spinal cord. Spinal cord trauma often causes permanent disability such as paralysis because nerve fibers are slow to heal and if they are destroyed, nerve fibers do not regenerate. Spinal cord trauma that occurs in the high neck region (cervical spine) can cause death in some cases. Spinal cord injuries occur in approximately 12,000 to 15,000 people per year in the U.S. About 10,000 of these people are permanently paralyzed, and many of the rest die as a result of their injuries. Most spinal cord trauma occurs to young, healthy individuals. Males between 15 and 35 years old are most commonly affected. Only about 5% of spinal cord injuries occur in children. The fatality rate is higher with pediatric spine injuries. |
| Symptoms | Symptoms vary somewhat depending on the location of the injury. Lumbar injuries: weakness , loss of muscle control, or paralysis discrete transition below which sensation is impaired loss of bladder controlloss of bowel control loss of sexual functioning ( male impotence ) sensory loss including numbness to light touch, pain and temperature Note: It affects all muscles below the injury, usually from the chest down (paraplegia). Cervical injuries: all the symptoms of lumbar injury, plus weakness, paralysis, numbness includes the arms and hands (quadriplegia) breathing difficulties (from paralysis of the breathing muscles) Partial injuries are uncommon. If only one side of the spinal cord is injured, paralysis may occur on only one side of the body although sensation changes may occur on either or both sides. Additional symptoms that may be associated with this disease: urinary hesitancyurinary frequency/urgency - increasedpenis painmuscle spasms (cramps)constipation breathing, absent temporarily abnormal lack of sweating hypotension or "spinal shock" (low blood pressure) positive Babinski's reflex |
| Signs and tests | Symptoms may have developed immediately after injury or may occur gradually because of fluid accumulation around the spinal cord or edema (swelling) within the spinal cord itself. Spinal cord injury is a medical emergency requiring immediate attention to minimize the long-term effects. A neurologic examination indicates the level of the spinal cord injury if the location is not immediately evident. The reflexes may be abnormal or may be absent in affected areas of the body. There may be some recovery of reflexes after swelling has subsided. Muscle spasticity is common.Spine X-rays will show fracture or damage to the bones of the spine. A CT scan or MRI of the spine may pinpoint the location and extent of spinal cord trauma and demonstrate any compressive lesions like blood clots (hematomas). Rarely a myelogram (an X-ray of the spine after injection of dye) may be recommended. |
| Treatment | A spinal cord trauma is a medical emergency requiring immediate treatment to reduce the long-term effects. The time between the injury and treatment is a critical factor affecting the eventual prognosis (probable outcome). Corticosteroids such as dexamethasone or methylprednisolone are used to reduce swelling that may compress the spinal cord. If spinal cord compression can be relieved before there is total destruction of the nerves of the spine, paralysis may in some cases be reduced or relieved. Ideally, corticosteroids should begin within 8 hours after the injury. Surgery may be recommended. This may include surgery to remove fluid or tissue that presses on the spinal cord (decompression laminectomy). Surgery may be needed to remove bone fragments, disc fragments or foreign objects or to stabilize fractured (broken) vertebrae (by fusion of the bones or insertion of hardware). Bedrest may be needed to allow the bones of the spine, which bears most of the weight of the body, to heal. Anatomic realignment is important. Spinal traction may reduce dislocation and/or may be used to immobilize the spine. This may include immobilization of the skull by use of tongs (metal braces placed in the skull and attached to traction weights or to a harness on the body). Neurologic losses are treated, including treatment of muscle spasms , care of the skin, and treatment of bowel and bladder dysfunction. Extensive physical therapy, occupational therapy, and other rehabilitation interventions are often required after the acute injury has healed. Rehabilitation assists the person in coping with disability that results from spinal cord trauma. |
| Support Groups | The stress of illness can often be helped by joining a support group where members share common experiences and problems. See spinal injury - support group . |
| Expectations (prognosis) | Paralysis and loss of sensation of part of the body are common outcomes. This includes total paralysis and/or numbness and varying degrees of movement or sensation loss. Death is possible, particularly if there is paralysis of the breathing muscles. The level of injury affects the outcome. Injuries near the top of the spine result in more extensive disability (numbness and paralysis, breathing difficulty) than injuries low in the spine. Recovery of movement or sensation within 1 week usually indicates eventual recovery of most function, although this may take 6 months or more. Losses that remain after 6 months are more likely to be permanent. |
| Complications | paralysis (paraplegia, quadriplegia) loss of sensationloss of bladder control increased risk of urinary tract infections increased risk of chronic bilateral obstructive nephropathyloss of bowel control loss of sexual functioning ( male impotence ) increased risk of injury to numb areas of the body paralysis of breathing muscles deep vein thrombosisshockhypovolemic shock from blood loss during the accident |
| Calling your health care provider | Call your health care provider if injury to the back or neck occurs. Call the local emergency number (such as 911) if there is any loss of movement or sensation, this is a medical emergency! Management and treatment of spinal cord injury begins in the field at the site of an accident with paramedics trained in immobilization of the injured spine to prevent further damage to the nervous system. |
| Prevention | Safety practices during work and recreation can prevent many spinal cord injuries. Use proper protective equipment if an injury is possible, and practice appropriate safety measures. Diving into shallow water is a major cause of spinal cord trauma. Check the depth of water before diving, and look for rocks or other possible obstructions. Football and sledding injuries often involve sharp blows or abnormal twisting and bending of the back or neck and can result in spinal cord trauma. Use caution when sledding and inspect the area for obstacles. Use appropriate techniques and equipment when playing football or other contact sports. Falls while climbing at work or during recreation can result in spinal cord injuries. Defensive driving practices and improved vehicular design may prevent many automotive accidents, and use of seat belts greatly reduces the risk of serious injury if there is an automobile accident. |
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