Spinal Cord Injury (SCI)

Encyclopedia Entry

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Overview

The spine, or "vertebral column", is made of many different bones (called "vertebrae") stacked on top of each other. Doctors group the 33 vertebrae into 5 types: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral and 4 coccygeal. The vertebrae support your body and also protect your spinal cord. The spinal cord is a long bundle of nerves that run down the middle of the spine through a hole in the middle of each vertebrae. The nerves carry signals between your brain and the different parts of your body. Some of the nerves in the spinal cord carry "sensory" messages to your brain so you can feel things. Others carry "motor" messages out to your body so you can move your arms, hands, legs, and other parts of your body.

If an injury blocks the sensory and motor messages along the spine, you will not be able to feel or move any part of your body below that blocked place on the spine. Because the nerves in the spinal cord run down from the brain and branch off like highway exits at different part of the body (neck, arms, back, hips, etc.), injuries that are high up on the spine cause the most problems. Injuries that happen low on the spine will only cause problems with the lower part of the body. Injuries near the top of the spine will cause problems with both upper and lower parts of the body.

If something blocks the nerves in the lower part of your spine, you might not be able to feel your legs, for instance, or move them. If the blocked place is a little higher up your spine, you will not be able to feel or move your hips and legs. The diagram below shows how the different parts of the body are linked to blockages at different levels of the spine.

Many things can block the nerve messages, including damage to the spine, infection of the spinal cord, or swelling inside the spinal cord. In the case of an infection or swelling, once the problem is taken care of, the nerves may get better and the person will recover. But if the nerves are damaged by a "lesion" or break, they will never completely recover.

There are two kinds of lesions of the spinal cord - complete and incomplete.

A complete lesion is a broken or crushed place in the spinal cord nerve bundle. After a complete lesion, you will have no feeling or voluntary movement below the place where the lesion is.

An incomplete lesion happens when the spinal cord is not completely broken or crushed. After an incomplete lesion, some feeling and movement may come back later, but if it is going to come back, it usually happens within six months of the injury.

So the kinds of problems a person has from a spinal cord injury depend on two things - how high up the injury was along the spinal cord and whether the lesion was complete or incomplete. People with spinal cord injuries may have a mix of symptoms.

Quadriplegia is caused by a complete lesion to the cervical area high up on the spinal cord. It means the person looses some or all of the feeling and movement in both their arms and their legs plus everything in between. Paraplegia is caused by a complete lesion to the thoracic area lower down on the spinal cord. It means the person loses some or all of the feeling and movement in their waist and legs.

Doctors label the different places along the spinal cord by the number and type of vertebrae along the spine. As the diagram shows, a C4 injury is higher than an L2 injury and will cause more problems. People with injuries at the top, close to the brain at the C1 or C2 level, often die. If they survive, they usually need a respirator to help them breath. At the bottom of this page is a more detailed list of the results of injuries at different levels of the spinal cord. 

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Other Problems From Spinal Cord Injuries

• Bowel and Bladder Control. Bowel and bladder control is what allows you to go to the bathroom when you want. People with spinal cord injuries may have trouble with bowel and bladder control. These problems fall into two types:
  • reflex emptying of the bowel and bladder. Usually occurs with injuries above T12-L1.
  • manual emptying of the bowel and bladder. This type occurs in paraplegia with lesions below L1.
• Sexual functioning. Although people with spinal cord injuries may lose feeling in their groins, they still have sexual desires because those come from the brain. This is an important part of their lives and should not be ignored. The kinds of sexual activities they can enjoy depends in part on the type of bowel and bladder function that they have. It is important to remember that people with spinal cord injury can have sex and may be able to have children.
• Eating. A person with a spinal cord injury above the level of the abdomen cannot feel if their stomach is hungry or full, so they have to remember when to eat and how much to eat. In addition, the body's control of the digestive track is not as good, so the person has to be careful about what they eat. They have to eat the same kinds of food and stay away from very fatty or spicy foods.
• Pressure sores - People with spinal cord injuries usually cannot feel pressure on their butts and legs and cannot shift their body easily to relieve the pressure. Because of this they may get "pressure sores", also called "decubitus ulcers". A pressure sore is basically a place where some of the skin has died because it did not get enough blood. The skin will grow back if the blood gets to it, but until then there is a hole, or ulcer, there and it can get infected.
• Infections of the urinary tract - The urinary tract is how you pee. Infections down there can be a problem for people with spinal cord injuries. Many are unable to control their bladders and urinary tracts, so they need a tube, or "catheter" inserted to drain the pee into a bag that they wear. Because the body is not designed to have a tube stuck in there for a long time, sometimes the catheter causes an infection in the bladder and urinary tract.
• Trouble Coughing - If a person has a spinal cord injury higher than T7 (see below), they won't be able to cough very well because the nerves to their chest have been hurt. If they get a respiratory infection, like a cough or bronchitis, they will not be able to cough hard enough to clear their lungs. If that happens, someone will need to "cough them" manually.
• Autonomic Dysreflexia- Autonomic Dysreflexia is a sudden rise in blood pressure, and it may include sweating and headaches. It only happens in people with lesions above T4 and it is a real emergency. The person may die if their blood pressure is not controlled quickly.
• Contracture - Contracture happens when a person's joints start to freeze up and cannot be moved as widely as before. For instance, if someone's elbow cannot straighten all the way out because it has been held bent for so long, that would be contracture. For someone with a spinal cord injury, contracture happens in joints they cannot move voluntarily any more. Having someone else flex the joint for them will prevent contracture.

There are around two hundred thousand (200,000) people in the US with spinal cord injuries. Every year ten thousand (10,000) new people acquire a spinal cord injury. More than one third of these injuries are caused by car accidents. One fourth of the injuries are caused by gunshot wounds or similar kinds of violence. The number of injuries caused by gunshot wounds has been growing in the last few years.

More than half of the people acquiring spinal cord injuries are younger than thirty years old. More than half are White (Cuacasian), one third are African American, and one tenth are Hispanic. Four out of five are men. Until a few years ago, three-fourths of the people acquiring spinal cord injuries were White and only one tenth were African American.

Slightly more than one half of people with spinal cord injuries have quadriplegia (problems with feeling in or use of all four limbs), and most of the rest have paraplegia (problems in only the legs).

Nine out of ten people with spinal cord injuries end up living at home rather than in an institution or group home. Within 8 years, one third of them find jobs. In general, people with spinal cord injuries do not live as long as the rest of the population. In general, people with spinal cord injuries are slightly less likely to get married than the general population.

[This info comes from the National Spinal Cord Injury Statistical Center at the University of Alabama, Birmingham, January, 1998]

There are many kinds of "assistive technology" for people with spinal cord injuries. These include both complicated and simple tools. Complicated tools include specially modified vans that will hold wheelchairs, lifts to raise them out of their wheelchairs, electric wheelchairs, electric beds, joysticks to control things like wheelchairs, and voice-controlled computers. Simple tools include wheelchair ramps, raised desks to fit wheelchairs, and TV remote controllers.

• C1-C3 = injury here means the absence of respiratory muscle contraction, including the diaphragm, and as a result most people who suffer compete lesions at these levels die at the scene of their accident. If they survive and get to a hospital, they will need a ventilator to help them breath for the rest of their life and probably will need a tracheostomy.
  • C1 = the person has sensation and movement in face only.
  • C2 = the person also has sensation in their scalp at back of their head. (In either C1 or C2, the neck cannot support the head and the person needs surgical or external stabilization to sit upright.)
  • C3 = the person has sensation to entire head and neck as well as control of the neck muscles.
• C4 = initially the person needs a ventilator, which is used to gradually retrain the person's diaphragm and so they can breath on their own again. People with a C4 injury hold their shoulders up because the muscles that raise the shoulders work, but the muscles that lower them do not.
• C5 = The person has useful movement of the upper arms, but no real control of their hands. They also have better use of their diaphragm than someone with a C4 injury. Someone with a C5 injury usually holds their shoulders up and has flexed elbows, for the same reason described above.
• C6 = The person has a little control of their hands and they can feel their upper forearms, thumb and index finger. The person needs a wrist brace to support their hands.
• C7 = The person can move their arms and hands some. They have better control of their upper arms, which allows them to straighten their elbows. A person with a C7 injury will usually hold their shoulders and elbows normally, but their hands will be open instead of half closed. They can feel their arms, thumb, index finger, middle finger and part of their ring finger.
• C8 = The person can move and feel their hands well, although there may be some problems with fine hand movement. They have good control of finger and thumb extensions which allows them to pick up and hold things. They cannot feel parts of the inside of their arms.
• T1 = The person has good control of their hands and arms. people with injuries at T1 or below are considered paraplegic rather than quadriplegic. They can feel all parts of their arms and hands.

 T2-T5 = Upper thoracic levels = People with injuries in the upper thoracic area of the spinal cord have no trouble with their arms and legs but will have some trouble breathing. The lower down a person's injury is, the less trouble they will have breathing, but coughing will still be difficult.

• T6-T12 = Lower thoracic levels = People with injuries in the lower thoracic levels can breath well but have trouble with their abdominal muscles. The abdominal muscles allow you to cough, among other things. With an injury at the T9 level or lower, a person can cough.
• Lumbar (L) and Sacral (S) levels = People with injuries in the lumbar or sacral are of the spine have different amounts of feeling and control of their legs, depending on the vertebrae level of the injury.
• L1-L5 = Bowel and bladder functioning is still a problem for people with injuries in the lumbar region, but reflex emptying may be possible.
• Sacrum = the person can walk, but may need help. Bowel and bladder function may still be a problem.