Spinal Cord Injury

Spinal cord injuries can result from damage to the spinal cord itself or to the bones that surround the spinal cord, known as the vertebrae. Injuries also may happen as a result of damage to the ligaments or disks of the spinal column.

A sudden, traumatic blow to the spine can fracture, dislocate, crush or compress one or more of the vertebrae. A gunshot or knife wound that penetrates and cuts the spinal cord also can cause a spinal cord injury.

Additional damage usually occurs over days or weeks. This is because of bleeding, swelling and fluid accumulation in and around the spinal cord after an injury.

Other causes of a spinal cord injury don’t include trauma. Arthritis, cancer, inflammation, infections or disk degeneration of the spine can be possible causes.

Your brain and central nervous system

The central nervous system includes the brain and spinal cord. The spinal cord is made of soft tissue and is surrounded by bones called vertebrae. It extends down from the base of the brain and contains nerve cells and groups of nerves called tracts. The tracts go to different parts of your body.

The lower end of your spinal cord stops a little above your waist in the region called the conus medullaris. Below this region is a group of nerve roots called the cauda equina.

Tracts in your spinal cord carry messages between your brain and the rest of your body. Motor tracts carry signals from your brain to control muscle movement. Sensory tracts carry signals from body parts to your brain relating to heat, cold, pressure, pain, and the position of your arms and legs.

Damage to nerve fibers

Whether the cause is traumatic or nontraumatic, spinal cord damage affects the nerve fibers passing through the injured area. This can impair part of or all the muscles and nerves below the injury site.

An injury to the chest or lower back can affect the trunk, legs, bowel, bladder and sexual function. A neck injury affects the same areas plus movements of the arms and possibly the ability to breathe.

Common causes of spinal cord injuries

The most common causes of spinal cord injuries in the United States are:

• Motor vehicle accidents. Auto and motorcycle accidents are the leading cause of spinal cord injuries. They account for almost half of new spinal cord injuries each year.
• Falls. A spinal cord injury after age 65 is most often caused by a fall.
• Acts of violence. About 12% of spinal cord injuries result from violent encounters, usually from gunshot wounds. Knife wounds also are common.
• Sports and recreation injuries. Athletic activities, such as impact sports and diving in shallow water, cause about 10% of spinal cord injuries.
• Diseases. Cancer, arthritis, osteoporosis and inflammation of the spinal cord also can cause spinal cord injuries.

A spinal cord injury usually results from an accident and can happen to anyone. But certain factors can increase the risk of having a spinal cord injury, including:

• Being male. Spinal cord injuries largely affect men. In fact, women account for only about 20% of traumatic spinal cord injuries in the United States.
• Being between the ages of 16 and 30. More than half of spinal cord injuries occur in people in this age range.
• Being 65 and older. Another spike in spinal cord injuries occurs at age 65. Falls cause most injuries in older adults.
• Alcohol use. Alcohol use is involved in about 25% of traumatic spinal cord injuries.
• Engaging in risky behavior. Motor vehicle crashes are the leading cause of spinal cord injuries for people under 65. Other risky behaviors include diving into shallow water and playing sports without wearing safety gear or taking proper precautions.
• Having certain diseases. A minor injury can cause spinal cord damage if you have a condition that affects your joints or bones, such as osteoporosis.

A spinal cord injury can lead to many complications. Your rehabilitation team helps you develop tools to address these complications. The team also recommends equipment and resources to promote your quality of life and independence. Areas often affected include:

• Bladder control. The bladder continues to store urine from the kidneys after a spinal cord injury. But the injury may interfere with the brain receiving the messages it needs to control the bladder.

  Changes in bladder control increase the risk of urinary tract infections. The changes also may cause kidney infections and kidney or bladder stones. During rehabilitation, you learn ways to help empty your bladder.

• Bowel control. The stomach and intestines work much like they did before the injury, but control of bowel movements is often altered. A high-fiber diet might help regulate the bowels. You also can learn ways to help control your bowel.

• Pressure injuries. Below the neurological level of your injury, you might have lost some or all skin sensations. Therefore, your skin can’t send a message to your brain when it’s injured by certain things such as prolonged pressure.

  This can increase the risk of getting pressure sores. Changing positions often — with help, if needed — can help prevent the sores. Proper skin care also can help prevent pressure sores.

• Circulatory control. People with a spinal cord injury may have low blood pressure when they rise, known as orthostatic hypotension. They also may have swelling in the arms and legs. This can increase the risk of developing blood clots, such as deep vein thrombosis or a pulmonary embolus.

  Another issue with circulatory control is a potentially life-threatening rise in blood pressure, known as autonomic dysreflexia. Your rehabilitation team can teach you how to address these issues if they affect you.

• Respiratory system. If the injury affects the stomach and chest muscles, it may be hard to breathe and cough.

  The neurological level of injury determines what kind of breathing problems you may have. If the injury affects your neck and chest, you might have an increased risk of pneumonia or other lung conditions. Medicines and therapy can be helpful for treatment and prevention.

• Bone density. A spinal cord injury increases the risk of osteoporosis and fractures below the level of injury.
• Muscle tone. Some people with spinal cord injuries have a tightening or motion in the muscles, known as spasticity. Other people may have soft and limp muscles lacking muscle tone, known as flaccidity.

• Fitness and wellness. Weight loss and muscle thinning are common soon after a spinal cord injury. Because limited mobility can lead to a more sedentary lifestyle, there is a risk of weight gain, cardiovascular disease and diabetes.

  A dietitian can help you eat a nutritious diet to sustain a healthy weight. Physical and occupational therapists can help you develop a fitness and exercise program.

• Sexual health. A spinal cord injury may lead to changes in erection and ejaculation, or in changes in lubrication. Healthcare professionals specializing in urology or fertility can offer options for sexual functioning and fertility.
• Pain. Some people have pain, such as muscle or joint pain, from overuse of particular muscle groups. Nerve pain can occur after a spinal cord injury, especially in someone with an incomplete injury.
• Depression. Pain and the changes a spinal cord injury brings can cause depression in some people.

Following this advice might reduce your risk of a spinal cord injury:

• Drive safely. Car crashes are one of the most common causes of spinal cord injuries. Wear a seat belt every time you are in a moving vehicle.

  Make sure that your children wear a seat belt or use an age- and weight-appropriate child safety seat. To protect them from air bag injuries, children under age 12 should always ride in the back seat.

• Check water depth before diving. Don’t dive into a pool unless it’s at least 9 feet (about 2.74 meters) deep and clearly marked safe for diving. Competition diving requires a deeper depth. And don’t dive into an aboveground pool or into water if you don’t know how deep it is.
• Prevent falls. Use a step stool with a grab bar to reach high-up objects. Add handrails along stairways. Put nonslip mats on tile floors and in the tub or shower. For young children, use safety gates to block stairs and consider installing window guards.
• Take precautions when playing sports. Always wear recommended safety gear. Avoid leading with your head in sports. For example, don’t slide headfirst in baseball. In American football, don’t tackle using the top of your helmet. Use a spotter for new moves in gymnastics.
• Don’t drink and drive. Don’t drive after drinking alcohol or while under the influence of drugs. Don’t ride with a driver who has been drinking.