Spinal cord injury (SCI) occurs when the spinal cord is damaged due to traumatic or non-traumatic causes. Because the spinal cord transmits signals between the brain and the rest of the body, injuries can result in loss of motor function, sensory deficits, and impaired autonomic control, significantly affecting quality of life.
Causes of Spinal Cord Injury
SCI can be broadly categorized into traumatic and non-traumatic injuries:
Traumatic Causes
Motor vehicle accidents: The leading cause of SCI.
Falls: Especially in older adults, leading to vertebral fractures.
Sports injuries: High-impact or extreme sports such as diving, skiing, or football.
Violence: Gunshot or stab wounds.
Non-Traumatic Causes
Spinal tumors: Primary or metastatic lesions.
Infections: Epidural abscess, vertebral osteomyelitis.
Vascular conditions: Spinal artery thrombosis or hemorrhage.
Degenerative diseases: Spinal stenosis or disc herniation causing chronic compression.
Spinal Cord Injury Levels and General Effects
SCI severity depends on the injury level and whether it is complete or incomplete:
Complete SCI
Total loss of motor and sensory function below the injury level.
Incomplete SCI
Partial preservation of function.
Examples include anterior cord syndrome and Brown-Séquard syndrome.
Injury Levels
Cervical (C1-C8): May cause tetraplegia/quadriplegia affecting arms, legs, and trunk.
Thoracic (T1-T12): Often results in paraplegia affecting trunk and legs.
Lumbar (L1-L5): Impacts lower extremity and pelvic function.
Sacral (S1-S5): Distal leg muscles, bladder, and bowel control.
Signs and Symptoms
Severe neck or back pain.
Weakness or paralysis in limbs.
Numbness or tingling sensations.
Neurogenic claudication (leg pain during walking, relieved by rest or bending forward).
Loss of bladder or bowel control.
Respiratory difficulty in high cervical injuries.
Diagnosis
Clinical and Neurological Assessment
Motor examination: Muscle strength and tone tested in all extremities.
Sensory evaluation: Light touch, pain, temperature, and proprioception.
Reflex assessment: Patellar, Achilles, Babinski, deep tendon reflexes.
Functional assessment: Walking, sitting, standing, and daily living activities.
Imaging Studies
X-rays: Detect vertebral fractures and alignment abnormalities.
Computed Tomography (CT): Detailed bone structure and instability.
Magnetic Resonance Imaging (MRI): Soft tissue, spinal cord edema, hematoma, and compressio
Myelography: Evaluates spinal canal pressure and cerebrospinal fluid flow.
Electrophysiological tests: Motor and sensory evoked potentials to assess neural conduction
Treatment
Management of SCI is multidisciplinary and time-sensitive, aiming to preserve neurological function, stabilize the spine, and relieve pressure.
Acute Phase
Spinal immobilization with collars or braces.
Corticosteroids to reduce spinal cord edema (selective use based on protocols).
Pain management.
Surgical Intervention
Urgent surgery is indicated for acute compression syndrome to the spinal cord.
Surgery is indicated in patients with spinal instability, progressive neurological deficits, or persistent pain:
Decompression surgery: Laminectomy or laminotomy to relieve pressure on the spinal cord.
Stabilization and fusion: Rods, screws, bone grafts, or synthetic cages maintain vertebral alignment.
Vertebroplasty or kyphoplasty: Stabilize fractured vertebrae and reduce pain.
Rehabilitation post-surgery: Muscle strengthening, mobility restoration, bladder/bowel training, and functional recovery.
Long-Term Rehabilitation
Physical therapy for strength, mobility, and endurance.
Adaptive devices for daily activities.
Psychological support and counseling.
Life Expectancy and Prognosis
Spinal cord injury life expectancy depends on injury level, severity, and quality of care. Early surgical intervention, intensive rehabilitation, and comprehensive multidisciplinary care significantly improve outcomes. High cervical injuries may reduce life expectancy due to respiratory complications, whereas lower-level injuries generally allow longer survival with appropriate support.
Living with SCI
Regular neurological and nephrological follow-up and imaging.
Pain and spasticity management.
Physical exercise and spine health support.
Psychological counseling and social support programs.