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Spinal Cord Injury Consultation

Understanding The Basics Of A Spinal Cord Injury

Sierra Care | February 25, 2021

 

Understanding The Basics of a Spinal Cord Injury

The diagnosis of a spinal cord injury is potentially life-changing. If you or a loved one have been diagnosed with a spinal cord injury you likely have countless questions. This article will review the basics of spinal cord injury and the services Sierra Care provides that can prime your body for the best possible recovery.

What is a Spinal Cord Injury?

Spinal cord injury is a diagnosis that is given to a wide range of injuries that stop signals from traveling from the brain to the rest of the body through the nerves of the spinal cord, which is located within the bones of the spine. The most important types of spinal cord injury are “partial” and “complete” injuries.

  • A partial spinal cord injury occurs when some of the spinal cord remains intact after an injury allowing some signals to pass through the injured area.
  • A complete spinal cord injury results when the entire spinal cord in an area has been damaged, preventing signals from passing the damaged area.
  • An acute spinal cord injury is an injury that has just occured, a chronic spinal cord injury is one that occurred more than several months ago and is likely already in treatment.

What is the Spinal Cord?

The spinal cord acts as a highway for information between the brain and the rest of the body. It is a bundle of nerves that transmits the signals that our brain uses to tell the muscles of the body to move and allow the sensations of touch, pain, and pressure to travel from our skin to our brain.
 
The spinal cord runs from the skull to the lower back through the bones of the back that make up the spine. These bones are called “vertebrae” and shaped like rings with the fragile spinal cord traveling through their center. This is how the spinal cord is protected from damage, by the bony vertebrae that make up the spine.
 
The most important thing to understand about the spinal cord is that it is like a long highway with many exits, if you cut off the highway no traffic can pass the damaged area to reach the exits past the damaged area. The medical term used to describe where the spinal cord is damaged is the spinal injury level.

What is a Spinal Cord Level?

Spinal cord “levels” are used by doctors to describe where along the back the spinal cord has been damaged. These levels have both a letter and a number which represents one of the vertebrae (bones) of the spine. The three letters used are C, T, and L.

  • C stands for “cervical” which is the name for the vertebrae that make up the neck.
  • T stands for “thoracic” the name for the vertebrae that make up the upper back.
  • L stands for “lumbar” the name of the vertebrae that make up the lower back.

There are a different total number of vertebrae in each of these categories, the bigger the number the further down the spine the injury has occurred. This is important because it determines which parts of the body will be affected by a spinal cord injury.

  • An injury at the C4 level or above is likely to result in loss of control in both the arms and legs. This is known as Tetraplegia.
  • An injury at the T4 level or below will result in loss of control of the legs but not the arms. This is known as Paraplegia.

What can cause a spinal cord injury?

The vast majority of spinal cord injuries that are treated at Sierra Care are the result of a traumatic injury or accidents. Some of the most common causes of spinal cord injury are:

  • Motor Vehicle Collisions
  • Falls
  • Diving related injuries
  • Sports-related injuries
  • Violent injuries (stabbings or gunshot wounds)

There are many other causes of spinal cord injury as well, these are less common than trauma but in many cases are treated in a similar way:

  • Surgical complications
  • Damage from blood clots (spinal ischemia)
  • Bleeding around the spine (spinal hematoma)
  • Infections within the spine (epidural abscess)
  • Severe autoimmune conditions

These conditions can lead to either complete or partial spinal cord injury, incomplete spinal cord injuries are the most common type of spinal cord injury. Any of these causes can result in either partial or complete spinal cord injury depending on the severity of the injury.

 What are the Symptoms of a Spinal Cord Injury?

No two patients with a spinal cord injury are alike, the exact symptoms will vary heavily based on where and how severely the spinal cord is damaged. However, there are some general symptoms we expect to see in all patients with spinal cord injury.

In patients with a complete spinal cord injury the most common symptoms are:

  • Complete loss of movement and sensation below the level of the injury
  • Pain in the spine at the level of the injury
  • Inability to control urination or defecation
  • Difficulty breathing (with cervical injuries)

In patients with a partial spinal cord injury the most common symptoms are:

  • Partial loss of movement below the injury
  • Partial loss of sensation below the injury
  • Loss of only certain types of sensation below the injury
  • Partial or complete loss of bowel and bladder control

How is a Spinal Cord Injury Diagnosed?

Almost all patients with a suspected spinal cord injury are brought to an emergency room for immediate evaluation due to the severity of their symptoms. The diagnosis is confirmed with several advanced tests and a detailed examination known as the ASIA examination.

  • A Computed tomography (CT) scan, sometimes called a “cat” scan, of the spine will be performed. This looks for injuries to the bony vertebrae of the spine.
  • Magnetic Resonance Imaging (MRI) of the spine will also be performed. This will show damage to the spinal cord itself which the CT scan cannot see.

The ASIA (American Spinal Injury Association) exam is performed by a neurologist or another doctor specialized in the care of spinal cord injury. This exam is a detailed assessment of any changes in the ability of the body to move or feel various sensations and is graded from A (most severe) to E (normal).

The most important grades of the ASIA exam are A, B, and C.

  • A: Complete loss of strength and sensation below the injury.
  • B: Complete loss of strength but some preserved sensation.
  • C: Partial loss of strength with complete or partial loss of sensation.

How do you Treat a Spinal Cord Injury?

The treatment of spinal cord injury is intense and time-critical. Patients with a spinal cord injury of any severity benefit from aggressive rehabilitation and therapy by a combination of physicians, nurses, physical therapists, and occupational therapists.

The majority of this treatment occurs outside of the hospital the patient was admitted to for their spinal cord injury. This is known as subacute care and is a bridge between the hospital and discharge home. Sierra Care is equipped to provide these subacute services to patients with any severity of spinal cord injury, specializing in the most severe form, complete spinal cord injury. Some of the interventions provided in subacute care are:

  • Monitoring by physicians to optimize any medical treatments
  • Daily exercise to maximize recovery of motor function
  • Occupational therapy to teach job and school skills
  • Skills to avoid further injury in the home and in public
  • The use of assistive devices such as wheelchairs, braces, and walkers
  • Management of bowel and bladder function
  • Prevention of complications such as pain, bedsores, and infections

Unlike most other medical conditions a spinal cord injury cannot be effectively managed with medications and follow-up visits after hospitalization. The skills that patients with a spinal cord injury need to optimize their recovery and live life to the fullest are best taught in an intensive environment with supervision from many medical specialists. Click here to learn more about Sierra Care’s program for spinal cord injury recovery.

What does Recovery From a Spinal Cord Injury Look Like?

One of the most common questions that patients with spinal cord injury have is “when will life get back to normal.” For many patients, a return to normal life will only be possible with the new skills they learn during subacute care. While complete recovery is rare, the treatment provided in subacute care is critical to maximizing recovery.

  • The most rapid recovery occurs in the first 3 months after injury, aggressive daily therapy during this period can dramatically improve recovery.
  • The majority of recovery occurs in the first 6 to 9 months after injury but may continue at a slower pace up to 5 years after the injury.
  • 30% or patients with a complete spinal cord injury recover some function with therapy.
  • 76% of patients with the partial function of their legs recover their ability to walk.
  • 5% of patients with complete loss of function in their legs recover their ability to walk.
  • Patients that lose function in their arms generally show improvement with therapy.

One of the most important elements of recovery from a spinal cord injury is avoiding the idea that nothing can be done. No matter how devastating the injury, improvement is made with therapy. Sierra Care is dedicated to maximizing your recovery and getting you or your loved one back to the long and fulfilling life they have yet to live.