Learn all about Spinal Cord Injury (SCI) and its impact
A spinal cord injury usually begins with a sudden, traumatic blow to the spine that fractures or dislocates vertebrae. The damage begins at the moment of injury when displaced bone fragments, disc material, or ligaments bruise or tear into spinal cord tissue. Most injuries to the spinal cord don’t completely sever it. Instead, an injury is more likely to cause fractures and compression of the vertebrae, which then crush and destroy axons — extensions of nerve cells that carry signals up and down the spinal cord between the brain and the rest of the body. An injury to the spinal cord can damage a few, many, or almost all of these axons. Some injuries will allow almost complete recovery. Others will result in complete paralysis.
The level is denoted by the letter-and-number name of the vertebra at the injury site (such as C3, T2, or L4).
- There are seven cervical vertebrae (C1 through C7), which are in the neck.
- There are 12 thoracic vertebrae (T1 through T12), which are located in the upper back. There are five lumbar vertebrae (L1 through L5), which are found in the lower back.
- Below those are five sacral vertebrae, which are fused to form the sacrum. Finally, there are the four vertebrae of the coccyx, or tailbone.1
There are two broad types of SCI, each comprising a number of different levels:
- Tetraplegia (formerly called quadriplegia) generally describes the condition of a person with an SCI that is at a level anywhere from the C1 vertebra down to the T1. These individuals can experience a loss of sensation, function, or movement in their head, neck, shoulders, arms, hands, upper chest, pelvic organs, and legs.
- Paraplegia is the general term describing the condition of people who have lost feeling in or are not able to move the lower parts of their body. The body parts that may be affected are the chest, stomach, hips, legs, and feet. The state of an individual with an SCI level from the T2 vertebra to the S5 can usually be called paraplegic. A recent prospective multicenter trial called STASCIS is exploring whether performing decompression surgery early (less than 24 hours following injury) can improve outcomes for patients with bone fragments or other tissues pressing on the spinal cord.
Secondary conditions associated with SCIs include:
- Breathing problems
- Bowel and bladder problems, including overactive bladder and incontinence
- Heart problems
- Pressure sores
- Sexual function problems
- Blood clots
- Impaired muscle coordination (or spasticity)
- Autonomic dysreflexia (or hyperreflexia), which causes a potentially lethal increase in blood pressure
- Increased likelihood of certain cancers, including bladder cancer
Other impacts to the body
After an SCI, many of the body’s functions may change dramatically. The following issues may arise:
- Bone loss
- Muscle atrophy
- Pressure ulcers
- Cardiovascular problems
- Changes in sexual and reproductive functions
- Depression and adjustment to illness
In recent decades, individuals with an SCI have been gaining longer life spans and the importance of understanding the impact of aging on the above issues has become increasingly evident.
How do people adjust to living with SCI?
Paralysis can completely change a person’s life. It can be depressing, frightening, and daunting at first to consider how to reengage with previous activities and relationships, such as those involving family, employment, friendships, and recreation/exercise. Even so, a patient with an SCI can develop strong motivation and a good support system for recovery and enjoy a fulfilling and happy life.
While the NICHD conducts studies to examine various aspects of SCI outcomes and quality of life for those affected by SCIs and their families, the manner of adjustment is not currently a focus of the Institute’s research on SCIs. However, many other organizations and agencies do focus solely on adjustment and provide information for patients and their families.
Some of these organizations include:
SCI treatment currently focuses on preventing further injury and empowering people with an SCI to return to an active and productive life.
At the Scene of the Incident
Quick medical attention is critical to minimizing the effects of head, neck, or back trauma. Therefore, treatment for an SCI often begins at the scene of the injury.
Emergency personnel typically:
- Immobilize the spine as gently and quickly as possible using a rigid neck collar and a rigid carrying board
- Use the carrying board to transport the patient to the hospital
In the Emergency Room
Once the patient is at the hospital, health care providers focus on:
- Maintaining the person’s ability to breathe
- Immobilizing the neck to prevent further spinal cord damage
Health care providers also may treat an acute injury with:
- Surgery. Doctors may use surgery to remove fluid or tissue that presses on thespinal cord (decompression laminectomy); remove bone fragments, disk fragments, or foreign objects; fuse broken spinal bones; or place spinal braces
- Traction. This technique stabilizes the spine and brings it into proper alignment
- Methylprednisolone (Medrol). If this steroid medication is administered within 8 hours of injury, some patients experience improvement. It appears to work by reducing damage to nerve cells and decreasing inflammation near the site of injury
- Experimental treatments. Scientists are pursuing research on how to halt cell death, control inflammation, and promote the repair or regeneration of nerves.2 See “Is there a cure for SCI?”
People with SCI may benefit from rehabilitation, including3,4:
- Physical therapy geared toward muscle strengthening, communication, and mobility
- Use of assistive devices such as wheelchairs, walkers, and leg braces
- Use of adaptive devices for communication
- Occupational therapy focused on fine motor skills
- Techniques for self-grooming and bladder and bowel management
- Coping strategies for dealing with spasticity and pain
- Vocational therapy to help people get back to work with the use of assistive devices, if needed
- Recreational therapy such as sports and social activities
- Improved strategies for exercise and healthy diets (obesity and diabetes are potential risk factors for persons with SCI)
- Functional electrical stimulation for assistance with restoration of neuromuscular function, sensory function, or autonomic function (e.g., bladder, bowel, or respiratory function).
The major developments in the treatment of SCI have been in the areas of rehabilitation and improvement in quality of life. Even though SCI may disrupt one’s life, those who have experienced this injury can be taught how to use mechanical and technological devices to provide more independence in terms of mobility, working, interacting with their families, and recreation.6 Additional help can be provided to help people with SCIs manage emotional and sexual issues.
Research is ongoing to treat the various symptoms and problems associated with SCI and to develop therapies that promote the regeneration of nerves.
The International Research Consortium on Spinal Cord Injury is one such organization committed to this research. Funded by the Reeve Foundation, the IRCSCI is a collection of laboratories working towards the identification of potential spinal repair treatments. Click here to find out more.
All information above cited from:
NICHD (National Institute of Child Health and Human Development)
FOR PEOPLE WITH SCI…
65% are unemployed
35% Diagnosed with Depression
52% Have no health coverage
50% deal with substance abuse
38% Vehicular inflicted
45% Incomplete Tetraplegia
- Given the current population size of 314 million people in the U.S., the recent estimate showed that the annual incidence of spinal cord injury (SCI) is approximately 54 cases per million population in the U.S. or approximately 17,000 new SCI cases each year.
- The number of people in the U.S. who are alive in 2016 who have SCI has been estimated to be approximately 282,000 persons, with a range from 243,000 to 347,000 persons.
- The average age at injury has increased from 29 years during the 1970s to 42 years currently.
- Incomplete tetraplegia is currently the most frequent neurological category followed by incomplete paraplegia, complete paraplegia, and complete tetraplegia. Less than 1% of persons experienced complete neurological recovery by hospital discharge.
- At one year after injury, 12% of persons with SCI are employed, and by 20 years post-injury, about one third is employed.
- Click here for the official 2016 publication of the National Spinal Cord Injury Statistical Center in collaboration with the Model Systems Knowledge Translation Center.