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
• Pain
• Blood clots
• Impaired muscle coordination (or spasticity)
• Pneumonia
• 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
• Obesity
• 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:

• American Spinal Injury Association
• Christopher and Dana Reeve Foundation
• National Spinal Cord Injury Association
• Paralyzed Veterans of America
• Shriner’s Hospitals for Children
• Spinal Injury 101  

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).