Spinal cord injury occurs when something interferes with the function or structure of the cord. This can include consequences of a medical illness or trauma resulting in over stretching the nerves, a bump, the bone of the vertebra pressing against the cord, a shock wave, electrocution, tumors, infection, poison, lack of oxygen (ischemia), cutting or tearing of the nerves. Spinal cord injury can occur as a fetus develops, from trauma or medical conditions.
Results of a spinal cord injury can appear differently depending on the type and location of the injury. The most common is loss of motor, sensory and slowing of some of the body’s internal organs (autonomic nerve function) below the level of the injury. In general, the higher in the spinal cord an injury occurs, the more function, sensation and internal body functions will be affected.
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Injury that affects all four limbs is called tetraplegia (this used to be called quadriplegia). An injury that affects the lower half of the body is called paraplegia. The significance of these injuries is much more than just arm and leg movement as sensation and all body systems are affected.
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Complete injuries are those where there is no function or sensation below the level of injury. It really means all messages to and from the brain are completely blocked. It does NOT mean your spinal cord is completely severed. Complete injuries indicate no messages are getting through the affected area of injury in the spinal cord. Incomplete injury indicates some messages are getting through. Incomplete injuries are unique to the person. No two incomplete injuries are exactly the same, although they can be similar. Abilities of an individual with an incomplete injury depend on which nerves are transmitting messages.
Individuals with spinal cord injury from medical causes might have several locations of injury resulting in mixed results. Disease caused spinal cord injury evolves over time as the medical condition progresses. An individual may be able to compensate for some muscle weakness or sensory loss in the early stages of the disease. However, at some point, a critical level of disease will occur where function or sensation is severely diminished or lost. No one knows exactly when this time will occur as it is individual for everyone by type of disease and progression.
Traumatic injury occurs suddenly, mostly due to an accident. The area of the spinal cord involvement might be at one level or consecutive levels. Some people might have trauma at two different level of the spinal cord or more depending on location(s) of the injury. Other trauma to the body may also occur at the same time. Effects of the spinal cord injury is immediate.
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Medical professionals might use the term ‘lesion’ to describe the sight of a spinal cord injury. A lesion is damage to an area of the body. It can be from trauma, bruising, pressure, tumor, lack of oxygen, scarring, plaque or any cause of disruption to the spinal cord.
An injury in the cervical and thoracic area of the spinal cord results in an upper motor neuron lesion (UMN). This type of injury is associated with the development of tone (spasticity). You will see this in your muscles of your arms and legs perhaps even in your trunk. Inside your body, organs are also affected by tone. Tone is easiest to notice internally by bowel and bladder function as small amounts of stool or urine automatically being expelled without emptying.
In the lumbar and sacral areas of the bowel, a lower motor neuron lesion (LMN) occurs. This injury results in flaccidity. Very soon after your injury, you might notice the muscles of your legs becoming smaller as the muscles lack tone. The bowel and bladder will fill but not expel stool or urine. Both can become overdistended leading to major complications. Sometimes, the bowel and bladder will expel overflow waste without emptying.
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Anterior Cord Syndrome (sometimes called Ventral Cord Syndrome) is caused by lack of blood flow or lack of oxygen (infarction) to the front two thirds but not the back of the spinal cord and in a part of the brain called the medulla oblongata. The result is loss of motor, pain and temperature sensations but where your body is in space (proprioception) and vibration sensations remain from the level of injury down. Individuals with Anterior Cord Syndrome will note their body position by visually observing their environment as opposed to sensing where their body is positioned.
Central Cord Syndrome is usually caused most often by a fall with over stretching (hyperextension) of the neck. Loss of function occurs from the neck to the nipple line which includes the arms and hands. The torso has variable function and sensation. The lower body has unaffected function but variable to total lack of sensation. Individuals with this type of injury usually retain the ability to walk but might have poor balance. Central Cord Syndrome occurs most often in elderly individuals due to decreased flexibility with age.
Posterior Cord Syndrome results in loss of light touch, vibration and position sense starting at the level of injury. Motor function remains. It is caused from trauma, compression of any length of the back side of the spinal cord, tumors and Multiple Sclerosis.
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Brown-Séquard Syndrome is noted by one side of the body with motor function loss and the other side of the body with sensation loss. Depending on the location of the injury, the result can be presented as tetraplegia or paraplegia. Brown Sequard Syndrome can be caused from a tumor, injury, ischemia (loss of oxygen), puncture, infection or Multiple Sclerosis (MS).
Cauda Equina is an injury to the nerve roots below L2 which results in leg weakness, bowel incontinence, urinary retention and sexual dysfunction.
Conus Medullaris can be caused from an injury or disease affecting the core of nerves inside the nerve root. Injury to this area results in an incomplete spinal cord injury affecting leg function, bowel, bladder and sexual function. Pain is typically present.
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Cord Concussion results from a bump to the spinal cord. Much like a concussion to the brain, the spinal cord can be bruised or have message disruption for about 48 hours with possible return of function thereafter. As with brain concussion, long term dysfunction of various types can occur. Cord concussion is sometimes referred to as a ‘stinger’ especially in the sporting world.
Tethered Cord is an attachment of the spinal cord to the tissues in the tract where the spinal cord is housed in the body. This typically is an anatomical anomaly formed as a fetus and not detected until birth or later in early childhood. Sometime, tethered cord is not detected until adulthood. Surgery can release the cord if necessary. Tethered cord can appear after spinal cord injury due to complications of the injury.
Spina Bifida and other neural tube diseases occur in fetal development. The spinal cord does not form in the enclosed space of the vertebrae. In utero surgery (surgery before birth) can possibly correct spinal placement before a baby is born. Surgery after birth can correct the placement but with mixed results. Taking folic acid (vitamin B9) during pregnancy can reduce the risk of spina bifida. A vitamin like molecule, Inositol, is being tested to assess if prevention of neural tube defects is possible.
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The nerves exiting the vertebrae in the neck area or cervical segments are referred to as C1 through C8. These nerve control signals to the neck, arms, hands, and internal organs. Injuries to these areas result in tetraplegia. Injuries at the cervical level can distort where your body is positioned in space (proprioception.)
Individuals who have an injury above the C4 level usually means loss of movement and sensation in all four limbs, although often shoulder and neck movement is available to facilitate sip and puff devices for mobility, environmental control and communication.
Individuals with C5 injuries often have control of shoulder and biceps, but there is not much control at the wrist or hand. Individuals with a C5 level of injury typically can feed themselves and perform some activities of daily living.
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An individual with an injury at C6 generally has enough wrist control to be able to drive adapted vehicles and handle some toileting activities but lack fine motor control.
Nerves in the thoracic or rib cage area (T1 through T 12) relay signals to the torso and some parts of the arms.
Individuals with injuries from T1 to T8 usually affect control of the upper torso, limiting trunk movement and sensation as the result of a lack of abdominal muscle control. This can affect balance as well as proprioception (where your body is in space).
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Nerves in the lumbar and sacral levels of the spinal cord affect the legs, bowel, bladder and sexual function. The lower nerves are peripheral nerves (outside of the spinal cord) and might be able to be transferred, split or grafted surgically to improve function.
There are two main parts of the nervous system, the central nervous system (CNS) and the peripheral nervous system (PNS). The central nervous system (CNS) is made up of the brain and spinal cord which is
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