A spinal cord injury is damage to the spinal cord. The spinal cord is a soft bundle of nerves that extends from the base of the brain to the lower back. It runs through the spinal canal, a tunnel formed by holes in the bones of the spine. The bony spine helps protect the spinal cord.
The spinal cord carries messages between the brain and the rest of the body. These messages allow you to move and to feel touch, among other things. A spinal cord injury stops the flow of messages below the site of the injury. The closer the injury is to the brain, the more of the body is affected.
A spinal cord injury may be complete or incomplete. A person with a complete injury doesn't have any feeling or movement below the level of the injury. In an incomplete injury, the person still has some feeling or movement in the affected area.
A spinal cord injury usually happens because of a sudden severe blow to the spine. Often this is the result of a car crash, fall, gunshot, or sporting injury. Sometimes the spinal cord is damaged by infection or spinal stenosis, or by a birth defect, such as spina bifida.
At the hospital, treatment starts right away to prevent more damage to the spine and spinal cord. Steps are taken to get your blood pressure stable and help you breathe. You may get a steroid medicine to reduce swelling of the spinal cord. A number of tests are done. These include X-ray of the spine, CT scan, MRI, and ultrasound of the kidneys. These tests are repeated over time to check how you are doing.
A few days after the injury, you will be tested to see how you respond to pinpricks and light touch all over your body. The doctor will ask you to move different parts of your body and test the strength of your muscles. These tests help the doctor know how severe the injury is and how likely it is that you could get back some feeling and movement. Most recovery occurs in the first 6 months.
As soon as you are stable, rehabilitation (rehab) starts. The goal of rehab is to help prepare you for life after rehab and help you be as independent as possible. What happens in rehab depends on your level of injury. The rehab team will help you to learn how to:
There is a lot to learn, and it may seem overwhelming at times. But with practice and support, it will get easier.
Having a spinal cord injury changes some things forever, but you can still have a full and rewarding life. A saying among people who have a spinal cord injury is, "Before your injury, you could do 10,000 things. Now you can do 9,000. So are you going to worry about the 1,000 things you can't do or focus on the 9,000 things you can do?"
After they adjust, many people with spinal cord injuries are able to work, drive, play sports, and have relationships and families. Your rehab team can provide the support, training, and resources to help you move toward new goals. It's up to you to make the most of what they have to offer.
Adapting to life with a spinal cord injury can be tough. You can expect to feel sad or angry at times or to grieve for your lost abilities. It is important to express these feelings so they don't keep you from moving ahead. Talk with family and friends, find a support group, or connect with others online. Talking to other people who have spinal cord injuries can be a big help.
It's hard to enjoy life if you have ongoing pain or depression. If you do, tell your doctor. There are medicines and other treatments that can help.
Caring for a person who has a spinal cord injury can be both rewarding and difficult. If you help take care of someone who has a spinal cord injury, don't forget to take care of yourself too. Find a local support group, and make time to do things you enjoy.
Learning about a spinal cord injury (SCI):
Learning about rehabilitation:
Managing medical conditions and complications:
Living with an SCI:
Often a spinal cord injury (SCI) is caused by a blow to the spine, resulting in broken or dislocated bones of the spine (vertebrae). The vertebrae bruise or tear the spinal cord, damaging nerve cells.
When the nerve cells are damaged, messages cannot travel back and forth between the brain and the rest of the body. This causes a complete or partial loss of movement (paralysis) and feeling.
Sometimes the spinal cord is damaged by infection, bleeding into the space around the spinal cord, spinal stenosis, or a birth defect, such as spina bifida.
A person with a potential SCI is taken to an emergency department and then to an intensive care unit. The first priority is stabilizing blood pressure and lung function, as well as the spine, to prevent further damage. When a spinal cord injury is caused by a serious accident, such as a car crash or a fall from a roof, treatment for other injuries is often needed.
The following tests may be done right away to help find out the extent of the injury. They may also be done routinely throughout and after you leave rehabilitation (rehab).
A few days after the injury, your doctor will ask you questions. Also, he or she will test not only the strength of key muscles but also your response to light touch and pinpricks all over your body.
An SCI can be classified based on how much feeling and movement you have or where the damage occurred. When a nerve in the spinal cord is injured, the nerve location and number are often used to describe how much damage there is.
The vertebrae and spinal nerves are organized into segments, starting at the top of the spinal cord. Within each segment they are numbered.
People with SCIs often use a segment of the spine to talk about their functional level. (Your functional level is how much of your body you can move and feel.) For example, you might describe yourself as a "C7."
The nerves around a vertebra control specific parts of the body. Paralysis occurs in the areas of the body that are controlled by the nerves associated with the damaged vertebrae and the nerves below the damaged vertebrae. The higher the injury on the spinal cord, the more paralysis there is.
Damage to the spinal cord can be complete or incomplete.
Some recovery of feeling and movement may return after the injury-how much depends on the level of injury, the strength of your muscles, and whether the injury is complete or incomplete. Most recovery occurs within the first 6 months of the injury.
After a traumatic SCI, your loved ones will often ask questions about the injury and what it means. Keep your answers short, simple, and honest. You cannot give a complete answer, because it's often hard to know how serious the injury is and how much you will recover. This typically is not known until swelling and bleeding are reduced and the doctors can find out where the spinal cord has been injured.
After emergency treatment and stabilization, you will move into rehab. A rehab centre helps you adjust to life, both physically and emotionally. The goal of rehab is to help you be as independent as possible.
Your rehab depends on your level of injury. You may have to learn how to manage your bowel and bladder, walk with crutches, do breathing exercises, and move between a wheelchair and another location.
As soon as you are stabilized after your spinal cord injury (SCI), your transition into rehabilitation (rehab) begins. The initial focus of rehab is to prevent complications related to your SCI and for you to relearn how to do daily functions, sometimes by using different muscle groups.
Rehab centres help you adjust-physically and emotionally-to life with less mobility and feeling than you previously had. What rehab does depends on which part of your spine was injured. Rehab can include learning how to:
Rehab for an SCI generally takes place in a special centre. You and your family work with a rehab team, which includes your doctor, rehab nurses, and specialists such as physiotherapists and occupational therapists. Your rehab team designs a unique plan for your recovery that will help you recover as much function as possible, prevent complications, and help you live as independently as possible.
Choosing the right rehab centre is important. Be sure that you choose one that meets your specific needs. Before choosing a rehab centre, ask questions about its staff, accreditation, and activities, and how it transitions you back into your community.
Good bladder management can improve your quality of life by preventing bladder problems, which is one of the biggest concerns for people who have spinal cord injuries (SCIs).
Normally, the kidneys filter waste products and water from the blood to form urine, which is stored in the bladder. When the bladder is full, a message is sent from the bladder to the brain. The brain sends a message back to the bladder to squeeze the bladder muscle and relax the sphincter muscles that control the flow of urine. After the bladder starts to empty, it normally empties all of the urine.
After an SCI, the kidneys usually continue to filter waste, and urine is stored in the bladder. But messages may not be able to move between your bladder and sphincter muscles and your brain. This can result in the:
Not taking good care of your bladder can lead to urinary tract infections (UTIs), kidney and bladder problems, sepsis (a bloodstream infection), and, in rare cases, kidney failure. For information on testing for, treating, and preventing UTIs, see the topic Urinary Tract Infections in Teenagers and Adults.
A bladder management program lets you or a caregiver empty your bladder when it is easy for you and helps you avoid bladder accidents and prevent UTIs. You and your rehabilitation team decide which bladder management program is best for you. You need to consider where your spinal cord is injured and how it has affected your bladder function. You also need to consider your lifestyle, how likely you are to get bladder infections, and whether you or a caregiver is able to use a catheter.
The most important things in bladder management are monitoring the amount of fluids you drink, following a regular schedule for emptying your bladder, and being sure that you empty your bladder completely. Your rehab team will help you set up a schedule based on your needs and the amount of fluids you typically drink.
Common ways to manage bladder function include the following:
You may use just one method or a combination.
A number of medicines are available to help you manage your bladder. These include:
Research continues on bladder management. New methods include surgically implanted components that stimulate the bladder through a radio control.
Note: Bladder problems can trigger autonomic dysreflexia, which causes sudden very high blood pressure and headaches. If not treated promptly and correctly, it may lead to seizures, stroke, and even death. These complications are rare, but it's important to know the symptoms and watch for them.
You or a caregiver can manage your bowel problems to prevent unplanned bowel movements, constipation, and diarrhea. Although this often seems overwhelming at first, knowing what to do and establishing a pattern makes bowel care easier and reduces your risk of accidents.
A spinal cord injury generally affects the process of eliminating waste from the intestines, causing a:
When choosing a way to deal with bowel problems, you and your rehab team will discuss such things as the type of bowel problem you have, your diet, whether you or a caregiver will do the program, and any medicines that may affect your program.
For best results:
It is important to be clean and gentle when inserting anything into the anus.
Note: Bowel problems can trigger autonomic dysreflexia, which causes sudden very high blood pressure and headaches. If not treated promptly and correctly, it may lead to seizures, stroke, and even death. These complications are rare, but it is important to know the symptoms and watch for them.
When you have a spinal cord injury, the nerves that normally signal discomfort and alert you to relieve pressure by changing position may no longer work. This can cause pressure sores, which are injuries to the skin and the tissue under the skin. They often develop on skin that covers bony areas, such as the hips, heels, or tailbone. Pressure sores can also occur in places where the skin folds over on itself. They are described in four stages that range from mild reddening of the skin to severe complications, such as infection of the bone or blood. They can be hard to treat and slow to heal.
Pressure sores may be caused by:
Pressure sores are usually diagnosed with a physical examination. A skin and wound culture or a skin biopsy may be done if your doctor thinks you may have an infection.
You or your caregiver can help prevent pressure sores. These steps can help keep skin healthy:
For more information on prevention, see the topic Pressure Sores.
Watch for early signs of a pressure sore. These can include:
Contact your doctor if you:
General treatment for pressure sores is to keep the area dry and clean, eat well, and reduce pressure. All pressure sores need to be treated early. If a sore progresses to stage 3 or 4, it is hard to treat and can lead to serious complications. Specific treatment depends on the stage of the pressure sore.
For more information on treatment, see the topic Pressure Sores.
Note: Pressure sores can trigger autonomic dysreflexia, which causes sudden very high blood pressure and headaches. If not treated promptly and correctly, it may lead to seizures, stroke, and even death. These complications are rare, but it is important to know the symptoms and watch for them.
Breathing is usually something we do without thinking. But a spinal cord injury (SCI) may affect some of the muscles needed for breathing. This makes it hard to breathe, cough, and bring up mucus from the lungs, which leads to a greater risk of lung infections such as pneumonia.
How your breathing muscles are affected and what it means to your ability to breathe depends on which part of your spine was injured.
There are things you can do to help prevent lung problems.
And there are things you can do that aren't directly related to your lungs.
Choking is a danger if you have an SCI, because the usual cough mechanism may not be strong enough to bring up the item that is choking you. If choking occurs, your caregiver should:
All spinal cord injuries are different. How they affect intimacy and sexual function-and how people will react to the change-varies. Because of this, you need to make your own observations and evaluate your experiences to understand your changes in sexual function and how to best deal with them.
After a spinal cord injury (SCI), how you look and what you are able to do changes. An SCI may also affect how your sexual organs work. These changes often result in frustration, anger, and disappointment, all of which can strain a relationship. People with SCIs may wonder if they will be able to maintain the relationship they are in or develop new ones.
But being intimate means more than just having sex. Your interests, ideas, and behaviour play a greater role in defining you than your appearance or your ability to have sex. A relationship depends on many things, including shared interests, how you deal with personal likes and dislikes, and how you treat each other.
The most important thing in a relationship is how well you communicate. Talk to your partner. Be honest about how the SCI has affected your sexual function and how you feel about it. Always keep in mind that people with SCIs can have relationships and marry, have an active sex life, and have children.
Usually, men and women are sexually aroused through two pathways: direct stimulation of the genitals or other erotic area or through thinking, hearing, or seeing something sexually arousing. In men, this usually causes an erection, and in women it causes lubrication of the vagina and swelling of the clitoris. An SCI can affect either of these pathways and may change a person's physical response to arousal. Most people remain interested in sexual activity after an SCI, although the level of interest may decrease.
Many men with an SCI resume sexual activity within about 1 year of the injury. Men who are able to have an erection may find that the erection isn't rigid enough or doesn't last long enough for sexual activity. Some have retrograde ejaculation, in which semen goes into the bladder instead of out through the penis.
Women may have some, or complete, loss of vaginal sensation and muscle control. Both men and women can achieve orgasm, although it may not be as intense as before the SCI.
Your sex life will probably be different after your spinal cord injury, but sexual intimacy is still possible and encouraged. Your rehabilitation centre may have a counsellor or other health professional who specializes in sexual health after an SCI. He or she may be able to help you and your partner with these issues.
Always talk to a doctor familiar with SCIs before using any medicines or devices. Discuss the location of your injury, possible side effects, and any other medical conditions you have.
You also need to watch for autonomic dysreflexia, which causes sudden very high blood pressure. If not treated promptly and correctly, it may lead to seizures, stroke, and even death. These complications are rare, but it is important to know the symptoms and watch for them.
Men who can't get an erection can use the treatments for erection problems (erectile dysfunction). These include:
For information on the treatment of erection problems, see the topic Erection Problems.
Women who have problems being aroused and have little or no vaginal lubrication may use:
Both men and women can use sensual exercises that you do with your partner to find areas of your body that react to stimulation.
Most men with SCIs have poor sperm quality and have trouble ejaculating. To have children, men with SCIs can use penile stimulation to obtain sperm for assistive reproductive technologies. Vibrators are available that are specially made to induce ejaculation in men with SCIs.
Vibrators can damage your skin. Use them carefully if you don't have feeling in your penis.
If vibrator stimulation isn't successful, rectal probe electro ejaculation (RPE) is an option. In this procedure, your doctor inserts an electrical probe into the rectum to stimulate ejaculation.
An SCI usually won't affect a woman's ability to get pregnant. You may have a brief pause in your menstrual cycle after an SCI. But after your period returns, you will probably be able to get pregnant.
If you are sexually active after your injury, make sure to use birth control if you don't want to get pregnant.
If you do want to get pregnant, make sure to be aware of the special medical, psychological, and social issues involved in an SCI pregnancy. Work with doctors who understand these issues. Common concerns and complications during pregnancy include:footnote 1
Grief is one of the many challenges of adjusting to life after a spinal cord injury. It's your reaction to loss, and it affects you both emotionally and physically. But letting your emotions control you can result in unhealthy decisions and behaviour, a longer rehab, and taking longer to adjust to your spinal cord injury (SCI). Feeling and naming your emotions, and talking to others about them, will help you feel more solid and in control.
Talking to a professional counsellor who understands the challenges of living with an SCI can be very helpful during tough times.
For more information on the grieving process, see the topic Grief and Grieving.
Pain in an SCI can be complicated and confusing. You may feel pain where you have feeling. But you may also feel pain in an area where otherwise you have no feeling. The pain may be severe at some times. But at other times it may disappear or bother you only a little.
The most common type of pain is neuropathic pain, caused by damage to the nervous system. Other types of pain include musculoskeletal pain (in the bones, muscles, and joints), and visceral pain (in the abdomen).
Don't ignore your pain. Talk to your doctor about it. He or she can help figure out the type of pain and how to manage it. Also, pain can signal a more serious problem.
The best treatment depends on the type of pain. But you will probably need to:
For more information on managing pain, see the topic Chronic Pain.
Movement is what keeps your muscles strong and your joints flexible. So if you cannot move your muscles and joints easily, you may lose strength and some of your range of motion. This will make it harder to perform daily activities, such as getting dressed or moving between your wheelchair and other locations. With exercise, you can keep or improve your flexibility and reduce muscle spasticity. Exercise can also help prevent heart problems, diabetes, pressure sores, pneumonia, high blood pressure, urinary tract infections, and weight problems.
What exercises you can do will depend on what part of your spinal cord was injured. You may be able to do:
Taking part in sports is an excellent way to exercise. And there are often leagues or groups to promote wheelchair basketball and racing and other activities. Staying active provides both physical and emotional benefits.
Note: Exercise may trigger autonomic dysreflexia, which can cause sudden very high blood pressure and headaches. If not treated promptly and correctly, it may lead to seizures, stroke, and even death. These complications are rare, but it is important to know the symptoms and watch for them.
Eating a healthy diet can help you reduce your risk of some complications and can make other tasks, such as bowel management, easier. And it can help you reach and stay at a healthy weight. Being either underweight or overweight increases your risk of pressure sores.
If you have special nutritional needs, such as needing extra protein or fibre, a registered dietitian can help you plan a diet.
For more information on a healthy diet and weight, see:
Mobility is an important aspect of a spinal cord injury. Mobility devices, such as crutches, walkers, wheelchairs, and scooters, can help you be more independent. They may allow you to work, shop, travel, or take part in sports.
Moving from a wheelchair to another location is known as a transfer. Your injury and strength will determine what type of transfer you can do. You may be able to do it yourself, or you may need help. There are some important things to know for safe transfers, such as to lock your wheelchair and make the distance between the transfer surfaces as small as possible.
As your rehab ends, you and your loved ones need to start thinking about what you need to do when you are at home. Because you may have to use a wheelchair (lowering your height) and have limited movement and feeling, you may have to adapt your home.
Considerations for adapting your home include ramps and widened doorways, special utensils for eating, and special devices for dressing and grooming.
Today, with improved medical care and support, the outlook for people with SCIs is better than ever. In many cases, 1 year after the injury, life expectancy is close to that of a person without an SCI.footnote 2
If you are planning to work, you have the same legal rights as before your injury. People with spinal cord injuries who want to work are legally protected from discrimination by the Employment Equity Act.
Plan ahead for possible serious and life-threatening complications. You, your family, and your doctor should discuss what types of medical treatment you want if you have a sudden, life-threatening problem. You may want to create an advance care plan to province your wishes if you become unable to communicate.
For more information, see:
There may be a time when you have a medical emergency and need to contact a doctor.
Be prepared to call your spinal care injury provider,
, or other emergency services if you or the person with the spinal cord injury has the symptoms of autonomic dysreflexia, which causes sudden very high blood pressure. If it isn't treated promptly and correctly, it may lead to seizures, stroke, and even death. Symptoms include:
or other emergency services if you fall or have another accident and you notice:
Call your doctor right away if you have symptoms of a urinary tract infection. These include:
Depending on your level of injury, you may also feel burning while urinating and/or pain or discomfort in the lower pelvic area, belly, or lower back.
Call your doctor right away if you have symptoms of pneumonia. These include:
Call your doctor for an appointment if you have a pressure sore and:
Your first experience as a caregiver for a spinal cord injury (SCI) usually comes during rehabilitation (rehab). Although the rehab team takes the lead at this point in your loved one's recovery, there are some things you can do to help.
Before your loved one returns home, a decision has to be made about who is to be the main caregiver. You or another family member may feel that you should be the main caregiver. But there may be reasons why this could be hard, such as:
Discuss with the rehab team what it means to be a caregiver. They can help you see what the full impact of caring for someone with an SCI will be. And if you cannot be a full-time caregiver, the rehab team can help you find a nursing home, an assisted-living facility, or in-home help. They can also give you training in helping your loved one, even if you aren't the full-time caregiver. You may need to help him or her do exercises, move in and out of the wheelchair, and get dressed, for example.
Whether or not you are the main caregiver, you need to attend to your own well-being.
Whether or not you are the main caregiver for your loved one, living with and/or caring for him or her can be both rewarding and difficult. Watching someone deal with such a serious injury can be painful but also inspirational. Sharing the small and large victories can provide a shared pleasure and forge a stronger relationship. But setbacks and "bad days" can be frustrating and traumatic.
The key to working through frustrations is communication. It is important that both you and your loved one talk about what bothers you and about what your expectations are. In a sense, you are in a new relationship: roles in your family may have changed dramatically. Discuss what you are feeling about the changes, and explain them. This can help you understand each other's needs and foster a healthy relationship. Love and support are key to your loved one's recovery and to your well-being as a caregiver.
In the past, the results of a spinal cord injury were considered permanent, but new research is changing this outlook. There may be a cure for paralysis some day.
Major research areas for SCIs include ways to stimulate activity in damaged nerve cells (neurorestorative), stimulate growth in damaged nerve cells (neuroregenerative), transplant new nerve tissue into the spinal cord (neuroconstructive), and insert genes into the spinal cord (neurogenetic). Research is also looking at ways to improve what people with SCIs can do physically (functional research).
Spinal cord injuries are extremely complex. And research must move from theory to practical and from animal studies to human studies. When a treatment is being studied in humans, it must be proved beneficial and safe. And it can take years before a new treatment reaches the public.
American College of Obstetricians and Gynecologists (2002, reaffirmed 2005). Obstetric management of patients with spinal cord injuries. ACOG Committee Opinion No. 275. Obstetrics and Gynecology, 100(3): 625–627.
National SCI Statistical Center (2012). Spinal cord injury facts and figures at a glance. Birmingham, AL: National Spinal Cord Injury Statistical Center. Available online: https://www.nscisc.uab.edu.
Other Works Consulted
Consortium for Spinal Cord Medicine (2006). Bladder management for adults with spinal cord injury. Available online: http://www.pva.org.
Keenan MAE, et al. (2014). Rehabilitation. In HB Skinner, PJ McMahon, eds., Current Diagnosis and Treatment in Orthopedics, 5th ed., pp. 595–642. New York: McGraw-Hill.
McDonald JW, Becker D (2003). Spinal cord injury: Promising interventions and realistic goals. American Journal of Physical Medicine and Rehabilitation, 82(10, Suppl): S38–S49.
ByHealthwise StaffPrimary Medical ReviewerAdam Husney, MD - Family MedicineBrian D. O'Brien, MD - Internal MedicineMartin J. Gabica, MD - Family MedicineE. Gregory Thompson, MD - Internal MedicineSpecialist Medical ReviewerNancy Greenwald, MD - Physical Medicine and Rehabilitation
Current as ofNovember 14, 2016
Current as of: November 14, 2016
Adam Husney, MD - Family Medicine
& Brian D. O'Brien, MD - Internal Medicine & Martin J. Gabica, MD - Family Medicine & E. Gregory Thompson, MD - Internal Medicine & Nancy Greenwald, MD - Physical Medicine and Rehabilitation
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