Injury to the spinal cord is a medical emergency that may result in severe and permanent disability. The spinal cord—which along with the brain comprises the central nervous system—is a bundle of nerve cells that travels almost the entire length of the spine, connecting the brain to the nerves in the rest of the body. The vertebrae, the small bones that make up the spine, form a bony tunnel that surrounds the cord and protects it from injury. However, if a blow is severe enough, or if the bones are weakened by disease, the spinal cord is vulnerable to damage.
Destroyed nerve cells cannot regenerate; injury to the spinal cord may thus result in permanent paralysis of the legs (paraplegia) or, in the case of a neck injury, the arms, torso and legs (quadriplegia). About half of the cases of spinal cord injury involve the neck. However, partial or complete recovery may be expected in cases when neurons in the spinal cord have been traumatized but not completely destroyed. Outcome thus depends upon both the severity and the specific location of the injury. Damage to the spinal cord will affect nerves at the level of the injury and below.
What Causes Spinal Cord Trauma?
- Injury, from motor vehicle or sports accidents, falls, gun shot or knife wounds, or industrial accidents, is the most common cause of spinal cord trauma.
- Displaced or broken vertebrae can damage the spinal cord directly.
- Swelling of nearby tissues, or a blood clot, may compress the spinal cord.
- Trauma may damage the cord by interrupting its blood supply.
- People with bones weakened by osteoporosis, rheumatoid arthritis, polio or bone cancer are at greater risk for spinal cord damage.
- Joining in risky physical activities, diving into shallow water or not wearing protective gear during work or play are some of the risk factors.
Symptoms of Spinal Cord Trauma
- Intense localized back or neck pain
- Swelling at the site of injury
- Weakness, numbness, tingling and impaired sensation in the limbs and torso below the injured area of the spinal cord
- Paralysis of the legs (paraplegia) or of both the arms and legs (quadriplegia)
- Loss of bowel and bladder control
- Erectile dysfunction (impotence)
- Breathing difficulty
- Spasticity (increase in muscle tone)
- Sensory changes
Spinal Cord Trauma Prevention
- Wear shoulder and lap belts when traveling in a car.
- Be sure water is sufficiently deep before diving.
- Wear protective gear when playing sports.
- Get enough calcium to reduce the risk of osteoporosis. Medications may be recommended to postmenopausal women to prevent osteoporosis.
Diagnosis of Spinal Cord Trauma
- Patient history and physical examination
- X-rays of the spine
- CT (computed tomography) scans or MRI (magnetic resonance imaging)
- X-rays may be taken after injection of a contrast medium (myelography) to outline the spinal cord.
- Neurological exam
How to Treat Spinal Cord Trauma
- Call an ambulance immediately. Do not attempt to move someone who may have a spinal cord injury because any movement may cause further damage to the spinal cord.
- Roll up towels or blankets and put them on both sides of the head. Keep the person’s neck and head still.
- Careful immobilization of the head and back by means of traction, splints, and braces is necessary to prevent further damage.
- Oxygen may be supplied through a small tube inserted into the nose if breathing is impaired owing to paralysis of respiratory muscles.
- Intravenous methylprednisolone, a corticosteroid medication, may be administered within the first eight hours of injury to minimize the extent of nerve damage.
- Surgical decompression of the spinal cord may restore some function if cord damage is incomplete.
- Long-term use of a urinary catheter may be necessary if bladder control is lost.
- Tube feedings may be needed to provide ample nutrition.
- Special prescription support hose and anticoagulant drugs such as heparin help prevent the formation of blood clots in immobilized limbs and the resultant pulmonary emboli.
- Frequent repositioning helps avoid skin breakdown (bed sores) over pressure points.
- Extensive physical therapy can prevent immobilization of joints and contractures of muscle.
- Occupational and emotional therapy help patients and their families cope with major lifestyle changes.
When to Call a Doctor
- EMERGENCY Call an ambulance immediately if you suspect someone has sustained a back or neck injury. Do not attempt to move the person, and do not allow him or her to sit up.
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media