A spinal cord injury (SCI) occurs when trauma causes damage to the spinal cord or its surrounding structures, resulting in partial or complete loss of motor, sensory, or autonomic function below the level of injury. SCI can result from high-impact trauma, such as vehicle accidents, falls, or sports injuries, but may also occur due to penetrating wounds or vertebral fractures compressing the cord. Prompt evaluation and decompression within the first hours after injury can significantly improve neurological recovery and long-term function.
Classification
Based on Mechanism of Injury
- Contusion: Bruising of the spinal cord tissue due to transient compression.
- Compression: Continuous pressure from bone fragments, herniated disc, or hematoma.
- Laceration or Transection: Direct tearing, often from penetrating trauma.
- Ischemic injury: Reduced blood flow leading to cord infarction.
Based on Level of Injury
- Cervical (Neck): May cause quadriplegia (tetraplegia) — paralysis of all four limbs.
- Thoracic: Affects trunk and legs (paraplegia), but arm function remains intact.
- Lumbar and Sacral: Causes paraplegia with preserved upper body strength, often with bowel, bladder, or sexual dysfunction.
Based on Completeness
- Complete injury: No motor or sensory function below the injury level (ASIA A).
- Incomplete injury: Partial preservation of function (ASIA B–E), with varying degrees of recovery potential.
Symptoms
The symptoms depend on the level and severity of spinal cord damage. Common presentations include:
- Loss of sensation (numbness, tingling, or total loss of feeling) below the injury
- Weakness or paralysis in limbs
- Loss of bladder and bowel control
- Breathing difficulty (if the injury involves the cervical spine)
- Pain or burning sensation around the injury level
- Low blood pressure and irregular heart rate (from autonomic dysfunction)
Immediate paralysis after trauma may not always mean permanent injury — spinal shock can cause temporary loss of function that may improve in days or weeks.
Diagnosis
Accurate diagnosis is critical for early intervention.
- Neurological examination: Using the ASIA (American Spinal Injury Association) Impairment Scale to grade motor and sensory function.
- CT scan: Detects fractures, bone fragments, or spinal canal narrowing.
- MRI: Visualizes the spinal cord itself, showing edema, hemorrhage, or compression from disc or ligament injury.
- X-rays: Useful for initial assessment in emergency settings.
In multi-trauma patients, full spinal imaging is essential, as injuries can occur at multiple levels.
Treatment & Management
Emergency and Initial Care
- Immobilization of the spine using cervical collars or backboards during transport to prevent further injury.
- Airway, breathing, and circulation (ABC) management — especially critical in cervical injuries affecting respiration.
- High-dose corticosteroids (e.g., methylprednisolone) were once standard but are now controversial; their use is case-dependent.
- Prompt surgical evaluation for decompression and stabilization.
Surgical Decompression and Stabilization
- Surgery is indicated when there is ongoing compression, progressive neurological deficit, or unstable spinal fracture.
- Decompression: Removal of bone, disc, or hematoma pressing on the spinal cord.
- Fixation/Stabilization: Placement of screws and rods to restore spinal alignment and stability.
- Timing: Early surgery (within 24 hours) improves motor recovery and outcomes.
Intensive Care and Rehabilitation
- ICU monitoring for respiratory and cardiovascular stability
- Prevention of pressure ulcers, infections, and thrombosis
- Physiotherapy and occupational therapy begin as soon as medically safe
- Bladder and bowel training, with urological support
- Psychological support and family counseling are integral parts of recovery.
Advanced Rehabilitation
- Functional electrical stimulation (FES) and robotic gait training
- Exoskeleton-assisted walking programs
- Spasticity control using medications or intrathecal baclofen pumps
- Assistive technology for independence in daily activities
Recovery & Prognosis
Recovery depends on injury severity, timing of decompression, and rehabilitation intensity.
- Incomplete injuries often regain partial function.
- Complete injuries may show limited recovery but benefit greatly from early rehab and adaptive techniques.
Maximum neurological improvement typically occurs within the first 6–12 months, though rehabilitation continues beyond this period for functional independence.
Complications
- Pressure ulcers from immobility
- Deep vein thrombosis (DVT) and pulmonary embolism
- Autonomic dysreflexia — dangerous rise in blood pressure due to stimuli below injury
- Respiratory infections, especially in cervical injuries
- Spasticity and chronic pain
- Urinary and bowel dysfunction
Multidisciplinary management helps prevent and control these complications.
When to Seek Emergency Care
- Weakness, numbness, or loss of sensation in the limbs
- Loss of bladder or bowel control
- Severe neck or back pain after injury
- Difficulty breathing or maintaining balance
Early immobilization, imaging, and surgical evaluation are critical for preserving function and preventing permanent paralysis.
Patient Advisory
Treatment and recovery plans are always individualized. Each patient’s condition is unique — some require early surgical decompression, while others may recover with conservative care and rehabilitation. Decisions must always be made by the treating neurosurgeon. Do not rely solely on online information for medical decision-making.