Spinal Cord Injury

A spinal cord injury refers to the damage caused to the spinal cord and the resulting disruption of the nervous connection between the spinal cord and the brain. The spinal cord is a long, fragile tubular structure contained within the spinal canal, which runs inside the vertebral column. It extends from the end of the brainstem to the lower part of the lumbar region and, along with the brain, forms the central nervous system. It is made up of bundles of nerve axons that pass between the vertebrae and transmit nerve signals between the brain and the rest of the body. When it is damaged, the transmission is interrupted in the area below the level of the injury.

Spinal cord injuries can affect the spinal cord, the roots of the spinal nerves, or the cauda equina (the bundle of nerve roots extending from the end of the spinal cord). This is a severe condition that leads to a significant alteration of bodily functions.

Symptoms

The main symptom of a spinal cord injury is the reduction or loss of sensory and motor function, which can be temporary or permanent. Depending on the degree of damage, spinal cord injury is classified as:

• Complete Injury: Complete loss of sensation and movement below the level of the injury. This condition is called paralysis.
• Incomplete Injury: Some sensory or motor function remains below the level of the injury.

The area of the body affected by paralysis depends on the location of the injury:

• Tetraplegia: Paralysis of the upper and lower limbs, trunk, and pelvic organs. The spinal cord injury is located in the cervical region of the spine.
• Paraplegia: The upper limbs are unaffected. The spinal cord injury is located in the thoracic, lumbar, or sacral regions.
• Decreased sensation and mobility in the ankle, foot, buttocks, and back of the leg, although walking ability is usually preserved. The injury is located in the conus medullaris (the caudal end of the spinal cord) or the cauda equina.

Causes

Spinal cord injury is usually caused by trauma, either directly damaging the spinal cord or, more commonly, injuring the structures of the vertebral column that result in compression or tearing of the spinal cord. The most frequent causes of spinal cord trauma include:

• Traffic accidents
• Falls and direct blows
• Work or sports injuries
• Stab or gunshot wounds

Although less common, spinal cord injury can also have a non-traumatic origin:

• Congenital malformations, such as spina bífida
• Infections, such as polio
• Tumors
• Degeneration of intervertebral discs
• Vertebral osteoarthritis
• Spinal stenosis
• Ischemia
• Osteoporosis

Risk Factors

Factors that increase the risk of spinal cord injury due to trauma include:

• Sex: More frequent in men
• Age: Increases between the ages of 16 and 30 and after 65
• Alcohol consumption: Involved in a high percentage of traumatic spinal cord injuries
• Risk behaviors, such as reckless driving or practicing sports without protection
• Bone or joint disorders: Trauma-induced damage is more severe

Complications

Paralysis caused by spinal cord injury is likely to be permanent, especially in cases of complete spinal cord injury, which significantly affects the patient’s quality of life. Additionally, spinal cord injury has other consequences:

• Loss of control over bowel and bladder functions
• Sexual dysfunction: The injury can affect erection, ejaculation, lubrication, or fertility
• Muscle atrophy or loss of muscle tone
• Spasticity: Continuous muscle contraction causing stiffness and shortening
• Pressure ulcers, caused by maintaining the same position for prolonged periods
• Circulatory disorders, such as hypotension or thrombosis
• Autonomic dysreflexia: Increased blood pressure due to an exaggerated response from the autonomic nervous system to pain or discomfort. This is a potentially life-threatening disorder
• Weight gain, increasing the risk of cardiovascular disease or diabetes
• Neuropathic pain: Affects the damaged areas but can also radiate
• Respiratory function impairment: Difficulty breathing and coughing or an increased risk of pulmonary diseases
• Mental health deterioration: Pain and the consequences of spinal cord injury can lead to depression

Prevention

Reducing the risk of spinal cord injury means addressing its risk factors:

• Drive safely and responsibly, using a seatbelt and avoiding alcohol or drugs before driving
• Use protective gear when practicing sports
• Reduce the risk of falls by avoiding slippery surfaces, using handrails on stairs, placing non-slip mats in the bathroom, etc.

Which Doctor Treats Spinal Cord Injury?

Spinal cord injuries require a multidisciplinary approach involving specialists in neurology, neurosurgery, orthopedic surgery, physical medicine and rehabilitation, and the traffic unit.