Spinal Injury

Effects of Spinal Injury

The spinal cord

The spinal cord is houses within the spinal column and links the brain to the body. It is a cylindrical cord comprising of millions of nerve fibres and is the around ½ inch thick. It is surrounded by a spinal fluid which provides protective cushioning.

The spinal cord is a nerve system which runs alongside the spinal column and receives signals from the brain in order to control our body. The spinal nerves branch off from the spinal cord into the vertebrae.

The spinal Column

The spinal column comprises of bones (thirty-three vertebrae) which help give the body structure and assist in providing movement. The spinal column also protects the spinal cord. It runs from the base of the skull down to the pelvis. The vertebrae are held together by a number of ligaments and muscles that allow flexibility. Each vertebrae is separated by cartilage which act as shock absorbers.

The spine comprises of five separate regions:

The Cervical spine

The cervical spine is the neck and contains seven vertebrae named C1 to C7. The cervical region supports the neck and has the greatest range of movement. Vertebrae C1 allows the head to nod whereas C2 allows the head to move side to side. There are eight pains of spinal nerves in the cervical region which enable breathing in addition to providing movement and feeling to the head, neck, shoulders, arms and hands.

The Thoracic

The thoracic region is the upper to mid back and contain twelve vertebrae named T1 to T12. The vertebrae in the thoracic region offer limited movement and provide structure around the rib cage in addition to protecting the internal organs. There are twelve pairs of spinal nerves in the thoracic region. The upper nerves help with breathing whereas the lower nerves provide power to the abdominal muscles (which is important for balance and posture) and help with coughing.

The Lumbar

The lumbar region is the lower back and contains five vertebrae named L1 to L5. They are typically larger and carry most of the body’s weight. They absorb stress from lifting and carrying and offer a greater range of movement. There are five pairs of spinal nerves which power the lower limbs and therefore control standing and walking.

The Sacrum

This is the pelvic area and contains vertebrae named S1 to S5. The vertebrae are fused in a triangular shape sitting behind the pelvis. There are five pairs of spinal nerves (S1 to S5) that supply the buttocks, the bladder, bowel, the sexual region, the legs and the feet.

The Coccyx

This is the tailbone and comprises of four fused bones providing an anchor to the pelvis.

Damage to any one of the spinal nerves can cause a devastating impact.

Types of spinal injury

The types of spinal cord injury are typically classified into the following categories:

  • Complete spinal cord injury

                                 - Paraplegia

                                 - Tetraplegia

  • Incomplete spinal cord injury

                                 - Anterior cord syndrome

                                 - Central cord syndrome

                                 - Posterior cord syndrome

                                 - Brown-Sequard syndrome

                                 - Cauda equina syndrome

Complete spinal cord injury

Of the two main types, a complete spinal cord injury is the most severe and usually involves damage across the whole width of the spinal cord resulting in a complete and permanent loss of function and sensation below the level of injury. The condition is known as paraplegia or tetraplegia.

Paraplegia

Paraplegia is the result of complete damage to the spinal cord below the neck and typically occurs when the thoracic region or below is damaged. This causes complete loss of movement and feeling in the legs whereas the arms and hands can still be normal. 

Injury to the higher thoracic region (the T1 to the T6 vertebrae) causes a complete loss of function and sensation below the mid-chest meaning abdominal muscle is diminished providing little or no trunk control and poor balance when sitting. Bladder and bowel functions may no longer work properly.

Damage in the lower thoracic region causes a loss of function and sensation in the legs although abdominal muscle strength is preserved so there is good balance when sitting along with some general movement of the trunk.

There are also a number a secondary effects following paraplegia including:

  • Chronic nerve pain
  • Deep vein thrombosis
  • Fertility problems
  • High blood pressure
  • Osteoporosis
  • Pressure sores
  • Spasticity

Treatment comprises of a stay in a specialist spinal hospital for up to five months during which time extensive rehabilitation comprising of helping the patient adapt to their injury.

After leaving hospital complete paraplegics can usually achieve a level of self-care using a self-propelled wheelchair. In some cases walking a short distance is possible with aids and equipment.

Tetraplegia

Tetraplegia is where there is a complete loss of function and sensation in the arms, body and legs which typically happens when there has been a severe injury to the cervical region. The higher the site of injury the more severe the loss of function.

Symptoms can include:

  • Complete paralysis of arms, body and legs
  • Inability to breath without assistance
  • Loss of bower and bladder function
  • Inability to transfer independently

In cases where the damage to the spinal cord is lower down the cervical region, there may be some limited use of limbs.

There are a number of secondary effects following Tetraplegia including:

  • Deep vein thrombosis
  • Fertility problems
  • Frozen joints
  • Pressure sores
  • Pneumonia
  • Spasticity
  • High blood pressure

Treatment comprises of a stay in a specialist spinal hospital for up to 12 months. Thereafter an extensive care regime with an emphasis on avoiding secondary symptoms is required, for example regularly moving the patient to prevent pressure sores from occurring.

Incomplete spinal cord injury

Incomplete spinal cord injuries mean that the spinal cord remains intact often meaning that some limited mobility or sensation remains.

If spinal shock has occurred, symptoms exhibited immediately post injury (including paralysis) may improve with some movement and sensation returning in time.

Incomplete spinal cord injuries are typically classified into the following categories:

Anterior cord syndrome

This injury happens when an impact is strong enough to damage the artery that runs along the front of the spinal cord, perhaps by a fragment of broken bone or a slipped disc.   This case lead to a loss of feeling of temperature and vibration.

Central cord syndrome

This is an injury to the nerves at the centre of the spinal cord preventing the brain sending information down the spinal cord to the rest of the body. Damage to the central cord can impact on arm function in addition to bladder and bowel control.

Posterior cord syndrome

This is an injury to the back of the spinal cord which often mean that the patient can continue to move but lacks limb control and coordination.

Brown-Sequard syndrome

Injury occurs to one side of the spinal cord often leading to a complete loss of movement on one side of the body but with preserved sensations of pain and temperature.

Cauda equina syndrome

The cauda equina is a mass group of nerves in the lower back area. Once trauma is suffered the nerves are compressed often causing severe lower back pain. It can cause bladder and bowel dysfunction.

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