Spinal Cord Injuries (SCI)

Scott Smith

Contributor

0 CommentsPrint ArticleSubscribe

Spinal Cord Injury (SCI) is damage to the spinal cord that results in a loss of function such as mobility or feeling. Frequent causes of damage are trauma (car accidents, gunshots, falls, etc.) or disease (polio, spina bifida, Friedreich's Ataxia, etc.). The spinal cord does not have to be severed in order for a loss of functioning to occur. In fact, in most people with SCI, the spinal cord is intact, but the damage to it results in loss of functioning. Almost 11,000 people in the U.S. sustain a traumatic spinal cord injury each year, resulting in temporary or permanent sensory deficit, motor deficit, or bowel or bladder dysfunction. In this country, nearly 200,000 people live with paralysis caused by SCI. More than half the people who sustain an SCI are between 16 and 30 years old. More males than females sustain this type of injury - the ratio is more than four to one. The most common cause of SCI is motor vehicle crashes, account for at least 36% of these injuries (broken down as follows: no restraints uses, 20%, restraints used, 13.7%, motorcycle, 7.4%, accidents involving pedestrians, 5.2%, other 2.1%). Violence-related SCIs have been steadily increasing over the past two decades, and today, violence is associated with 29% of SCIs. Falls and sports cause 21% and 7% of SCI cases, respectively.

In spinal cord injury cases it is essential that measures be taken promptly to preserve evidence, review the medical procedures in questions, and to enable physicians or other expert witnesses to thoroughly evaluate the accident record and injuries.

Effects of SCI

The effects of SCI depend on the type of injury and the level of the injury. SCI can be divided into two types of injury - complete and incomplete. A complete injury means that there is no function below the level of the injury; no sensation and no voluntary movement. Both sides of the body are equally affected. An incomplete injury means that there is some functioning below the primary level of the injury. A person with an incomplete injury may be able to move one limb more than another, may be able to feel parts of the body that cannot be moved, or may have more functioning on one side of the body than the other. With the advances in acute treatment of SCI, incomplete injuries are becoming more common.

The level of injury is very helpful in predicting what parts of the body might be affected by paralysis and loss of function. Remember that in incomplete injuries there will be some variation in these prognoses. Cervical (neck) injuries usually result in quadriplegia. Injuries above the C-4 level may require a ventilator for the person to breathe. C-5 injuries often result in shoulder and biceps control, but no control of the wrist or hand. C-6 injuries generally yield wrist control, but no hand function. Individuals with C-7 and T-1 injuries can straighten their arms but still may have dexterity problems with the hand and fingers.

Injuries at the thoracic level and below result in paraplegia, with the hands not affected. At T-1 to T-8 there is more often control of the hands but poor trunk control as the result of lack of abdominal muscle control. Lower T-injuries (T-9 to T-12) allow good trunk control and good abdominal muscle control. Sitting balance is very good. Lumbar and Sacral injuries yielded decreasing control of the hip flexors and legs.

Besides loss of sensation and motor functioning, individuals with SCI also experience other changes. For example, they may experience dysfunction of the bowel and bladder. Sexual functioning is frequently affected: men with SCI may have their fertility affected, while women's fertility is generally not affected. Very high injuries (C-1, C-2) can result in a loss of many involuntary functions including the ability to breathe, necessitating breathing aids such as mechanical ventilators or diaphragmatic pacemakers. Other effects of SCI may include low blood pressure, inability to regulate blood pressure effectively, reduced control of body temperature, inability to sweat below the level of injury, and chronic pain.

A person can "break their back and neck" yet not sustain a spinal cord injury if only the bones around the spinal cord (the vertebrae) are damaged, but the spinal cord is not affected. In these situations, the individual may not experience paralysis after the bones are stabilized. When a SCI occurs, there is usually swelling of the spinal cord. This may cause changes in virtually every system in the body. After days or weeks, the swelling begins to go down and people may regain some functioning. With many injuries, especially incomplete injures, the individual may recover some functioning as late as 18 months after the injury. In very rare cases, people with SCI will regain some functioning years after the injury. However, only a very small fraction of individuals sustaining SCIS recover all functioning. Currently there is no cure for SCI. There are may researchers attacking this problem, and there have been many advances in the lab. Many of the most exciting advances have resulted in a decrease in damage at the time of the injury. Steroid drugs such as methylprednisolone reduce swelling, which is a common cause of secondary damage at the time of injury. The experimental drug Sygen appears to reduce loss of function, although the mechanism is not complete understood.

In spinal cord injury cases it is essential that measures be taken promptly to preserve evidence, review medical procedures in question, and to enable physicians or other expert witnesses to thoroughly evaluate the accident record and injuries.