Definition

A spinal cord injury (SCI) is caused by damage to the spinal cord that leads to a partial or complete loss of function. The spinal cord is not necessarily severed. The amount of permanent disability and possibility of recovery depend primarily on the severity of the injury, at what level the spinal cord was injured, and can also be influenced by treatment that is received.

Causes

Trauma, such as car accidents, falls, diving accidents, gunshot wounds, shrapnel injury, etc. is by far the leading cause of SCI. Other causes are:

  • Tumor, either of the spinal cord itself or in or around the spinal column causing compression of the spinal cord.
  • Spinal vascular malformations
  • Ischemia (lack of blood flow to the spinal cord)
  • Abscess
  • Hematoma (blood clot)
  • Certain neurodegenerative disorders

Risks

Risk factors are things associated with an increased chance of developing a disease or condition. Risk factors for SCI include:

  • Age – more than half of all SCIs occur in the 16-30 age group
  • Male gender – over 80% of all SCIs occur in males and almost 90% of sports related SCIs
  • Drunken driving
  • High speed, high risk sports
  • Gun violence
  • Cancer
  • Infections
  • Herniated disks, severe spinal stenoisis
  • Spina bifida
  • Neurodegenerative disease
  • Multiple sclerosis

Symptoms 

Symptoms depend on the severity, type, spinal level, and duration of the injury. The higher up on the spinal cord the injury occurs, the more function is lost. Partial injuries may leave the victim with some movement or sensation. Complete injury means there is no function or sensation below the injured level. About half of all SCIs are complete. 

    Early symptoms

  • Pain
  • Muscle spasm
  • Loss of movement and/or sensation below the level of injury
    • Tetraplegia or quadriplegia (cervical spine)
    • Chest/leg dysfunction (thoracic spine)
    • Paraplegia and loss of bowel/bladder function (lumbar spine)
  • Tingling sensation in the hands, feet or digits
  • Inability to breathe independently, regulate blood pressure, heart rate and body temperature
  • Loss of bowel/bladder control
  • Problems with balance or walking

    Late symptoms

  • Spasticity
  • Autonomic dysreflexia

Diagnosis 

SCI is usually suspected when a patient loses function below the level of injury. In cases where impaired mental status, drug or alcohol intoxication, or painful injuries make an accurate physical assessment difficult, there should be a high degree of suspicion of SCI in trauma cases. 

Also useful are:

  • Magnetic Resonance Imaging
  • Computerized Tomography scan
  • X-ray

Treatment 

Prompt stabilization and decompression of the spinal cord are essential to maximize any possible recovery.

  • Immobilization of the spinal column
  • Intensive care monitoring
  • Traction is sometimes indicated for cervical spine injury
  • High dose steroids as soon as possible after injury
  • Surgery for correctable lesions such as ongoing compression, for removal of tumors and vascular malformations, to repair damage to the spinal column or to prevent further worsening
  • Rehabilitation

Prevention 

Avoiding injury is the most important way to prevent SCI.

  • Wear seatbelts & use age appropriate car seats for children
  • Always have a designated driver
  • Avoid falls – use nonskid rugs, handrails & rubber mats in the bathroom, avoid icy surfaces in winter, and be aware of medications that may cause dizziness or weakness.
  • Avoid diving in shallow water or under the influence of drugs or alcohol
  • Use proper athletic protective equipment for contact sports
  • Follow good firearm safety practices


MRI showing a herniated disk at C4/5 (arrow), cord edema at multiple levels and signal change within the spinal cord (light areas) indicating change.

Case Study

A 58 year old female presented with a severe central cord injury after falling in the bathroom. The damage was significant; unable to walk, operate her wheelchair or use her hands, she required total care. Her MRI showed a large cervical disc herniation and significant spinal stenosis causing compression of the cord. In this case a two staged (anterior and posterior) multilevel decompression procedure was performed.

In the immediate post-operative period she did not recover a great deal of function. She was referred to the Mount Sinai Spinal Cord Injury Rehabilitation Program where she spent five weeks. Upon discharge she continued with physical therapy from home. At her follow-up visit three months later she had improved dramatically. Though she still had some left-sided weakness, she was walking again, using only a cane for assistance. She had regained her independence and significantly improved her quality of life.

If you want to learn more about treatment for Spinal Cord Injury, call the Mount Sinai Department of Neurosurgery at 212-241-2377.