Diagnosis of Traumatic Spinal Cord Injury

The diagnostic process may start at the scene of the traumatic incident.

If you’ve suffered a physically traumatic event and suspect a spinal cord injury (SCI), it’s important you receive prompt emergency care. The emergency department doctor’s evaluation of your condition includes a comprehensive physical and neurological examination, usually with imaging tests that help assess the status of your spinal column and spinal cord.
Doctor performing a diagnostic evaluation on a tablet computerIf your doctor suspects spinal cord injury, imaging tests are performed to provide detailed information about your spinal column and spinal cord. This article describes how doctors diagnose SCI, and includes some of the common signs and symptoms that may help confirm a diagnosis.

Signs and Symptoms of Spinal Cord Injury
The location and severity of SCI depends on where damaged nerve roots exit your spinal canal and the amount of preserved spinal cord tissue. Though the damage occurs in your spine, the signs and symptoms of spinal cord injury can extend well beyond your neck and back.

Spinal cord injury can cause partial or complete loss of sensation and function (paralysis) below the injury, and nerve dysfunction throughout your body depending on where the injury occurred. For example, injuries in your upper cervical spine (neck) can cause nerve dysfunction in your diaphragm, and injuries above your lumbar spine (low back) can cause nerve problems in your abdomen.
Spine and Segments ChartThe cervical, thoracic, lumbar and sacral levels of the spinal column includes the parts of the body each nerve root innervates.In addition to affecting sensation and movement, SCI can also disrupt the sympathetic nervous system (SNS), as some sympathetic nerve cells live in the spinal cord. Your SNS is key to several active functions throughout your body, including breathing and digestion. In SCI, the reduction in sympathetic nerve cells from the spinal cord may change the functional ability of blood vessels below the level of injury. In the case of someone experiencing a SCI in the neck or upper back, this can lead to severe low blood pressure and slowed heart rate. Slowed heart activity after SCI is called neurogenic shock, which shouldn’t be confused with spinal shock (a short-term state of paralysis after SCI).

SCI can also disrupt the nerves serving your secondary lymphatic organs, including your lymph nodes and spleen. This can increase your risk for infection, which is of particular concern as urinary tract infections and pneumonia are leading causes of early death in people with spinal cord injury.

The Spinal Cord Injury Diagnostic Process
Often, first responders or emergency medical technicians (EMTs) arrive early at the scene of a traumatic event. EMTs provide immediate urgent care that may be life-saving and help ensure your safe arrival to the hospital. They check your vital signs, monitoring your breathing, and stabilize your spine with a rigid neck brace and backboard for transport in the ambulance.

Once at the hospital, you undergo a complete physical and neurological examination to assess your ability to move (ie, functional capacity) and determine any loss of feeling, such as in your arms and legs. If your doctor suspects spinal cord injury, imaging tests are performed to provide detailed information about your spinal column and spinal cord. Depending on the early results of your examinations and imaging studies, additional tests may be necessary.

Tests to Confirm Spinal Cord Injury
The 3 most common imaging tools used to diagnose SCI are x‑rays, CT scans, and magnetic resonance imaging (MRI).

X-ray
X‑rays can detect obvious spinal fractures that often occur after SCI, but they are less helpful at identifying smaller fractures in the neck.

Computed Tomography (CT) scan
Another common first-line diagnostic tool is the CT scan, which is extremely accurate in identifying spinal fractures and bone problems. In fact, many doctors prefer to use CT scan over x-ray to get a clearer, more comprehensive picture of the spinal damage. However, CT scans are less useful at detecting soft-tissue damage affecting the spinal discs, ligaments, spinal cord, and nerve roots.

  • CT angiography may also be performed. This test combines CT technology with a contrast medium (ie, radiopaque dye) to highlight details of the blood vessels, such as the vertebral arteries in your neck.

Magnetic Resonance Imaging (MRI)
Though CT scans aren’t ideal for showing soft tissue structures, MRI can illuminate them. MRI can reveal specifics about a spinal injury, such as hemorrhage, disc herniation, or other types of soft tissue disruptions.

The timing and use of MRI to diagnose a spinal cord injury is somewhat controversial. In some cases, MRI has clear benefits for patients with SCI. For example, using MRI in patients who have a cervical spinal cord injury before they undergo traction treatment allows doctors to see a possible disc bulge or herniation. Identifying a disc disorder before traction may help prevent new or additional nerve-related problems down the line.

However, waiting on MRI means possibly preventing the patient from receiving a timely decompression surgery. Another risk associated with MRI is physically moving a patient with an unstable spine to the machine. Ultimately, your doctor decides whether MRI poses clear benefits or risks for you.

How Electrophysiology Sheds Light on Spinal Cord Damage
A more advanced way to identify nerve dysfunction is through electrophysiology. It is the study of electric activity within the body. As it relates to SCI, electrophysiology can help your doctor understand the extent of your neurological damage.

Electrical signals can show if nerve pathways are damaged. The data from how the nerves process the signals is then shown on a chart for analysis. By understanding the extent of your nerve damage, your doctor is better able to predict what recovery and realistic outcomes might look like for you.

More research is needed to refine electrophysiology as a diagnostic predictor for SCI patients. However, electrophysiology might help researchers better understand which therapies are most effective at improving functional recovery after spinal cord injury.

You’ve Been Diagnosed with a Spinal Cord Injury—Now What?
Learning you’ve suffered a traumatic SCI is scary and can be overwhelming, but there is hope. Your doctor can help you understand your prognosis and path forward. Surgery and rehabilitation may help you to manage pain and protect your quality of life. Even more encouraging is the investment in spinal cord injury research, which promises a brighter future for people impacted by these injuries.

Suggested Additional Reading
A special issue of the Global Spine Journal set forth guidelines for the Management of Degenerative Myelopathy and Acute Spinal Cord Injury, which is summarized on SpineUniverse in Summary of the Clinical Practice Guidelines for the Management of Degenerative Cervical Myelopathy and Traumatic Spinal Cord Injury.

Updated on: 04/24/18
Continue Reading
Spinal Cord Injury Classification and Syndromes
SHOW MAIN MENU
SHOW SUB MENU
Cancel
Delete
Continue Reading:

Spinal Cord Injury Classification and Syndromes

Spinal cord injury is classified by type and severity. The American Spinal Injury Association or ASIA impairment grading system is a diagnostic tool doctors utilize to classify SCI.
Read More