Spinal Cord Injury (SCI): Aftermath and Diagnosis

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The physical and emotional consequences from a spinal cord injury (SCI) can be devastating. Loss of spinal cord function can affect activities that are autonomous (eg, breathing) as well as thought-driven actions (eg, driving). Both motor and sensory functions may be lost.
two people going out for a walk on a sunny day, one using a walker.Spinal cord injury is usually first diagnosed when the patient presents with a loss of function below the level of injury.According to the National Spinal Cord Injury Association (NSCIA), not every spinal cord injury results from a motor vehicle accident (42%), violence (24%), falling (22%), or sports (8%). Occasionally SCIs are caused by diseases such as polio. Spinal cord injuries are usually described using the following terms:

  • Paraparesis: A slight degree of paralysis affecting the lower extremities
  • Paraplegia: Complete paralysis of both lower extremities and usually the lower trunk. The upper extremities are not involved.
  • Quadriparesis: Partial paralysis of all four limbs (arms, legs)
  • Quadriplegia or Tetraplegia: Complete paralysis of all four limbs

Other terms used to describe neural dysfunction include:

  • Paresis: Partial paralysis
  • Paralysis: Partial or complete loss of motor function
  • Paresthesias: Abnormal sensation such as burning or tingling

The spinal cord does not have to be severed for function or sensation to be lost. Most people with spinal cord dysfunction present with the cord intact. Cord injuries usually fall into one of the following categories:

  • Contusions, or bruising of the spinal cord
  • Compression injuries that place pressure on the cord
  • Lacerations or tearing (eg, from a bullet)
  • Central Cord Syndrome
  • Complete severing (rare)

When injury occurs and for a time period following, the spinal cord swells. Loss of function occurs below the level of the injury and may be permanent or temporary. Much depends on the severity of the injury.

Spinal Region Location Area Effected Spinal Levels
Cervical Neck Neck, arms, hands C1 thru C7
Thoracic Chest Torso, parts of the arms T1 thru T12
Lumbar Low Back Hips, legs T12 thru L5
Sacral Pelvis Groin, toes, parts of the leg S1 thru S5

Symptoms may include loss of motor function, sensation or proprioception. The nerves responsible for these functions transmit their messages through the muscles, tendons, joints and other organs.

Destruction of sensory nerve fibers may lead to loss of sensation such as touch, pressure, and temperature. Reflexes may become exaggerated, bladder and bowel control may be lost, even the ability to breath normally may be compromised.

When spinal cord injury is suspected (eg, spinal fracture) immediate medical attention is required. Spinal cord injury is usually first diagnosed when the patient presents with a loss of function below the level of injury.

The initial evaluation includes x-rays, a CT scan, and possibly a MRI. Fractures are demonstrated on plain radiographs. CT scanning and MRI studies are used to evaluate the soft tissues in the spinal column. In addition, a myelogram may be performed to identify and evaluate spinal cord lesions caused by trauma or disease.

The neurologic evaluation includes assessment of the patient's symptoms, which might include loss of motor or sensory function. Other neurologic symptoms may include pain, numbness, paresthesias (eg, tingling), muscle spasm, weakness, and bowel/bladder changes.

Commentary by Michael G. Fehlings, MD, PhD, FRCSC, FACS

Traumatic spinal cord injury (SCI) occurs with an annual incidence of 12,000 new cases per year in the United States and Canada.The physical, emotional and socio-economic impact of these injuries is significant. Accurate information regarding the anatomy, physiology and consequences of these injuries is of fundamental importance to the patient, family and health care professional.

Updated on: 04/24/18
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Traumatic Spinal Cord Injury's Secondary Injury Cascade
Michael G. Fehlings, MD, PhD, FRCSC, FACS
Professor of Neurosurgery
Department of Surgery
University of Toronto
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Traumatic Spinal Cord Injury's Secondary Injury Cascade

Within a few hours after spinal cord injury, a series of changes called the secondary injury cascade begins and may continue months past the initial SCI.
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