What is spinal cord injury?

Spinal cord injuries (SCIs) can be classified based on function (how much feeling and movement you have) or on where the damage occurred. When a nerve in the spinal cord is injured, the nerve location and number are often used to describe how much damage there is. For example, a C7 injury is associated with the seventh cervical nerve of the neck and its effect on feeling and movement. C7 is known as the functional level of injury. People who have SCIs often use these classifications to describe themselves.

SCIs are also described as complete and incomplete. An incomplete injury is further classified into four subsections. The American Spinal Injury Association (ASIA) classifies these injuries as follows:

A (complete).

There is no feeling or movement of the areas of your body that are controlled by your lowest sacral nerves. This means that you don't have feeling around the anus. You can't control the muscle that closes the anus. People with complete spinal cord injuries don't have control of bowel and bladder function.

B (incomplete).

There is feeling but no movement below the level of injury, including sacral segments that control bowel and bladder function.

C (incomplete).

There is feeling and movement below the level of injury. More than half of key muscles can move, but not against gravity. Moving against gravity means moving up. An example is raising your hand to your mouth when you are sitting up.

D (incomplete).

There is feeling and movement below the level of injury. More than half of key muscles can move against gravity.

E (Feeling and movement are normal).

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At the hospital, treatment for an SCI starts right away to prevent more damage to the spine and spinal cord. Steps are taken to get your blood pressure stable and help you breathe. You may get a steroid medicine to reduce swelling of the spinal cord. When a spinal cord injury is caused by a serious accident, treatment for other injuries is often needed.

As soon as you are stable, rehabilitation (rehab) starts. The goal of rehab is to help prepare you for life after rehab and help you be as independent as possible. What happens in rehab depends on your level of injury.

You may have poor sperm quality and have trouble ejaculating. Penile stimulation can be used to obtain sperm for assistive reproductive technologies. Special vibrators can be used to cause ejaculation.

Vibrators can damage your skin. So use them carefully if you don't have feeling in your penis.

If vibrator stimulation doesn't work, rectal probe electroejaculation (RPE) is an option. In this procedure, your doctor inserts an electrical probe into the rectum. This can stimulate ejaculation.

A computed tomography scan (CT scan) and magnetic resonance imaging (MRI) may be done right away to help find out the extent of the injury.

You will be tested to see how you respond to pinpricks and light touch all over your body. The doctor will ask you to move different parts of your body and test the strength of your muscles. These tests help the doctor know how severe the injury is. They help determine how likely it is that you could get back some feeling and movement.

Having an SCI changes some things forever. But you can still have a full and rewarding life. Many people with spinal cord injuries are able to work, drive, play sports, and have relationships and families. But it takes time to adjust. Your rehab team can provide the support, training, and resources to help you move toward new goals. It's up to you to make the most of what they have to offer.

A saying among people who have a spinal cord injury is, "Before your injury, you could do 10,000 things. Now you can do 9,000. So are you going to worry about the 1,000 things you can't do or focus on the 9,000 things you can do?"

Adapting to life with a spinal cord injury can be tough. You can expect to feel sad or angry at times or to grieve for your lost abilities. It is important to express these feelings so they don't keep you from moving ahead. Talk with family and friends, find a support group, or connect with others online. Talking to other people who have spinal cord injuries can be a big help.

It's hard to enjoy life if you have ongoing pain or depression. If you do, tell your doctor. There are medicines and other treatments that can help.

Today, with improved medical care and support, the outlook for people with an SCI is better than ever.

So it's important to plan ahead for your care and other life goals. If you plan to work, you have the same legal rights on the job as before your injury. People with an SCI who want to work are legally protected from discrimination by the Americans with Disabilities Act.

Plan ahead for possible serious and life-threatening complications. You, your family, and your doctor should discuss what types of medical treatment you want if you have a sudden, life-threatening problem. You may want to create an advance directive. It allows you to state your wishes if you become unable to communicate.

Movement keeps your muscles strong and your joints flexible. When you have an SCI and can't move your muscles and joints easily, you may lose strength and some of your range of motion. This makes it harder to perform daily activities, such as getting dressed or moving from your wheelchair to other locations.

With exercise, you can keep or improve your flexibility. You can also reduce muscle spasticity. Exercise can also help prevent heart problems, diabetes, pressure injuries, pneumonia, high blood pressure, urinary tract infections, and weight problems.

What exercises you can do will depend on what part of your spinal cord was injured. You may be able to do:

• Flexibility exercises on your own or with help.
• Strength exercises with free weights or weight machines.

Taking part in sports is also a great way to exercise. Some places have leagues or groups that promote wheelchair basketball and racing and other activities. Staying active provides both physical and emotional benefits.

If someone you care about has had a spinal cord injury, you may feel helpless. It's hard to watch someone who used to be active and independent struggle with basic activities. But there are some things you can do to help.

• Visit and talk with the person often. Find activities you can do together, such as playing cards or watching a movie. Try to keep in touch with their friends as much as possible. Encourage them to visit.
• Help the person practice and learn new skills.
• Find out what they can do without help or what they need help with. Avoid doing things for them that they are able to do without your help.
• Learn what you and your family can do after the person returns home. This may include helping with the wheelchair, getting to and from the bathroom, and eating.

After rehab

Before the person returns home, talk with them and the health care team to see if additional care will be needed at home. If any home care is needed, you all need to agree who will provide this care. If you are deciding whether you can be a caregiver, be sure to consider things such as:

• Your own health, which may limit what you can do to help.
• Your job, which provides income for your family and leaves you with limited time.
• Your own doubts that you could handle taking care of someone who has an SCI.

Discuss with the rehab team what it means to be a caregiver. They can help you see what the full impact of caring for this person will be. And if you cannot provide all of that care, the rehab team can help you find assistance that could include in-home help, an assisted-living facility, or a nursing home. They can also train you to help the person you're supporting, even if you aren't the main caregiver. You may need to help them do exercises, move in and out of their wheelchair, and get dressed, for example.

Relationship challenges

Whether or not you are the main caregiver for the person, living with and/or caring for them can be both rewarding and difficult. Watching someone deal with such a serious injury can be painful but also inspiring. Sharing the small and large victories can provide a shared pleasure and forge a stronger relationship. But setbacks and "bad days" can be frustrating and traumatic.

The key to working through frustrations is communication. It is important that both you and the person talk about what bothers you and about what your expectations are.

In some ways, you are in a new relationship: roles may have changed a lot. Discuss what you're feeling about the changes, and explain them. This can help you understand each other's needs and foster a healthy relationship. Love and support are key to the person's recovery and to your well-being as a caregiver.

The spinal cord is surrounded by protective rings of bone called vertebrae. The vertebrae and spinal nerves are organized into segments, starting at the top of the spinal cord. Within each segment, the vertebrae and nerves are numbered. The segments are as follows:

Cervical.

The neck area contains 7 cervical vertebrae (C1 through C7) and 8 cervical nerves (C1 through C8). Cervical spinal cord injuries (SCIs) usually cause loss of function in the chest, arms, and legs. Cervical injuries can also affect breathing and bowel and bladder control.

Thoracic.

The chest area contains 12 thoracic vertebrae (T1 through T12) and 12 thoracic nerves (T1 through T12). The first thoracic vertebra, T1, is where the top rib attaches to the spine. Thoracic SCIs usually affect the chest and the legs. Injuries to the upper thoracic area can affect breathing. Thoracic injuries can also affect bowel and bladder control.

Lumbar.

The lumbar area (between the chest area and the pelvis) contains 5 lumbar vertebrae (L1 through L5) and 5 lumbar nerves (L1 through L5). Lumbar SCIs usually affect the hips and legs. Lumbar injuries can also affect bowel and bladder control.

Sacral.

The sacral area (from the pelvis to the end of the spine) contains 5 sacral vertebrae (S1 through S5) and 5 sacral nerves (S1 through S5). Sacral SCIs usually affect the hips and legs. Injuries to the upper sacral area can also affect bowel and bladder control.

The higher the damage occurs on the spinal cord, the more of the body is affected. This is because the nerves in the area of a vertebra control body parts in that area. When the spinal cord is damaged, messages can't "jump over" the damaged area. This means that messages sent from the brain can't make it to body parts below the damaged area, and vice versa. So the body at and below the level of injury is affected.

For example, in an injury to the spinal nerves in the neck area (C1 through C8), messages are stopped in the neck area. This usually causes at least some paralysis of the chest, arms, and legs (tetraplegia, also known as quadriplegia). In an L3 injury, messages are stopped at the lower back. This causes at least some paralysis of the legs and hips (paraplegia).

When you have an SCI, you may need to have follow-up tests over time. These may include:

• A bladder test. This measures the size and function of your bladder.
• A spinal X-ray. This monitors your spine's condition.
• A computed tomography scan (CT scan) and magnetic resonance imaging (MRI), which provide detailed pictures of the spine.
• A bone density test. This measures the minerals (such as calcium) in your bones using a special X-ray, a CT scan, or ultrasound.

An SCI usually happens because of a sudden, severe blow to the spine. Broken or dislocated bones of the spine (vertebrae) may damage the spinal cord. Often this is the result of a car accident, fall, gunshot, or sporting accident. Sometimes the spinal cord is damaged by infection or spinal stenosis, or by a birth defect such as spina bifida.

A spinal cord injury (SCI) is damage to the spinal cord. The spinal cord is a soft bundle of nerves that goes from the base of the brain to the lower back. It runs through the spinal canal, a tunnel formed by holes in the bones of the spine. The bony spine helps protect the spinal cord.

The spinal cord carries messages between the brain and the rest of the body. This allows you to move and to feel touch, among other things. A spinal cord injury stops the flow of messages below the site of the injury.

The closer the injury is to the brain, the more of the body that is affected.

• Injury to the middle of the back usually affects the legs. This is called paraplegia.
• Injury to the neck can affect the arms, chest, and legs. This is called quadriplegia.

A spinal cord injury may be complete or incomplete. A person with a complete injury doesn't have any feeling or movement below the level of the injury. In an incomplete injury, the person still has some feeling or movement in the affected area.

Treatment for pain from an SCI depends on the type of pain you have. Treatments may include:

Complementary therapies.

These may help reduce pain. They may also help you cope with stress and improve your emotional and physical well-being. These therapies include:

• Acupuncture. This involves putting very thin needles into the skin at certain points on the body.
• Biofeedback. This is a method of consciously controlling something that is normally controlled automatically by the body, such as skin temperature.
• Guided imagery. This is a series of thoughts and suggestions that direct a person's imagination toward a relaxed, focused state.
• Hypnosis. This is a state of focused concentration. In hypnosis, a person becomes less aware of their surroundings. Some people learn to manage pain by concentrating in this way.
• Yoga. This uses meditation and exercise. Yoga helps you improve your breathing, be more flexible, reduce stress, and stay healthy.

Transcutaneous electrical nerve stimulation (TENS).

This treatment applies brief pulses of electricity to nerve endings in the skin. It can relieve chronic pain.

Counseling (such as cognitive-behavioral therapy).

This focuses on your mental health and conditions such as stress and depression. These can happen along with chronic pain and can make it worse. To recover from your chronic pain, it's important to take care of your emotional health and your physical health.

Medicines for neuropathic pain.

These include anticonvulsants (such as gabapentin) and tricyclic antidepressants (such as amitriptyline).

Anesthetic medicine or surgery.

Segmental pain may be treated by injecting an anesthetic medicine into the space between the wall of the spinal canal and the covering of the spinal cord. This is called an epidural block. Or surgical procedures that cut nerve roots may be used for this type of pain.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen.

These may be used to treat secondary overuse pain. Limiting or taking breaks from the activity that causes pain may also help.

Antispasmodics such as baclofen and tizanidine (Zanaflex).

These are used to treat muscle spasm pain.

If you have pain, don't ignore it. Talk to your doctor. Pain can be a sign of a more serious problem.

Eating a healthy diet can help you reduce your risk of some complications from a spinal cord injury. It can also make other tasks, such as bowel management, easier. And it can help you reach and stay at a healthy weight. Being either underweight or overweight increases your risk of pressure injuries.

If you have special nutritional needs, such as needing extra protein or fiber, a registered dietitian can help you plan a diet.

If you aren't able to stretch your muscles yourself because of a spinal cord injury, you can do passive stretching. This means that someone stretches the muscle for you. This type of stretch can be done for upper and lower body muscles. Your rehabilitation (rehab) team will be able to teach a loved one how to do these exercises. They include:

• Flexing and extending the hip, knee, shoulder, wrist, fingers, and elbow.
• Stretching the hamstring (the muscle on the back of the thigh) and foot and ankle muscles.
• Rotating the hip and shoulder.