Spinal cord injury (SCI) can be a devastating diagnosis.  Whenever spinal cord injury is suspected, urgent medical care is necessary because the spinal cord carries nerve messages between the brain and the rest of the body.  Some patients with SCI have a temporary or permanent loss of sensation and/or function below the injured level of the spine.

Types of SCI
The spinal cord can be injured by inadequate blood flow, bruising, or cutting without severing (rare).  There are two basic types of spinal cord injury; complete and incomplete.  A complete SCI is loss of all feeling and function on both sides of the body below the injury level.  An incomplete SCI means some feeling and function remains below the injury level and one side of the body may have more feeling or function than the other.

Sensation and function
There is a pair of spinal nerve roots at each level of the spine.  There are 5 regions of the spine. In general, each of these 5 regions provides feeling (sensation) and function (movement) to different parts of the body.

Symptoms
There are many possible symptoms associated with SCI.  Symptoms vary and no two patients with spinal cord injury are the same.

• Inability or difficulty breathing without help
• Inability to regulate heart rate, blood pressure, body temperature
• Bladder and/or bowel dysfunction
• Pain
• Uncontrollable muscle contractions (spasticity)
• Infertility, sexual dysfunction

Paraplegia and quadriplegia (tetraplegia) are types of paralysis associated with SCI.  Paraplegia is spinal cord injury below the cervical spine.  Quadriplegia involves the cervical spine and these patients are not able to move their arms or legs.

Causes
The causes of spinal cord injury fall into one of two primary groups: traumatic and non-traumatic.  Examples of trauma include car accidents, gunshots, falling down, diving into shallow water, or sports injuries. Non-trauma causes are restricted blood flow (ischemia), spinal tumor, fracture, and other spine-related problems. 

Medical care
The medical staff moves swiftly to quickly assess the patient’s condition noting any difficulty breathing, level of consciousness, ability or inability to move the arms and legs, and pain.

The evaluation process often involves complex and detailed imaging studies to determine where the injury is, its cause, and severity.  Other types of tests may be needed.

Treatment
Powerful anti-inflammatory drugs are often part of the first course of immediate care to control inflammation caused by injury.  Next steps include preserving sensation and function, restoring function (eg, rehabilitation), and minimizing complications during aftercare.   Depending on the extent of the SCI, other concerns may include breathing, nutrition, bladder and bowel care, and skin problems (eg, bed sores).

There are many medical specialists involved in treating spinal cord injury.  These include physiatrists, rehabilitation nurses, occupational and physical therapists, speech pathologists, recreational and vocational therapists, and psychologists.

Depending on the cause and severity of the injury, surgery may be necessary to decompress the spinal cord and stabilize the spine.  Surgery can be important to help prevent pain, spinal deformity, and worsening of neurologic problems (eg, bladder dysfunction, weakness).

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