Understanding Spinal Cord Injury: Causes, Types, and Treatment Options
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on December 23, 2024
In Australia, approximately 20,000 people live with a spinal cord injury (SCI). These injuries, often caused by accidents, falls, or medical conditions, can dramatically alter a person's life, affecting mobility, independence, and overall quality of life.
A spinal cord injury occurs when the spinal cord is damaged by trauma, disease, or degeneration. This damage disrupts the communication between the brain and the body, potentially resulting in paralysis, sensory loss, and a range of secondary health issues. The impact of SCI can vary significantly depending on the severity and location of the injury, from minor functional limitations to complete loss of movement and sensation below the site of the injury.
This article explores the multifaceted nature of spinal cord injury, delving into its types, common causes, symptoms, and the latest treatment options available. Additionally, we’ll highlight the crucial role of physiotherapy in maximizing recovery and improving the quality of life for those affected.
Types of spinal cord injury
Spinal cord injuries (SCI) are classified by the extent of damage and the affected area, influencing recovery and treatment.
Complete vs. Incomplete Injuries
Complete: Total loss of motor and sensory function below the injury site, with limited recovery potential.
Incomplete: Partial preservation of function below the injury site, offering better recovery prospects.
Tetraplegia (Quadriplegia) vs. Paraplegia
Tetraplegia: Caused by cervical spine injuries (C1-C8), affecting the arms, hands, trunk, and legs.
Paraplegia: Results from thoracic, lumbar, or sacral injuries, impacting the lower body while sparing the arms.
Levels of spinal cord injury
Cervical (C1-C8): Can cause tetraplegia; common causes include motor vehicle accidents and falls.
Thoracic (T1-T12): May lead to paraplegia, affecting trunk stability and lower body function.
Lumbar (L1-L5): Impacts lower body movement, sensation, and bowel/bladder control.
Sacral (S1-S5): Affects bowel, bladder, sexual function, and partial leg and hip movement.
Accurate classification is key for prognosis and tailored rehabilitation plans.
Causes of spinal cord injury (SCI)
Spinal cord injuries (SCI) can be broadly categorized into traumatic and non-traumatic causes. Understanding these causes is crucial for prevention, early intervention, and treatment.
Traumatic causes
These result from external physical impacts or injuries to the spine.
Car accidents:
Statistics: Motor vehicle crashes are a leading cause of SCI worldwide, accounting for nearly 40-50% of traumatic cases. In Australia, road accidents are a significant contributor, especially among young adults.
Prevention: Seatbelt use, adherence to speed limits, and avoiding distractions while driving can reduce risk.
Falls:
Common scenarios: Falls are a leading cause of SCI in older adults, often occurring at home or in workplaces. In younger populations, falls from heights are more common.
Risk factors: Poor balance, osteoporosis, and unsafe environments.
Prevention: Installing safety measures like railings, using assistive devices, and addressing balance issues can help.
Sports injuries:
High-risk sports: Contact sports like rugby, diving into shallow water, and extreme sports such as skiing or mountain biking are common causes.
Safety measures: Proper training, use of protective gear, and adherence to safety guidelines can significantly lower the risk.
Violence:
Types: Gunshot wounds, stabbings, and physical assaults are significant causes, particularly in urban areas.
Prevention: Community violence prevention programs and gun safety regulations play a key role.
Non-traumatic causes
These result from medical conditions or internal factors affecting the spinal cord.
Diseases:
Examples: Conditions like multiple sclerosis, polio, and spina bifida can damage the spinal cord over time, leading to SCI.
Management: Early detection and treatment of these diseases can minimize complications.
Infections:
Examples: Meningitis and epidural abscesses can compress the spinal cord and cause inflammation, leading to injury.
Prevention: Vaccination and prompt treatment of infections are crucial.
Tumors:
Types: Both benign and malignant tumors can press on or invade the spinal cord, disrupting its function.
Management: Regular screenings and early intervention are vital.
Spinal cord stroke or loss of blood flow:
Mechanism: Reduced blood flow to the spinal cord, often caused by blockages or bleeding, can result in ischemic damage.
Risk factors: Atherosclerosis, blood clots, or trauma disrupting blood supply.
Prevention: Managing cardiovascular health through diet, exercise, and regular medical check-ups reduces risk.
Both traumatic and non-traumatic SCIs underscore the importance of prevention, early intervention, and awareness to mitigate their life-changing impact.
Signs and symptoms of spinal cord injury (SCI)
The signs and symptoms of a spinal cord injury (SCI) vary depending on the location and severity of the injury. They can include physical, sensory, and autonomic changes that significantly impact daily life.
Loss of motor function
Paralysis or weakness: SCI can result in complete or partial loss of motor function below the injury level.
Complete injuries: Total paralysis.
Incomplete injuries: Varying degrees of weakness.
Spasticity: Muscle stiffness or involuntary spasms, which can interfere with movement and cause discomfort.
Sensory changes
Loss of sensation: Reduced or absent ability to feel temperature, touch, or pressure below the injury site.
Pain: Neuropathic pain, often described as burning or stabbing, can develop due to nerve damage and is common in SCI patients.
Autonomic nervous system effects
Blood pressure and temperature regulation: Difficulty maintaining stable blood pressure and body temperature due to impaired autonomic control.
Bladder and bowel control: Loss of voluntary control, requiring interventions like catheterization or bowel programs.
Sexual dysfunction: Challenges with arousal, sensation, or function, depending on the level and extent of the injury.
Other symptoms
Breathing difficulties: High-level injuries (e.g., cervical) can impair the muscles involved in breathing, requiring ventilatory support.
Increased risk of blood clots: Reduced mobility increases the likelihood of deep vein thrombosis (DVT).
Pressure sores: Prolonged immobility can cause skin breakdown and ulcers over bony areas, such as the hips or sacrum.
Recognizing these symptoms early can guide timely intervention, improve management strategies, and enhance quality of life for individuals with SCI.
Prevention of spinal cord injury (SCI)
Preventing spinal cord injuries requires awareness and proactive measures across various aspects of daily life, recreation, and the workplace. Implementing safety strategies can significantly reduce the risk.
Safety measures in daily life
Home safety:
Install grab bars and non-slip mats in bathrooms to prevent falls.
Ensure proper lighting and keep walkways free of clutter.
Use correct lifting techniques (bend at the knees, not the waist) to avoid back strain.
Road safety:
Always wear a seatbelt when driving or riding in a car.
Avoid distractions like texting or using devices while driving.
Follow speed limits and practice defensive driving to reduce accident risk.
Sports and recreational activity precautions
Safety equipment:
Wear appropriate gear, such as helmets and padding, during activities like biking, skiing, or contact sports.
Check that equipment fits properly and is in good condition.
Safety guidelines:
Avoid diving into shallow or unknown waters.
Follow rules and guidelines specific to high-risk sports, such as rugby or motocross.
Workplace safety
Ergonomics:
Arrange workspaces to minimize strain on the spine, with properly adjusted chairs and desks.
Lifting techniques:
Use proper body mechanics, lifting with the legs rather than the back.
Utilize tools like forklifts or dollies for heavy lifting.
Safety protocols:
Follow safety regulations and use protective equipment in high-risk jobs like construction or warehousing.
Regularly inspect tools and machinery for safety compliance.
By incorporating these preventive strategies into daily routines, recreational activities, and workplaces, individuals can significantly lower their risk of experiencing a spinal cord injury.
Diagnosis of spinal cord injury (SCI)
Physical Examination
Initial Assessment:
At the accident scene or hospital, healthcare providers assess for life-threatening injuries, immobilize the spine, and monitor vital signs.
They check for signs of paralysis, abnormal reflexes, or other indications of spinal damage.
Neurological Examination:
Reflexes, muscle strength, and sensory responses (e.g., to touch, pain, and temperature) are tested to evaluate the extent of motor and sensory impairment.
Imaging Tests
X-Rays:
Often the first imaging test used, X-rays can identify fractures, dislocations, or spinal alignment issues.
CT Scans:
Provide detailed cross-sectional images of bones to detect subtle fractures or damage.
MRI:
Essential for visualizing soft tissues, including the spinal cord, intervertebral discs, and ligaments. MRI can identify compression, bleeding, or swelling in the spinal cord.
Neurological Tests
ASIA Impairment Scale:
The American Spinal Injury Association (ASIA) scale is a standardized tool used to assess motor and sensory function. It helps classify the injury as complete or incomplete and determines the severity.
Other Functional Tests:
Additional tests assess autonomic functions, such as bladder and bowel control, and determine the impact on mobility and daily activities.
Accurate diagnosis using these methods helps guide treatment decisions, predict recovery potential, and develop personalized rehabilitation plans for individuals with SCI.
Treatment options for spinal cord injury (SCI)
Effective management of spinal cord injuries involves immediate stabilization, medical interventions, and long-term rehabilitation to optimize recovery and improve quality of life.
Immediate Treatment and Stabilization
Emergency Response:
Proper immobilization at the accident scene is critical to prevent further damage. This includes using a cervical collar or spinal board during transport.
Medications:
Administering medications such as corticosteroids (e.g., methylprednisolone) within the first few hours may help reduce inflammation and limit spinal cord damage.
Medications
Pain Management:
Analgesics, including nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids, are used to control acute and chronic pain.
Complication Management:
Muscle relaxants and antispasmodics for spasticity.
Bladder and bowel management medications.
Drugs to prevent infections or blood clots.
Surgery
Goals:
Decompress the spinal cord, stabilize the spine, and repair fractures or dislocations.
Common Procedures:
Decompression Surgery: Relieves pressure caused by bone fragments or swelling.
Spinal Fusion: Stabilizes the spine by fusing affected vertebrae with hardware such as rods or screws.
Rehabilitation
Process Overview:
Rehabilitation begins as soon as the patient is stable, focusing on improving function, mobility, and independence.
Multidisciplinary Approach:
Involves physiotherapists, occupational therapists, neurologists, psychologists, and social workers working collaboratively.
Assistive Devices and Adaptive Equipment:
Wheelchairs, braces, and other mobility aids.
Adaptive technologies, such as voice-activated devices or environmental control systems, to enhance independence.
SCI treatment is tailored to the individual’s needs, emphasizing early intervention, comprehensive care, and ongoing rehabilitation to support recovery and maximize quality of life.
Physiotherapy's role in spinal cord injury (SCI) treatment
Physiotherapy is a cornerstone of spinal cord injury rehabilitation, aiming to restore function, improve independence, and enhance overall quality of life.
Goals of Physiotherapy
Maintaining and Improving Muscle Strength and Flexibility:
Preventing muscle atrophy and joint stiffness through targeted exercises.
Enhancing Mobility and Independence:
Helping patients relearn essential movements, such as transferring, standing, or walking, when possible.
Managing Pain and Preventing Complications:
Addressing spasticity, neuropathic pain, and secondary complications like pressure sores or blood clots.
Specific Techniques and Exercises
Range of Motion Exercises:
Regular stretching to maintain joint flexibility and reduce contractures.
Strength Training Adaptations:
Using resistance bands, weights, or functional electrical stimulation (FES) to strengthen preserved muscles.
Transfer and Mobility Training:
Teaching safe and effective techniques for moving from a wheelchair to a bed or car, and mobility training with assistive devices.
Respiratory Physiotherapy Techniques:
Breathing exercises and airway clearance techniques, particularly for high-level injuries affecting respiratory muscles.
Evidence-Based Effectiveness
Recent Studies:
Research consistently highlights the benefits of physiotherapy in improving strength, mobility, and quality of life for SCI patients.
Statistics:
Studies report significant improvements in functional outcomes and reduced complication rates among individuals engaging in regular physiotherapy.
Long-term Management and Support
Ongoing Physiotherapy Needs:
Continued sessions to address changing needs and maintain gains in strength and mobility.
Home Exercise Programs:
Personalized routines to enable progress between physiotherapy visits.
Adaptive Sports and Recreational Activities:
Encouraging participation in activities like wheelchair basketball or swimming to promote fitness and mental well-being.
Physiotherapy plays an integral role in the recovery and long-term management of spinal cord injuries, offering tailored interventions that empower patients to lead active, fulfilling lives.
Conclusion
Spinal cord injuries (SCI) are life-changing events that affect motor, sensory, and autonomic functions. They require a comprehensive approach to diagnosis, treatment, and long-term management. Understanding the types, causes, and symptoms of SCI, combined with early and ongoing professional care, is essential for optimizing recovery and improving quality of life.
Physiotherapy plays a pivotal role in SCI rehabilitation, helping to restore strength, enhance mobility, manage pain, and prevent complications. Through targeted exercises, assistive technologies, and long-term support, physiotherapy empowers individuals to regain independence and participate in meaningful activities.
Thanks to advancements in medical care, rehabilitation techniques, and adaptive technologies, the outlook for people with SCI continues to improve. With the right support and a commitment to rehabilitation, individuals can lead fulfilling, active lives despite their challenges.
References:
American Spinal Injury Association. (2019). ASIA impairment scale: Assessment standards. Retrieved from https://www.asia-spinalinjury.org
Arora, M., & Craig, A. R. (2024). Special Issue—Spinal Cord Injuries: Advances in Rehabilitation. Journal of Clinical Medicine, 13(6), 1782–1782. https://doi.org/10.3390/jcm13061782
Hurlbert, R. J. (2001). The Role of Steroids in Acute Spinal Cord Injury. Spine, 26(Supplement), S39–S46. https://doi.org/10.1097/00007632-200112151-00009
Nas, K. (2015). Rehabilitation of Spinal Cord Injuries. World Journal of Orthopedics, 6(1), 8. https://doi.org/10.5312/wjo.v6.i1.8
Spinal cord injury facts – SpinalCure Australia. (n.d.). https://www.spinalcure.org.au/research/spinal-cord-injury-facts/
Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.
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