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Spinal cord 101

What is Spinal Cord Injury (SCI)?

     A spinal cord injury usually begins with a sudden, traumatic blow to the spine that fractures or dislocates vertebrae. The damage begins at the moment of injury when displaced bone fragments, disc material, or ligaments bruise or tear into spinal cord tissue. Most injuries to the spinal cord don't completely sever it. Instead, an injury is more likely to cause fractures and compression of the vertebrae, which then crush and destroy the axons, extensions of nerve cells that carry signals up and down the spinal cord between the brain and the rest of the body. An injury to the spinal cord can damage a few, many, or almost all of these axons.
 
     A spinal cord injury often causes permanent disability or loss of movement (paralysis) and sensation below the site of the injury.

"Spinal Cord Injury." MayoClinic.com. http://www.mayoclinic.com/health/spinal-cord-injury/DS00460.

 

  Spinal Cord Injury Definitions 

 

What is the spinal cord and the vertebrae?  

The spinal cord is the major bundle of nerves that carries nerve impulses to and from the brain and to the rest of the body.
 
     The spinal cord is about 18 inches long and extends from the base of the brain, down the middle of the back, to about the waist. The nerves that lie within the spinal cord are upper motor neurons (UMNs) and their function is to carry the messages back and forth from the brain to the spinal nerves along the spinal tract. The spinal nerves that branch out from the spinal cord to the other parts of the body are called lower motor neurons (LMNs). These spinal nerves exit and enter at each vertebral level and communicate with specific areas of the body. The sensory portions of the LMN carry messages about sensation from the skin and other body parts and organs to the brain. The motor portions of the LMN send messages from the brain to the various body parts to initiate actions such as muscle movement.
 
     The spinal cord is the major bundle of nerves that carry nerve impulses to and from the brain to the rest of the body. The brain and the spinal cord constitute the Central Nervous System. Motor and sensory nerves outside the central nervous system constitute the Peripheral Nervous System, and another diffuse system of nerves that control involuntary functions such as blood pressure and temperature regulation are the Sympathetic and Parasympathetic Nervous Systems.
 
     The spinal cord is surrounded by rings of bone called vertebra. These bones constitute the spinal column (back bones). In general, the higher in the spinal column the injury occurs, the more dysfunction a person will experience. The vertebra are named according to their location. The eight vertebra in the neck are called the Cervical Vertebra. The top vertebra is called C-1, the next is C-2, etc. Cervical SCI's usually cause loss of function in the arms and legs, resulting in quadriplegia. The twelve vertebra in the chest are called the Thoracic Vertebra. The first thoracic vertebra, T-1, is the vertebra where the top rib attaches.
 
     Injuries in the thoracic region usually affect the chest and the legs and result in paraplegia. The vertebra in the lower back between the thoracic vertebra, where the ribs attach, and the pelvis (hip bone), are the Lumbar Vertebra. The sacral vertebra run from the Pelvis to the end of the spinal column. Injuries to the five Lumbar vertebra (L-1 thru L-5) and similarly to the five Sacral Vertebra (S-1 thru S-5) generally result in some loss of functioning in the hips and legs.

"Spinal Cord 101." Spinal Cord 101. http://www.spinalinjury.net/html/_spinal_cord_101.html.

 

Basic Anatomy of the Spine and Spinal Cord

     The spine works as the main support for the spinal cord and the nerve pathways that carry information from the arms, legs, and rest of the body, and carries signals from the brain to the body.

     Your back is composed of 33 bones called vertebrae, 31 pairs of nerves, 40 muscles and numerous connecting tendons and ligaments running from the base of your skull to your tailbone. Between your vertebrae are fibrous, elastic cartilage called discs. These "shock absorbers" keep your spine flexible and cushion the hard vertebrae as you move.

"Basic Anatomy of the Spinal Cord." Spinal Cord 101. http://www.spinalinjury.net/html/_anatomy_of_a_spinal_cord.html.

 

Spinal Column Anatomy

Cervical Spine
     There are seven cervical bones (vertebrae). The cervical bones are designed to allow flexion, extension, bending, and turning of the head. They are smaller than the other vertebrae, which allows a greater amount of movement. Each cervical vertebra consists of two parts, a body and a protective arch for the spinal cord called the neural arch. Fractures or injuries can occur to the body, lim pedicles, or processes. Each vertebra articulates with the one above it and the one below it.
Thoracic Spine
     In the chest region the thoracic spine attaches to the ribs. There are 12 vertebrae in the thoracic region. The spinal canal in the thoracic region is relatively smaller than the cervical or lumbar areas. This makes the thoracic spinal cord at greater risk if there is a fracture.
   The motion that occurs in the thoracic spine is mostly rotation. The ribs prevent bending to the side. A small amount of movement occurs in bending forward and backward.
Lumbosacral Spine
     The lumbar vertebrae are large, wide, and thick. There are five vertebrae in the lumbar spine. The lowest lumbar vertebra, L5, articulates with the sacrum. The sacrum attaches to the pelvis. The main motions of the lumbar area are bending forward, to the side, and extending backwards.

 

Spinal Cord Anatomy

     Just like the spinal column is divided into cervical, thoracic, and lumbar regions, so is the spinal cord. Each portion of the spinal cord is divided into specific neurological segments.

Cervical Spine
     The cervical spinal cord is divided into eight levels. Each level contributes to different functions in the neck and the arms. Sensations from the body are similarly transported from the skin and other areas of the body from the neck, shoulders, and arms up to the brain.
Thoracic Spine
     In the thoracic region the nerves of the spinal cord supply muscles of the chest that help in breathing and coughing. This region also contains nerves in the sympathetic nervous system.
Lumbosacral Spine
     The lumbosacral spinal cord and nerve supply legs, pelvis, and bowel and bladder. Sensations from the feet, legs, pelvis, and lower abdomen are transmitted through the lumbosacral nerves and spinal cord to higher segments and eventually the brain.

spinal map    

"Spinal Cord Injury Resource Center." Spinalinjury.net. http://www.spinalinjury.net/

 

 

What is Paralysis, Paraplegia, and Quadriplegia?

     Paralysis is the inability to control the muscles that move the body. There are several levels of severity associated with paralysis, including paraplegia and quadriplegia. The injury, depending on where it is located on the backbone, will affect movement and sensation or lead to a complete loss.
 
     Paraplegia is a lower injury like at the thoracic or upper-back level and will affect just the legs and lower parts of the body.
 
    Quadriplegia is an injury to the spine in the cervical or neck level that can cause paralysis in both the legs, arms, and fingers. Quadriplegia injuries, also known as Tetraplegia, include loss of controlled functions of the bladder and bowel. It is a serious condition that requires permanent care.

 

Symptoms of Spinal Cord Injury

     Symptoms vary somewhat depending on the location of the injury. Spinal cord injury causes weakness and sensory loss at and below the point of the injury. The severity of symptoms depends on whether the entire cord is severely injured (complete) or only partially injured (incomplete).

 

     The spinal cord doesn't go below the 1st lumbar vertebra, so injuries at and below this level do not cause spinal cord injury. However, they may cause "cauda equina syndrome" -- injury to the nerve roots in this area.

Cervical (Neck) Injuries

     When spinal cord injuries occur near the neck, symptoms can affect THE LEGS, ARMS, HANDS AND/OR FINGERS:
  • Breathing difficulties (from paralysis of the breathing muscles)
  • Loss of normal bowel and bladder control (may include constipation, incontinence, bladder spasms, indwelling)
  • Numbness, tingling, or complete loss of feeling at and/or below site of injury
  • Spasticity 
  • Pain - Autonomic Dysreflexia
  • Weakness, paralysis
  • Dizziness, light-headed at times

Thoracic (Chest-Level) Injuries

     When spinal injuries occur at chest level, symptoms can affect THE LEGS:
  • Breathing difficulties (from paralysis of the breathing muscles)
  • Loss of normal bowel and bladder control (may include constipation, incontinence, bladder spasms)
  • Numbness, tingling, or complete loss of feeling at and/or below site of injury
  • Sensory changes
  • Spasticity
  • Pain - Autonomic Dysreflexia
  • Weakness, paralysis
     Injuries to the cervical or high-thoracic spinal cord may also result in blood pressure problems, abnormal sweating, and trouble maintaining normal body temperature.

Lumbar Sacral (Lower-Back) Injuries

     When spinal injuries occur at the lower-back level, varying degrees of symptoms can affect THE LEGS:
  • Loss of normal bowel and bladder control (may include constipation, incontinence, bladder spasms)
  • Numbness, tingling, or complete loss of feeling at and/or below site of injury
  • Pain
  • Sensory changes
  • Weakness and paralysis

"Spinal Cord Trauma." Google Heath. https://health.google.com/health/ref/Spinal+cord+trauma. Symptoms ● Causes ● Tests & Diagnostics ● Prevention

 

COMPLETE Vs. INCOMPLETE
     Spinal cord injuries are classified as either incomplete or complete. 

 

     An incomplete injury means that the ability of the spinal cord to convey messages to or from the brain is not completely lost. People with incomplete injuries retain some motor or sensory function below the injury.  Incomplete injuries can be sometimes be cured with the help of therapy and stem cells. This has been proven in Russia through the use of Adult stem cells.
 
     A complete injury is indicated by a total lack of sensory and motor function below the level of injury.
 
 
American Spinal Injury Association (ASIA) Impairment Scale*
 
Classification     Description
A    

Complete: no motor or sensory function is preserved below the level of injury, including the sacral segments S4 - S5

B    

Incomplete: sensory, but not motor, function is preserved below the neurologic level and some sensation in the sacral segments S4 - S5

C    

Incomplete: motor function is preserved below the neurologic level, however, more than half of key muscles below the neurologic level have a muscle grade less than 3 (i.e., not strong enough to move against gravity)

D    

Incomplete: motor function is preserved below the neurologic level, and at least half of key muscles below the neurologic level have a muscle grade of 3 or more (i.e., joints can be moved against gravity)

E    

Normal: motor and sensory functions are normal

* Used with permission of the American Spinal Injury Association.

 

 

Facts and Figures About Spinal Cord Injury

There are an estimated 10,000 to 12,000 spinalAquatics & &ry year in United States.

A quarter of a million Americans are currently living with spinal cord injuries.

The cost of managing the care of spinal cord injury patients approaches $4 billion each year.

55 percent of spinal cord injury victims are between 16 and 30 years old.

More than 80 percent of spinal cord injury patients are men.

Source: Facts and Figures at a Glance, May 2001. National Spinal Cord Injury Statistical Center.

Approximately 450,000 people live with SCI in the US.  Quadriplegia is slightly more common.

 

With SCI Come Other Problems

         Posture problems such as rounded shoulders or slouching can occur, which can lead to smaller lung capacity.
         Irregular heart beat, low blood pressure, and muscle spasms.
         More susceptible to blood clots, heart problems, and possible pneumonia.
         Increased number and severity of respiratory infections due to diminished ability to cough.
         Increased number of urinary tract infections and yeast infections for females.
         Muscle tone will decrease--particularly in the areas that are no longer used.
         Unless standing regularly, the feet will tend to drop (footdrop).
         If quadriplegia, typically you will need a tool to eat, write, and use the computer.
         General decrease in exercise which will lead to an increase in weight.

 

     

 

 

Pressure sores A pressure sore is any redness or break in the skin caused by too much pressure on your skin for too long a period of time. The pressure prevents blood from getting to your skin so the skin dies...
Bladder care management After a spinal cord injury, messages can no longer travel normally between the bladder or sphincter muscles and the brain. Individuals usually can not feel when the bladder is full or they do not have the "urge" to urinate. The methods most frequently used for SCI individuals are intermittent catheterization (ICP) and indwelling catheter (Foley).
Autonomic Dysreflexia

Autonomic Dysreflexia (AD) is a potentially dangerous complication of spinal cord injury SCI. In AD, an individual's blood pressure may rise to dangerous levels and if not treated can lead to stroke and possibly death. Individuals with SCI at the T-6 level or above are at greater risk. AD usually occurs because of a noxious (irritating) stimulus below the level of the injury. Symptoms include horrible headaches, facial flush, extreme perspiration, chill bumps, ice cold hands, and a stuffy nose.
 
 
 

 

Spasms
     "A spasm is a sudden, involuntary contraction of a muscle, a group of muscles, or a hollow organ, or a similarly sudden contraction of an orifice. It is sometimes accompanied by a sudden burst of pain, but is usually harmless and ceases after a few minutes."
"Spasm." Wikipedia. http://en.wikipedia.org/wiki/Spasm.
 
"Many of our reflex movements are controlled by the spinal cord but regulated by the brain. When the spinal cord is damaged, information from the brain can no longer regulate reflex activity. Reflexes may become exaggerated over time, causing spasticity."
"Spinal Cord Injury: Treatments and Rehabilitation (Cont.)." MedicineNet. http://www.medicinenet.com/spinal_cord_injury_treatments_and_rehabilitation/page6.htm.
 
Being injured at C6, I have constant acute-severe spasms in my body, majorly in my legs. But a lot of the time, it begins in the toes and shoots up my body to my spine and all the way to my neck. Sometimes when I get into bed after a long day of sitting in my chair, my spasms can be so bad that it can almost tense up my entire body to where it hinders my breathing.

 

 

 

HYPERTHERMIA & HYPOTHERMIA

     The temperature of a SCI individual has an increased tendency to fluctuate according to the temperature of the environment. If you are in a hot room your temperature may increase (hyperthermia) or, if you are in a cold room, your temperature may decrease (hypothermia). This occurs because of the altered function of the autonomic nervous system. The higher the level of injury, the greater the tendency for fluctuations in your body temperature.

 

Can people with SCI have sex or children?

     SCI frequently affects sexual functioning. However, there are many therapies that allow people with SCI to have an active and satisfying sex life. Fertility is also frequently affected in men with SCI. The fertility of women with SCI may be affected in the first months after injury. However, most women regain the ability to become pregnant after SCI. Many women with SCI are able to carry babies to full term.

 

 

 

 

 Life after a spinal cord injury can be as enjoyable and productive as any non-disabled person. A person's potential is only limited by their determination. But there are physical and sometimes psychological issues that come with a spinal cord injury that cannot be ignored, your health and quality of life depend on it. 

 

  

Essential Links

Spasticity     Pain     Bowel Program     SCI Urinary Tract     Pressure Sores

Bibliography

FSCIP Facts     NCIPC Facts     Basic Anatomy     101 Continued

SCI Pamplet     SCI Statistics     SCI Info     MediceneNet

 

                

This site was last updated 03/29/14