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What is Spinal
Cord Injury?
Spinal Cord Injury (SCI) is damage to the spinal cord that results in a loss of
function such as mobility or feeling. Frequent causes of damage are trauma (car
accident, gunshot, sports accidents, falls, etc.) or disease (polio, spina
bifida, spinal tumours, etc.). The spinal cord does not have to be severed in
order for a loss of functioning to occur. In fact, in most people with SCI, the
spinal cord is intact, but the damage to it results in loss of functioning. SCI
is very different from other back injuries such as ruptured disks, or pinched
nerves.
A person can "break their back or neck" yet not sustain a spinal cord
injury if only the bones around the spinal cord (the vertebrae) are damaged, but
the spinal cord is not affected. In these situations, the individual may not
experience paralysis after the bones are stabilized.
What is the spinal cord and
the vertebra?
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's carry messages about sensation from
the skin and other body parts and organs to the brain. The motor portions of the
LMN's 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.
What are the effects
of SCI?
The effects of SCI depend on the type of injury and the level of the
injury. SCI can be divided into two types of injury - complete and incomplete. A
complete injury means that there is no function below the level of the injury;
no sensation and no voluntary movement. Both sides of the body are equally
affected. An incomplete injury means that there is some functioning below the
primary level of the injury. A person with an incomplete injury may be able to
move one limb more than another, may be able to feel parts of the body that
cannot be moved, or may have more functioning on one side of the body than the
other. With the advances in acute treatment of SCI, incomplete injuries are
becoming more common.
The level of injury is very helpful in predicting what parts of the body might
be affected by paralysis and loss of function. Remember that in incomplete
injuries there will be some variation in these prognoses.
Tetraplegia
Cervical (neck) injuries usually result in four limb paralysis. This
is referred to as Tetraplegia or Quadriplegia.
Injuries above the C-4 level may require a ventilator for the person to
breathe. This is because the diaphragm is controlled by spinal nerves exiting
at the upper level of the neck. The well documented horse riding accident
of Christopher Reeve (Superman) resulted in a 'complete' spinal cord injury
above C3 and he now has to use a mechanical ventilator via a hole in his throat
to breathe.
C-5 injuries often result in shoulder and biceps control, but no control at the
wrist or hand. C-6 injuries generally yield wrist control, but no hand function.
Individuals with C-7 and T-1 injuries can straighten their arms but still may
have dexterity problems with the hand and fingers.
Paraplegia
Injuries at the thoracic level and below result in paraplegia, with the hands
not affected. At T-1 to T-8 there is most often control of the hands, but poor
trunk control as the result of lack of abdominal muscle control. Lower
T-injuries (T-9 to T-12) allow good truck control and good abdominal muscle
control. Sitting balance is very good. Lumbar and Sacral injuries yield
decreasing control of the hip flexors and legs.
Besides a loss of sensation or motor functioning, people with SCI also
experience other changes. For example, they may experience dysfunction of the
bowel and bladder,. Sexual functioning is frequently impaired or lost with
SCI. Men may have their fertility affected, while a women's
fertility is generally not affected. Other effects of SCI may include low
blood pressure, inability to regulate blood pressure effectively, reduced
control of body temperature, inability to sweat below the level of
injury, and chronic pain.
My Injury
If you are still reading this hopefully you will now have a greater
understanding of Spinal Cord Injury and its effects.
Every Injury is unique, particularly so with incomplete lesions. Recovery
from an incomplete injury can continue for up to 2-3 years post accident.
However spinal cord nerves do not repair themselves so 'all' damage to the cord
is permanent from the time of the injury.
My Injury is described as 'C4 incomplete Tetraplegia' Although my
spinal cord was damaged at that level after much hard work and time recovering I
am able to walk again, albeit slowly with the aid of crutches. For longer
distances I use a powered wheelchair. My arms are somewhat weaker than my
legs and my range of movement isn't great, but I'm able to use what function I
have well to get by pretty independently. I've been driving an adapted
motor vehicle since 1997 and that has been the biggest factor in restoring my
lost independence.
Clearly the outcome of my injury could have been so much worse, I'm
thankful to be alive and honestly regard myself as very fortunate to have
recovered to my present state.
For More
Information Please Visit
For further very detailed information about all medical aspects of a spinal cord
injury please visit
www.spinalnet.co.uk a new website with a
very comprehensive SCI medical section
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