What Happens

A traumatic spinal cord injury (SCI) begins with a blow to the spine, resulting in broken or dislocated vertebrae (the individual bone segments that make up the spine). The vertebrae bruise or tear the spinal cord, damaging nerve cells. When the nerve cells are damaged, messages cannot travel back and forth between the brain and the rest of the body, resulting in complete or partial loss of movement (paralysis) and feeling.

A person with a potential SCI is taken to an emergency department and then to an intensive care unit. Initial management of the injury includes stabilizing blood pressure and lung function as well as the spine, to prevent further damage. Because a spinal cord injury is often caused by a serious accident, treatment for other injuries is often needed. Immediately after an SCI, treatment decisions are made quickly by the doctor because of the seriousness of the injury.

Initial diagnosis often is made when a doctor examines you during emergency treatment. A few days after the injury, your doctor will ask you questions. Also, he or she will test not only the strength of key muscles but also your response to light touch and pinpricks all over your body.

The following tests may be done immediately, to help find out the extent of the injury, and routinely throughout and after you leave rehabilitation (rehab).

• An ultrasound of the kidneys checks your bladder function. This is done every 1 to 2 years.
• A spinal X-ray monitors your spine's condition. Your doctor lets you know how often this is done—usually monthly for the first 3 to 6 months.
• Computed tomography scan (CAT scan) and magnetic resonance imaging (MRI) of the spine are done as needed.
• A bone mineral density (BMD) test measures the concentration of minerals (such as calcium) in your bones using a special X-ray, computed tomography (CT) scan, or ultrasound.

A spinal cord injury usually happens because of a sudden severe injury to the spine. But sometimes the spinal cord is damaged by infection, bleeding into the space around the spinal cord, spinal stenosis, or by a birth defect, such as spina bifida.

Classifying a spinal cord injury

An SCI 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.

The vertebrae and spinal nerves are organized into segments, starting at the top of the spinal cord, and within each segment they 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 SCIs usually cause loss of function in the chest, arms, and legs. Cervical injuries can also affect breathing.
• Thoracic. The chest area contains 12 thoracic vertebrae (T1 through T12) and 12 thoracic nerves (T1 through T12). The first thoracic vertebra, T1, is the vertebra 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.
• 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.
• 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 also usually affect the hips and legs.

People with SCIs often use a segment of the spine to talk about their functional level. (Your functional level is how much of your body you can move and feel.) For example, you might describe yourself as a "C7."

The nerves around a vertebra control specific parts of the body. Paralysis occurs in the areas of the body that are controlled by the nerves associated with the damaged vertebrae and the nerves below the damaged vertebrae. The higher the injury on the spinal cord, the more paralysis there is. For example, damage to the spinal nerves in the neck can result in paralysis of the chest, arms, and legs (tetraplegia, also known as quadriplegia). Damage lower down on the spine (thoracic, lumbar, or sacral segments) can result in paralysis of the legs and lower body (paraplegia). Breathing is only affected by injuries high on the spinal cord. But bowel and bladder control can be affected no matter where the spinal cord is injured.

Damage to the spinal cord can be complete or incomplete. In a complete SCI, you do not have feeling or voluntary movement of the areas of your body that are controlled by your lowest sacral nerves—S4 and S5. These nerves control feeling and movement of your anus and perineum. In an incomplete SCI, you have varying amounts of movement and feeling of the areas of your body controlled by the sacral nerves. See how your level of injury affects function.

Some recovery of feeling and movement may return after the injury—how much depends on the level of injury, the strength of your muscles, and whether the injury is complete or incomplete. Most recovery occurs within the first 6 months of the injury.

For the family and caregivers

After a traumatic SCI, your loved ones will often ask questions about the injury and what it means. This should be encouraged, although you should keep your answers short, simple, and honest. You cannot give a complete answer, because it is often difficult to know how serious the injury is and how much movement or feeling will be lost. This typically is not known until swelling and bleeding are reduced and the doctors can find out where the spinal cord has been injured.

Transition into rehabilitation

After emergency treatment and stabilization, there is a transition into rehab. Rehab centers help you adjust to life, both physically and emotionally, with less mobility and feeling than you previously had. What happens in rehab depends on your level of injury. You may have to learn how to manage your bowel and bladder, walk with crutches, do breathing exercises, and move between a wheelchair and another location. The goal of rehab is to help you be as independent as possible.

Before rehab, your spine will be stabilized with surgery, braces, or both.