Spinal Cord Injury - the Basics
Posted by Steve Jones
Tue, Feb 17, 2015
The spinal cord is the nerve center of the body, connecting the brain to other parts of the body through nerves which control voluntary and involuntary movement and function throughout the body. Its companion, the spine, is made up of 33 vertebrae allowing us to walk, sit, lift, twist and bend. The spinal cord runs along the inside of the vertebrae through a hole in the center of each bone. The bones of the spine protect the spinal cord under most circumstances.
About 80% of spinal cord injuries (SCI) happen to people between the ages of 15 and 35, and 80% of those are male. SCI can occur as a result of sports injury, falls, diving into shallow water, and auto accident. Many of us tend to think of spinal cord injury as causing permanent paralysis, such as Christopher Reeves’ infamous fall from horseback. Amazingly, however, many people recover from injuries that their doctors say are permanent. More than 60% of people with severe SCI retain some motor or sensory function below the site of the injury, and many of them recover some functioning over time.
The spinal cord can be damaged by bone fragments piercing it, by discs or ligaments bruising it, or by compression, stretching (hyperextension), or twisting (shearing). The location and severity of the injury will determine whether the damage is permanent and what part(s) of the body will be affected. For instance, whiplash usually causes minor damage and resolves over time, whereas a shattered vertebra in the cervical (neck) area of the spine may cause permanent paralysis.
Doctors categorize SCI by levels – the level being the site of the injury. Doctors divide the spine into 4 sections:
- Cervical: neck bones, the top 7 bones (divided into 8 SCI levels) descending from the top of the neck to the shoulder
- Thoracic: mid-back bones, the 12 bones from the shoulder to the bottom of the ribcage
- Lumbar: lower back bones, the 5 bones from the bottom of the ribcage to the upper hips
- Sacral: The base of the spinal column, 5 individual bones in childhood fuse in late adolescence into a single strong bone which supports the entire upper body
The level of the injury determines where paralysis occurs, and the severity or completeness of the injury determines if the patient can recover some sensory or voluntary motor function.
- C1 to C4: The most severe of SCI levels will likely result in permanent quadriplegia (paralysis everywhere below the neck) with no voluntary control of muscles or bladder/bowel function, requiring 24-hour personal care.
- C5 to C8: Less severe, will likely have permanent paraplegia (paralysis of the legs) but may have some use of arms and possibly hands, no voluntary control of trunk or lower muscles and bladder/bowel function, may be able to manage somewhat on their own in a motorized wheelchair.
- T1 to T5: Arm and hand function are usually normal but will have paraplegia, no voluntary control of trunk or lower muscles and bladder/bowel function, but can manage mostly on their own with special equipment and some assistance transferring in and out of a manual wheelchair.
- T6 to T12: Normal upper body movement and usually paraplegia, little or no voluntary control of bladder/bowel function, most can manage getting into and out of a manual wheelchair on their own, and some can even walk with braces.
- L1 to L5: Some loss of function in the hips and legs, little or no voluntary control of bladder/bowel function, may be able to walk with braces
- S1 to S5: Little or no voluntary control of bladder/bowel function, but most likely will be able to walk
Recovery from SCI is usually long and difficult, both physically and emotionally, for the patient and their family. Many people will use wheelchairs and special equipment for the rest of their lives. Most people need 24-hour care in the early weeks and months after the injury. (We’ll talk about caring for an SCI patient in another blog post coming soon.) Yet amazingly, many SCI patients say their lives are better and they are happier after the injury than they were before it, no matter how much sensation and function they are able to recover. Perhaps we should all take a lesson from that.
If you or a loved one have a spinal cord injury from an auto accident, check out our posts about dealing with insurance: What you Need to Know about Ontario Auto Insurance and Navigating the Claims Process. We have specially trained nurses and PSWs who will provide care with compassion and dignity.