Acute spinal cord injury causes and treatment

What is an acute spinal cord injury?

It is a very serious (acute) injury of the spinal cord that is caused by bruising, partially tearing or severing the spinal cord. It is one of the most common causes of loss of feeling and movement, and permanent disability; very serious cases are often fatal. A spinal cord injury can cause paralysis (inability to move).

The spine is made up of a long series of bones called vertebrae. The vertebrae form a canal that protect the spinal cord and nerves. The spinal cord and nerves extend the length of the spinal canal. Nerves carry messages between the brain and body, allowing movement and sensations. If the spine is bent, compressed or damaged by injury, it can injure or sever the nerves that transmit messages to the brain.

How serious is an acute spinal cord injury?

It is a medical emergency needing immediate attention. The injury can cause permanent disability or death. There is no way to repair the damage caused by a serious trauma to the spinal cord. Some patients recover some function over time with good physical and occupational therapy. Most patients have long-term problems with mobility and overall health.

What causes an acute spinal cord injury?

The bending, compressing or tearing of the spinal cord can happen because of a fall, auto accident, sports injury, infection/abscess on the spinal cord, violence, or a birth injury.

What are the symptoms of an acute spinal cord injury?

Acute spinal cord injuries can cause a variety of symptoms. The location of the injury determines where and how the body is affected, and how severe the symptoms will be. The full extent of the damage from a spinal cord injury may not be known immediately. Problems with the nervous system may develop later. The extent of damage caused by a spinal cord injury is classified as complete injury (no movement or feeling below the injury) or incomplete injury (some feeling or movement below the injury).

Immediately after a spinal cord injury, your spine may be in shock, causing a decrease or loss in feeling, reflexes and the ability to move. Other symptoms can develop after the swelling decreases.
Loss of movement and ability to feel occur below the injury site. An injury to the neck vertebrae causes the worst symptoms. An injury to the first through fifth vertebrae (neck) can affect breathing muscles, and the patient may be unable to breathe without a mechanical respirator (breathing machine). An injury that affects the lower spine may allow breathing and arm movement, but restrict leg movement and sexual function, for example.

The most common symptoms of an acute spinal cord injury include:

Muscle weakness
Loss of ability to move muscles; quadriplegia is loss of function in arms and legs; paraplegia is loss of function in the legs and lower body
Breathing problems
Loss of feeling in the chest, arms or legs
Loss of ability to control bowels and bladder

In addition to these symptoms, spinal cord injury patients can develop complications over time. Complications may include:

Skin infections or sores
Severe headaches
Increasing pain
Fever, cough and signs of infection
Severe diarrhea or constipation
Severe muscle cramps or spasms
Problems urinating

How is an acute spinal cord injury diagnosed?

A possible spinal cord injury needs emergency evaluation. A doctor will ask questions about the accident, examine the patient, and test for feeling and movement. However, if the patient is not alert or fully awake, or complains of neck pain or has signs of weakness, emergency diagnostic tests will be used to diagnose a spinal cord injury.

Diagnostic tests may include:

X-rays can show problems with vertebrae, fractures, tumors or degenerative changes in the spine.
CT (computed tomography) scans provide clearer images of spinal problems by using computers to create a series of cross-sectional images.
MRI (magnetic resonance imaging) scan is used to identify herniated disks, blood clots or tumors that could be compressing the spinal cord.
Neurological exam will be done a few days after the injury when most of the swelling has decreased. This examination tests muscle strength and sense of touch. It helps the doctor determine if it’s a complete or incomplete injury.

Are there any treatments for an acute spinal cord injury?

Immediate emergency treatment at the accident scene can improve the chances of recovery, especially with trauma to the head or neck. Treatment begins with stabilizing the spinal cord, preventing shock, and maintaining the patient’s ability to breathe. A mechanical ventilator can provide breathing assistance.

In the emergency room, treatment is given to prevent complications with breathing, heart and blood circulation, formation of deep vein blood clots in the arms and legs, muscle contractures, and urine/stool retention. Traction to stabilize or align the spine is done with neck collars or braces.
Surgery may be required to stabilize the spinal cord and to prevent pain or deformity. Surgery may also be needed to remove bone fragments or foreign objects, or to treat herniated disks or broken vertebrae that are compressing the spine.
Ongoing treatment focuses on preventing any further injury and therapy to restore as much mobility and feeling as possible. The patient may be transferred to a rehabilitation facility for long-term therapy. Recovery to the patient’s pre-injury activity levels is determined by the severity and level of injury. Most of the recovery occurs in the first six months, although some patients continue to make some progress for up to two years. The rehabilitation team may include physical and occupational therapists, rehab psychologist, rehab nurse, doctor specializing in spinal cord injuries, dietitian, and social worker. It’s normal to feel depressed after a devastating injury and psychologists can help with talk therapy. It’s important to focus on maximizing the patient’s capabilities at home, work or school and in the community.
Medications are available to help manage some of the effects of spinal cord injury. Corticosteroids may be used to decrease swelling in the spinal cord. Other medications are used to relieve pain and muscle spasticity (rigid muscles or muscle spasms), improve bladder and bowel control, and sexual functioning.
Technology is helping to improve treatment and recovery for spinal cord injury patients. Examples include: modern wheelchairs, computer software for voice recognition, and voice or computer-based remote controlled electronic aids that help with daily living tasks. Electrical stimulation devices to control arm and leg muscles allow spinal cord injury patients to stand, walk, reach and grip.
Frequent testing and medical evaluations will be needed to monitor progress after hospitalization and rehabilitation have ended.

There is no treatment that can reverse damage to the spinal cord. Researchers are working on nerve cell regeneration to improve nerve function, induced hypothermia to reduce inflammation, and prostheses to help improve mobility after a spinal cord injury.

Johns Hopkins Medicine. (N.d.). Acute Spinal Cord Injury. Retrieved 10-18-21, {https://www.hopkinsmedicine.org/health/conditions-and-diseases/acute-spinal-cord-injury}

Mayo Clinic (Oct. 2021). Spinal cord injury. Retrieved 10-18-21, {https://www.mayoclinic.org/diseases-conditions/spinal-cord-injury/symptoms-causes/syc-20377890}

Mayo Clinic (Oct. 2021). Spinal cord injury: Diagnosis and Treatment. Retrieved 10-18-21, {https://www.mayoclinic.org/diseases-conditions/spinal-cord-injury/diagnosis-treatment/drc-20377895}

Medically reviewed by:

Dr. Desiree Levyim

Dr. Desiree Levyim is a board eligible neurologist in practice since 2020. She joins TeleMed2U in our mission to provide increased access to healthcare.

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References

Johns Hopkins Medicine. (N.d.). Acute Spinal Cord Injury. Retrieved 10-18-21, {https://www.hopkinsmedicine.org/health/conditions-and-diseases/acute-spinal-cord-injury}

Mayo Clinic (Oct. 2021). Spinal cord injury. Retrieved 10-18-21, {https://www.mayoclinic.org/diseases-conditions/spinal-cord-injury/symptoms-causes/syc-20377890}

Mayo Clinic (Oct. 2021). Spinal cord injury: Diagnosis and Treatment. Retrieved 10-18-21, {https://www.mayoclinic.org/diseases-conditions/spinal-cord-injury/diagnosis-treatment/drc-20377895}

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