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What is Spinal Cord Injury?

A spinal cord injury usually begins with a sudden, traumatic blow to the spine thatfractures or dislocates vertebrae. The damage begins at the moment of injury whendisplaced bone fragments, disc material, or

ligaments

bruise or tear into spinal cordtissue. Most injuries to the spinal cord don't completely sever it. Instead, an injury ismore likely to cause fractures and compression of the vertebrae, which then crush anddestroy 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. Some injuries will allow almost complete recovery.Others will result in complete paralysis.

Is there any treatment?

Improved emergency care for people with spinal cord injuries and aggressive treatmentand rehabilitation can minimize damage to the nervous system and even restore limitedabilities. Respiratory complications are often an indication of the severity of spinal cordinjury About one-third of those with injury to the neck area will need help with breathing and require respiratory support. The steroid drug methylprednisolone appears toreduce the damage to nerve cells if it is given within the first 8 hours after injury.Rehabilitation programs combine physical therapies with skill-building activities andcounseling to provide social and emotional support.

What is the prognosis?

Spinal cord injuries are classified as either complete or incomplete. An incomplete injurymeans that the ability of the spinal cord to convey messages to or from the brain is notcompletely lost. People with incomplete injuries retain some motor or sensory function below the injury. A complete injury is indicated by a total lack of sensory and motor function below the level of injury. People who survive a spinal cord injury will mostlikely have medical complications such as chronic pain and bladder and boweldysfunction, along with an increased susceptibility to respiratory and heart problems.Successful recovery depends upon how well these chronic conditions are handled day today.

What research is being done?

The National Institute of Neurological Disorders and Stroke (NINDS) conducts spinalcord research in its laboratories at the National Institutes of Health (NIH) and alsosupports additional research through grants to major medical institutions across thecountry. Advances in research are giving doctors and patients hope that repairing injuredspinal cords is a reachable goal. Advances in basic research are also being matched by progress in clinical research, especially in understanding the kinds of physical

rehabilitation that work best to restore function. Some of the more promisingrehabilitation techniques are helping spinal cord injury patients become more mobile.

http://www.ninds.nih.gov/disorders/sci/sci.htmWhat is Spinal Cord Injury?

Spinal Cord Injury (SCI) is damage to thespinal cord that results in a loss of function such as mobility or feeling. Frequentcauses of damage are trauma (car accident, gunshot, falls, etc.) or disease (polio, spina bifida,Friedreich's Ataxia, 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 toit results in loss of functioning. SCI is very different from back injuries such as ruptured disks,spinal stenosisor pinched nerves.A person can "break their back or neck" yet not sustain a spinal cord injury if only the bonesaround the spinal cord (the vertebrae) are damaged, but the spinal cord is not affected. In thesesituations, 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 andextends from the base of the brain, down the middle of the back, to about the waist. The nervesthat lie within the spinal cord are upper motor neurons (UMNs) and their function is to carry themessages back and forth from the brain to the spinal nerves along the spinal tract. The spinalnerves 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 communicatewith specific areas of the body. The sensory portions of the LMN carry messages about sensationfrom the skin and other body parts and organs to the brain. The motor portions of the LMN sendmessages 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 tothe 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 pressureand temperature regulation are the Sympathetic and Parasympathetic Nervous Systems.The spinal cord is surrounded by rings of bone called vertebra. These bones constitute thespinal column (back bones). In general, the higher in the spinal column the injury occurs, themore 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, thenext is C-2, etc. Cervical SCI's usually cause loss of function in the arms and legs, resulting inquadriplegia. The twelve vertebra in the chest are called the Thoracic Vertebra. The first thoracicvertebra, 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 fiveSacral 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. Bothsides of the body are equally affected. An incomplete injury means that there issome functioning below the primary level of the injury. A person with anincomplete injury may be able to move one limb more than another, may be ableto feel parts of the body that cannot be moved, or may have more functioning onone 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 incompleteinjuries there will be some variation in these prognoses.Cervical (neck) injuries usually result in quadriplegia. Injuries above the C-4level may require a ventilator for the person to breathe. C-5 injuries often result inshoulder and biceps control, but no control at the wrist or hand. C-6 injuriesgenerally yield wrist control, but no hand function. Individuals with C-7 and T-1injuries can straighten their arms but still may have dexterity problems with the hand and fingers.Injuries at the thoracic level and below result in paraplegia, with the hands not affected. At T-1 toT-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 goodabdominal muscle control. Sitting balance is very good. Lumbar and Sacral injuries yielddecreasing control of the hip flexors and legs.Besides a loss of sensation or motor functioning, individuals with SCI also experience other changes. For example, they may experience dysfunction of the bowel and bladder,. Sexualfunctioning is frequently with SCI may have their fertility affected, while women's fertility isgenerally not affected. Very high injuries (C-1, C-2) can result in a loss of many involuntaryfunctions including the ability to breathe, necessitating breathing aids such as mechanicalventilators or diaphragmatic pacemakers. Other effects of SCI may include low blood pressure,inability to regulate blood pressure effectively, reduced control of body temperature, inability tosweat below the level of injury, and chronic pain

How many people have SCI? Who are they?

Approximately 450,000 people live with SCIin the US. There are about 10,000 new SCI's every year; the majority of them (82%) involvemales between the ages of 16-30. These injuries result from motor vehicle accidents (36%),violence (28.9%), or falls (21.2%).Quadriplegia is slightly more common than paraplegia.

Isthere a cure?

Currently there is no cure for SCI. There are researchers attacking this problem, and there have been many advances in the lab (see research updates ). Many of the most exciting advances haveresulted in a decrease in damage at the time of the injury. Steroid drugs such asmethylprednisolone reduce swelling, which is a common cause of secondary damage at the timeof injury. The experimental drug SygenÆappears to reduce loss of function, although themechanism is not completely understood.

Do people with SCI ever get better?

When a SCI occurs, there is usually swelling of the spinal cord. This may cause changes invirtually every system in the body. After days or weeks, the swelling begins to go down and