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Spinal Cord Trauma

March 11, 2022

By Robert H. Shmerling, MD, Senior Faculty Editor,

Harvard Health Publishing; Editorial Advisory Board
Member, Harvard Health Publishing

What Is It?
The spinal cord carries nerve signals from the
brain to the rest of the body. Trauma to the spinal
cord can result from a number of injuries: about
half occur after motor vehicle accidents; followed
by falls; gunshot wounds or other violence; and
sports-related injuries. The average age at injury
is 42 years, and approximately 80% of those
affected are male. Up to one-quarter of cases occur
after signiFcant alcohol ingestion. Pre-existing
disease in the spine can make spinal cord trauma
more likely. For example, complications of
rheumatoid arthritis or osteoporosis may lead to
spinal cord damage.

Most spinal cord injuries occur in the area of the

neck called the cervical region. Trauma can result
from bruising to the spinal cord itself, loss of blood
Low to the cord or cuts in the cord. Spinal cord
injuries are serious and can cause diminished
strength, coordination and sensation as well as
other functions, such as bladder control.

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L EA R N M ORE

Symptoms
The symptoms of spinal cord trauma vary and
depend on the location and severity of the injury.
Complete spinal cord trauma -- an injury that
results in a total loss of sensation or the ability to
move -- occurs at about the same level as the
injury. For example, a person injured in the middle
of the neck will lack feeling and be unable to
move below the middle of the neck. Almost one-
half of all spinal cord injuries are complete.
Complete injuries that take place in the upper
neck can compromise breathing ability and
require the person to use a mechanical ventilator.
Injuries to the spinal cord in the neck or upper
back may cause abnormalities in blood pressure,
sweating and in regulating body temperature. In
addition, loss of bladder and bowel control and
increased muscle tone in the extremities
(spasticity) may accompany spinal cord injury.
Some of these symptoms may not be apparent
immediately after the injury.

Injuries to a speciFc side of the spinal cord or its

center will produce characteristic patterns of
symptoms, such as weakness or paralysis of arms
or legs, or one side of the body. In an injured
person who is unconscious, the degree of
neurological injury may be hard to assess, so
doctors must have a high degree of suspicion that
a spinal cord injury has taken place and take steps
to protect the spinal cord. This usually is done by
using a cervical collar to immobilize the neck or
by strapping the person to a stiff backboard for
transport.

Diagnosis
The possibility of spinal cord trauma should be
considered in anyone who has been in a severe
automobile accident or who has experienced
signiFcant injury to the head or neck.

If you are conscious, you will be asked about neck

pain and whether you can feel and move your
arms and legs. SigniFcant pain, bruising and
swelling of the skin and tissues over the neck or
back may raise the suspicion of a spinal cord
injury. A physical examination may reveal loss of
sensation, weakness, and abnormal reLexes.

You also will be assessed for whether you have

other injuries that may be diverting attention from
a neck injury, and for the presence of other signs
of spinal cord injury. X-rays, computed
tomography (CT) scans and magnetic resonance
imaging (MRI) also may be used to evaluate your
spine and the spinal cord.

A cervical collar to keep your neck immobilized

often will be left in place until the results of tests
are available. If a spinal cord injury is suspected,
the collar may be left in place for at least several
days, even if tests are negative, in case an injury
does exist but hasn't been detected because of
swelling or muscle spasm.

Complete spinal cord injuries are diagnosed when

total loss of sensation and control occurs.
Incomplete injuries cause variable amounts of
sensory loss, weakness or paralysis, depending on
the site of the injury.

Expected Duration
How long the symptoms of spinal cord injury last
depends on the nature and extent of the injury.
Minor bruising may go away over time, although
full recovery sometimes takes weeks or months.
More serious injuries often will result in
permanent loss of function. Strategies for helping
nerve cells (neurons) recover after injury is an
area of active research.

Prevention
Preventing spinal cord injury requires preventing
traumatic injury to the spinal column, especially
the neck. The leading causes of spinal cord injury
include automobile accidents, falls, sports, diving
accidents and Frearms. To prevent spinal cord
injury:

Always wear your seat belt.

Don't drink and drive.

Dive only in water at least 9 to 12 feet deep,

with your arms in front of you. Never dive into
water if you don't know its depth.

Wear protective equipment when playing

sports or engaging in any dangerous activity.

Protect yourself against falls.

Treatment
Emergency care, surgery (when necessary),
rehabilitation and supportive care, including use
of respirators, can help people with spinal cord
injuries survive and make the most of their
remaining neurologic function.

In the past, corticosteroids were often given just

after the injury to reduce swelling around the
injured spinal cord. While corticosteroid therapy
remains an option, a number of guidelines have
removed this treatment as a standard
recommendation due to a lack of convincing
evidence supporting its effectiveness and its
potential to cause side effects.

Most treatment of spinal cord injuries involves a

"wait and see" approach. If the injury is minor,
only time will reveal the extent of recovery. For
those with major injuries, a complete recovery is
highly unlikely, and treatment consists of
providing supportive care, teaching new skills and
developing coping strategies.

Surgery sometimes is required to stabilize a

damaged spine, to remove fragments of injured
bone, discs, or foreign objects (such as bullets), to
drain Luid or a blood clot that is pressing on the
spinal cord.

Active areas of research include:

cooling of the body temperature or cooling of

the tissues near the spinal cord

nerve-cell transplant

hormones and growth factors that encourage

nerve cell regeneration

electrical stimulation

Some believe that stem cells hold promise in

helping people with spinal cord trauma regenerate
damaged nerve cells so that neurologic function
can be regained.

When To Call a Professional

All cases of actual or possible spinal cord trauma
should be evaluated by a doctor immediately.

Prognosis
Spinal cord trauma may heal over time without
further problems, or it may result in permanent
deFcits, depending on the location and severity of
the injury. Early recovery of at least some
movement or sensation suggests that additional
recovery is possible. Lost sensation or function
lasting more than 6 months is unlikely to improve.

Additional Info
Christopher Reeve Paralysis Foundation
https://www.christopherreeve.org

United Spinal Association

https://www.unitedspinal.org

Think First National Injury Prevention

Foundation
https://www.think6rst.org/

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor,

Harvard Health Publishing; Editorial Advisory
Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical

chief of the division of rheumatology at Beth
Israel Deaconess Medical Center (BIDMC), and is
a current member of the corresponding faculty
in medicine at Harvard Medical School. … See
Full Bio

View all posts by Robert H. Shmerling, MD

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