TRAUMATIC

SPINAL
CORD
INJURY
 What is trauma?
The word trauma can be confusing. There are two main
definitions – firstly, that trauma relates to a distressing or
disturbing psychological experience. Trauma also means
physical injury which may result in wounds, broken bones,
or internal organ damage.
 Traumatic injury
Traumatic injury is a term that refers to physical injuries of sudden onset
and severity which require immediate medical attention. The insult may
cause systemic shock called “shock trauma”, and may require immediate
resuscitation and interventions to save life and limb.
 Traumatic injuries are the result of a wide variety of blunt,
penetrating, and burn mechanisms. They include motor vehicle
collisions, sports injuries, falls, natural disasters, and a multitude of
other physical injuries which can occur at home, on the street, or
while at work and require immediate care.
 Types of Traumatic injury
 Traumatic brain injury  Acoustic trauma
 Spinal cord injury  Crush injury
 Spine fractures  Concussion
 Amputation - traumatic  Broken bone
 Facial trauma  Jaw - Broken or dislocated
Spinal cord injury
 Anatomy: Spinal cord
 The spinal cord is a cylindrical structure that runs
through the center of your spine, from your brainstem to
your low back.
 It's a delicate structure that contains nerve bundles and
cells that carry messages from your brain to the rest of
your body.
 Your spinal cord is one of the main parts of
your nervous system.
 The spinal cord begins at the bottom part of your
brainstem, called the medulla oblongata. Ends at your
lower back, your spinal cord forms a cone shape called
the conus medullaris.
 . In most adults, your spinal cord is about 18 inches (45
centimeters) long.
Bones of
spinal
cord 7 – Cervical
12- Thoracic
5 – Lumbar
5- Sacral
3-4 Coccyx
 Spinal cord
injuries
According to WHO,
The term ‘spinal cord injury refers to damage
to the spinal cord resulting from trauma (e.g.
a car crash) or from disease or degeneration
(e.g. cancer).
A traumatic spinal cord injury (TSCI) is a
traumatic injury leading to damage of the
spinal cord, resulting in a temporary or
permanent change to neurological function,
including paralysis.
 Causes of Spinal cord injuries
78% of people with SCI are male, typically young men of 16-30 years. A spinal cord injury
is often the result of an unpredictable accident or violent event. The following can all
result in damage to the spinal cord:
• a violent attack such as a stabbing or a gunshot
• diving into water that’s too shallow and hitting the bottom
• Motor vehicle accidents. Auto and motorcycle accidents are the
leading cause of spinal cord injuries, accounting for almost half of
the new spinal cord injuries each year.
• falling from a significant height
• head or spinal injuries during sporting events.
• Delivery during birth, which most often affects the spinal cord in
the neck.
• Infection that forms an area of damage (abscess) on the spinal
cord.
• Injury that blocks circulation to the spinal cord
 Spinal Shock
Spinal shock is the altered physiologic state
immediately after a spinal cord injury (SCI),
which presents as loss of spinal cord function
caudal to the level of the injury, with flaccid
paralysis, anesthesia, absent bowel and bladder
control, and loss of reflex activity.
Initially, after a spinal cord injury, the patient
may experience spinal shock, which causes loss
or a decrease in feeling, muscle movement, and
reflexes. As swelling subsides, other symptoms
may appear depending on the location of the
injury.
Symptoms:
 Altered body temperature
 Skin colour and moisture changes (such
as dry and pale skin)
 Abnormal perspiration function
(decreased or increased sweating,
flushing)
 Increased blood pressure and slowed
heart rate
 Irregularities in the musculoskeletal
system
 Altered sensory response
 Unusual urinary bladder and GI tract
functions (overflow and incontinence)
 Neurological shock
Neurogenic shock is a condition in
which you have trouble keeping
your heart rate, blood pressure and
temperature stable because of
damage to your nervous system
after a spinal cord injury.
Symptoms of neurogenic shock
include:
 Low blood pressure (hypotension).
 Slow heart rhythm
(bradyarrhythmia).
 Flushed, warm skin that gets cold
and clammy later.
 Lips and fingernails that look blue.
 Lack of full consciousness
 Phases of Traumatic spinal cord
injury

The primary Secondary

injury injury

Acute injury phase ( Less than 48 hrs of injury)

Subacute injury (48hrs to 14 days later)
Intermediate and chronic phase ( 14 days to 6
months and beyond)days
 The American Spinal Injury Association (ASIA)

• The American Spinal Injury Association (ASIA) is a universal classification tool for
spinal cord injuries based on a standardized sensory and motor assessment, with the
most recent revision published in 2019.

• It involves both a Motor and Sensory examination to determine the Sensory Level and
Motor Level for each side of the body (Right and Left), the single Neurological Level
of Injury (NLI), and whether the injury is Complete or Incomplete.

• The ASIA Impairment Scale assigns the SCI a grade based on its severity. Grades
range from A to E, with A being the most severe injury and E being the least severe.
The American Spinal Injury Association (ASIA) classifies spinal
cord injuries into the following types
Grade A:
Complete sensory or motor function loss below the level of injury.

Grade B
A complete spinal cord injury with complete loss of movement

Grade C
An incomplete spinal cord injury with limited movement preserved, with less than half of muscles
unable to lift extremities
Grade D
An incomplete spinal cord injury with limited movement preserved, with more than half of muscles
unable to lift extremities

Grade E;
Normal sensation and motor function.
Types of spinal cord
injury
1. Based on severity: The
extent of the damage to the
spinal cord determines
whether the injury is
complete or incomplete . 
 a. Complete injury
• A complete injury means that there is no movement or feeling below
the level of the injury. A complete spinal cord injury causes permanent
damage to the area of the spinal cord that is affected. Paraplegia or
tetraplegia is the result of complete spinal cord injuries.
• Complete SCIs are the most serious and occur when the spinal cord is
injured, eliminating the brain’s ability to send signals below the injury
site. If all feeling (sensory) and all ability to control movement (motor
function) are lost below the spinal cord injury, your injury is called
complete.
• Complete injuries cause damage "through" the spinal cord at the
specific level of injury. A complete injury can be defined as having no
movement or feeling in the areas around the buttocks or rectum.
 Complications
Autonomic Dysreflexia
it is an acute syndrome characterized by a sudden excessive increase in
Systolic Blood Pressure. Autonomic dysreflexia is an abnormal, overreaction
of the involuntary (autonomic) nervous system to stimulation.
Autonomic dysreflexia can affect people who have had a spinal cord injury
at the level of T6 or above, and occurs more frequently in those with a
complete injury over those with an incomplete injury, presenting more
commonly during the chronic phase of spinal cord injury, around 3 - 6
months.
Their blood pressure rises significantly, and they may have a pounding
headache, a slow heart rate, profuse sweating, goose bumps, flushed skin,
blurred vision, and anxiety.
 b. Incomplete Injury
An incomplete injury means that there is still some degree of feeling or
movement below the level of the injury.
Incomplete SCIs commonly result from compression or damage being
inflicted on the spinal cord that reduces the brain’s ability to send signals
below the injury site. Because of the partially-compromised condition of the
spinal cord.
There can be varying degrees of incompleteness. The amount of
movement/feeling is determined by the location of the injury and how much
damage has been done to the cord. Each person and each injury are different.
Incomplete spinal cord injuries are more common than complete injuries.
Over 60% of all injuries to the spinal cord are incomplete.
These spinal injury types are usually classified based on which part of the
spinal cord the injury affected: the front, center, rear, or side.
Signs and symptoms of incomplete spinal cord injury:

 Weakness in the body below the site of the injury;

 A loss of control over one or more limbs;

 Difficulty breathing without assistance;

 Abnormal pain in the back, arms, or legs; and

 Numbness or loss of sensation below the injury site.

 1. Central cord syndrome:
Central cord syndrome is the most common
form of incomplete spinal cord injury
characterized by impairment in the arms and
hands and to a lesser extent in the legs. The
brain's ability to send and receive signals to and
from parts of the body below the site of injury
is reduced but not entirely blocked. Most have
moderate but incomplete recovery.
2. Anterior cord syndrome:
Anterior cord syndrome is an incomplete cord
syndrome that predominantly affects the
anterior 2/3 of the spinal cord, characteristically
resulting in motor paralysis below the level of the
injury. Anterior cord syndrome is when the front
of the spinal cord is damaged. This often
interferes with sensations of touch, pain, and
temperature. Most anterior cord injury survivors
can recover some movement with therapy. Poor
prognosis, 10-20% chance of motor recovery
 3. Posterior Cord Syndrome
Posterior cord syndrome is a rare type of
incomplete spinal cord injury that affects
the dorsal columns of the spinal cord (found in
the posterior—or backside—a region of the
spinal cord), responsible for the perception of
fine touch, vibration, sense of self-movement,
and body positioning (proprioception).
4 . Brown-Sequard Syndrome
Brown-Square syndrome (BSS) is a rare neurological
condition characterized by a lesion in the spinal
cord that results in weakness or paralysis
(hemiparaplegia) on one side of the body and a loss
of sensation (hemianesthesia) on the opposite side.
This injury may immobilize or weaken one side of
the body below the injury site while leaving the
other side almost fully functional.
 Diagnosis and treatment
 X-ray
 CT scan
 MRI SCAN
 Spinal tapes: A spinal tap is when a
doctor extracts cerebrospinal fluid
(CSF) from the spine for analysis. By
checking CSF, a doctor may be able to
identify certain infections that may be
affecting spinal cord health.
• Medications: various medications for a spinal cord injury,
including painkillers, blood thinners/anticoagulants, antibiotics,
and anti-inflammatories depending on the cause and nature of
the injury.
• Surgery: The type of surgical procedure performed may vary
depending on the SCI.
• Physical Therapy: Many SCI survivors undergo physical therapy
to help them improve their overall health, maintain muscle
mass, and prevent unhealthy weight gain.
• Occupational Therapy: focus is more on helping SCI survivors
regain their independence—relearning how to accomplish
specific tasks with their injury.
• Psychiatric Therapy: SCI survivors may struggle with depression,
anxiety, and other mental health issues as well. A psychiatrist
can help diagnose various disorders of the mind and prescribe
therapy regimens to help improve the well-being of an SCI
survivor.
2. Levels of Spinal cord injury/Spinal cord syndrome
1. Cervical spine injury (vertebrae C1 through C7): Injury to
the neck
•Cervical spinal cord injuries affect the head and neck
region above the shoulders. It is the most severe level of
spinal cord injury.
•This can cause loss of muscle function or strength in the
arms and legs and loss of feeling below the point of injury.
This is called tetraplegia (formerly known as quadriplegia)
with sensory loss.

2. thoracic spine injury (vertebrae T1 through T12): Injury to

the upper spinal cord
•This often causes weak chest muscles. The child may need
help with breathing using a breathing machine (ventilator).
Results in paraplegia.
•Thoracic spinal cord injuries affect the upper chest, mid-
back, and abdominal muscles. Arm and hand function is
usually normal with this level of spinal cord injury
3.Lumbar spine injury(vertebrae L1 through L5): Injury to
the lower spinal cord

 Lumbar spinal cord injuries affect the hips and legs.

Individuals may need a wheelchair or walk with braces with
this level of spinal cord injury.
 Potential loss of sexual function, bladder, and bowel control
4.Sacral spine (vertebrae S1 through S5): Injury to the lower spinal cord

 Sacral spinal cord injuries affect the hips, back of the thighs, buttocks,
and pelvic organs. Individuals are most likely able to walk with this level
of spinal cord injury.
 This can cause paralysis and loss of function in the legs. It can also cause
loss of nerve and muscle control to the bladder, bowel, and sexual
organs..
Based on part of the body injured

Tetraplegia

Paraplegia
 Tetraplegia

Tetraplegia (sometimes referred to as

quadriplegia) is a term used to describe the
inability to voluntarily move the upper and
lower parts of the body. The areas of impaired
mobility usually include the fingers, hands,
arms, chest, legs, feet and toes and may or
may not include the head, neck, and
shoulders.
 Symptoms
Primary Symptom Paralysis in all four limbs
Some of the other complications include:
 Bed sores and other skin lesions caused by spending too much time seated or lying down in the same
position.

 Muscle spasms (leg cramps

 inability to sense  heat or cold or touch

 sexual dysfunction

 Muscle atrophy due to a lack of activity

 Breathing difficulties that may eventually require a ventilator

 Difficulty maintaining a healthy heart rate and blood pressure

Types:
 Treatment
 Paralysis is not currently curable. However, treatment may help some people regain partial or
complete control over the affected areas.
 Doctors may also prescribe drugs to help with the pain or relax the muscles.
 Physical and occupational therapy may also be necessary to reduce muscle atrophy.
 Psychotherapy can also help with the emotional difficulties that some people experience with
tetraplegia. Sometimes, this will also involve family members or loved ones.
 Wheelchairs and other assistive devices can improve a person’s mobility.
 some researchers suggest that stem cell therapy may help some people regain some control
over the affected areas.
 b. Paraplegia

Loss of sensation, function, or movement in the

legs or lower parts of the body. Paraplegia is a type
of paralysis that affects your ability to move the
lower half of your body. It occurs when an illness
or injury impacts the part of your nervous system
which controls the lower half of your body.
People with paraplegia may be unable to
voluntarily move their legs, feet, and sometimes
their abdomen.
Some people experience incomplete paraplegia.
This is the case when paralysis only affects one leg.
 Symptoms

 a loss of sensation in the lower body

 impaired mobility
 weight gain
 Depression
 phantom bouts of pain or sensation in the
lower body
 chronic pain
 sexual dysfunction
 difficulty with bladder and bowel function
 secondary infections, such as bedsores and
skin problems
 autonomic dysreflexia
 Treatment
 There are currently no treatments to prevent or reverse paraplegia. However, it
is possible to treat some of the symptoms and complications that occur. It is
also possible for some people to regain partial or complete control over
affected areas with time.
 Physical therapy can also help a person preserve their strength and range of
motion.
 Devices to support mobility, such as a wheelchair or a mobility scooter, are
usually necessary.
 A doctor might also suggest some medications. For example, taking muscle-
relaxing medications can help with pain or spasms. Taking blood-thinning
medications will reduce the risk of blood clots.

 In some cases, surgery might be necessary. Surgery can help with swelling and
removing lesions
 Treatment of spinal cord injury:
1. Medication: such as corticosteroids (to help decrease the swelling in the spinal cord). An
injection of methylprednisolone is given within 6-8 hours after the injury. It helps by preventing
the inflammatory reaction at the injured site as well as by reducing further damage.
2. Bladder catheter. A tube is placed into the bladder helps to drain the urine into a collection bag.
3. Surgical management: It may be required to remove the herniated disc, and broken fragments of
bone and to stabilize the spine.
4. stem cell treatment: involves the administration of concentrated cells in the targeted area, wherein
they can colonize the damaged area, adapt the properties of resident stem cells, and initiate some of
the lost functions that have been compromised by the disease or injury.
5. Muscle relaxants or Botox: injections can help temporarily reduce the effects of spasticity by
blocking the signals that trigger muscle contractions.
6. Functional Electrical Stimulation (FES): Functional electrical stimulation is a non-invasive
treatment that involves placing electrodes on the surface of the skin while the patient performs a
task. The electric currents mimic brain signals and cause the muscles to contract. By directly
activating muscle contractions, FES can help improve circulation, range of motion, and muscle
strength.
 Complications of spinal cord injury:

 Septicaemia: This is an infection that enters the bloodstream. Symptoms can include fever
and chills, confusion, nausea and vomiting, increased heart rate, and low blood pressure.

 Pneumonia: This is a risk for people with SCI level T6 and above. Their blood pressure rises
significantly, and they may have a pounding headache, a slow heart rate, profuse sweating,
goose bumps, flushed skin, blurred vision, and anxiety.

 Spasticity: Many people with spinal cord injuries develop involuntary increases in muscle
tone—a condition called spasticity.  The muscles are very stiff and it is more difficult to move
the affected extremities because of the stiffness.
 Syringomyelia: This is a condition in which a fluid-filled cavity forms near the spinal
cord, putting pressure on surrounding areas.  It affects up to 5 percent of SCI patients

 Loss of bladder or bowel control: People with spinal cord injuries may need to learn
how to empty their bladder and bowels when they cannot feel the urge to go.

 Sexual dysfunction: Spinal cord injuries can reduce or remove the ability to obtain
an erection or become sexually aroused. They can also make it difficult or impossible
to have an orgasm. Women with spinal cord injuries may have difficulty getting
pregnant, and these injuries can sometimes prevent ejaculation in males.
 Conclusion

Traumatic spinal cord injury (TSCI) is a debilitating disease that

poses significant functional and economic burdens on both the
individual and societal levels. The prognosis is dependent on
the extent of the spinal injury and the severity of neurological
dysfunction. If not treated rapidly, patients with TSCI can suffer
further secondary damage and experience escalating disability
and complications. It is important to quickly assess the patient
to identify the location and severity of the injury to make a
decision to pursue surgical and/or conservative management.
However, there are many conditions that factor into the
management of TSCI patients, ranging from the initial
presentation of the patient to long-term care for optimal
recovery. 
Thank you