What is a spinal cord injury?
A spinal cord injury (SCI) is damage to the spinal cord, a bundle of nerves that carries messages between your brain and the rest of your body. This cord runs from your neck down through your back. Depending on where and how severe the injury is, it can affect movement (paralysis), feeling, or other body functions below the injury site. Some effects may be long-lasting or permanent.
SCIs are medical emergencies that can happen suddenly from an accident or injury or develop when another condition damages or puts pressure on the cord. With Level 1 Trauma Centers in Philadelphia and Lancaster, Penn Medicine cares for even the most severe injuries across the region. Penn Medicine neurology, neurosurgery, and critical care teams are leaders in comprehensive care for spinal cord injuries. We also provide ongoing, specialized trauma care and rehabilitation to help you recover.
Changes after a spinal cord injury
Symptoms of a spinal cord injury depend on where along the spine the damage occurs and how much of the cord is affected. A complete injury affects the entire width of the cord, while an incomplete injury leaves some nerve pathways working.
Symptoms can affect movement, sensation, breathing, and bladder and bowel function. They may include:
- Numbness or tingling that spreads down an arm or leg
- Weakness in the arms or legs
- Trouble walking
- Paralysis, or loss of movement, in the arms or legs
- Signs of shock, like pale or clammy skin, bluish lips or fingernails, or seeming dazed
- Loss of alertness or consciousness
- Neck stiffness, headache, or neck pain
- An unusual head position
Symptoms from a neck-level injury can affect the arms, legs, and torso, including the muscles used for breathing. They may show up on one or both sides of the body. If the injury is high in the neck, breathing problems can become severe.
Symptoms from a chest-level injury mainly affect the legs. Injuries here can also cause blood pressure changes, unusual sweating, and trouble regulating body temperature.
Symptoms from a lower back injury can affect one or both legs, along with the muscles that control the bladder and bowels.
How spinal cord injuries happen
Most SCIs happen suddenly, either from an event like a car accident, sports injury, or fall, or from another event that puts sudden force on the spine. Sometimes, an SCI can occur after a relatively minor injury.
Conditions that weaken or narrow the spine, like osteoporosis, osteopenia, rheumatoid arthritis, cancer, or infection, can make the spinal cord more vulnerable to damage. A narrowing of the spinal canal (spinal stenosis) can have the same effect, and it’s common in older adults who often don’t know they have it.
Diagnosing a spinal cord injury
A spinal cord injury is a medical emergency, and diagnosis usually starts right away in the emergency department. Your care team will do a physical exam, including a check of your brain and nervous system, to help find the exact location of the injury. Imaging and other tests look for damage to the spinal cord, spine, or surrounding tissues.
Depending on your symptoms, your care team may order a specialized imaging test with contrasting dye (myelogram) to get a clearer look at the spine. A bladder scan or a swallowing test may also be used to check how the injury may be affecting those functions.
Treating a spinal cord injury
The amount of time between a spinal cord injury and treatment can affect how well someone recovers. Early care focuses on protecting the spinal cord from further damage and stabilizing the spine. Surgery may be needed to realign the spinal bones, relieve pressure on the spinal cord, remove bone, disk, or other tissue fragments, or stabilize the spine with rods and screws.
Depending on the injury, treatment may also include spinal traction, a brace, or a cervical collar to help keep the spine properly aligned while it heals. After initial treatment, various outpatient rehabilitation therapies can help you regain function, manage lasting effects, and adapt to changes after an injury. Services like physical therapy, occupational therapy, and speech therapy support this recovery process.
Complications from a spinal cord injury
Complications caused by a spinal cord injury can vary depending on the location and severity of the injury. While treatment may help alleviate or manage complications, some may be permanent. Your health care team can help determine your risk of complications and identify signs of severe complications.
- Numbness or tingling
- Muscle spasms
- Muscular atrophy (muscle loss)
- Quadriplegia or tetraplegia (paralysis from the neck down)
- Paraplegia (paralysis of the lower body)
- Spinal shock, temporary loss of movement, reflexes, and sensory function
- Autonomic dysreflexia (AD), a dangerous condition that causes a severe rise in blood pressure
- Urinary tract infections (UTI)
- Blood clots
- Pressure sores
- Nerve pain
- Pneumonia
- Sepsis
- Death
Coordinated injury care, from trauma response to recovery
A spinal cord injury often requires the care of multiple specialists, from emergency treatment and surgery to neurological care and rehabilitation. At Penn Medicine, Level I Trauma Centers provide around-the-clock care for serious injuries, providing access to experts in trauma, neurosurgery, orthopaedics, and other areas as needed.
This collaborative approach can continue through rehabilitation, with physical medicine and rehabilitation specialists helping you work toward your goals for function, mobility, and independence.