1. Spinal Cord Injury

2. What is a spinal cord injury?
Spinal cord injury (or SCI for short) can happen when the spinal cord is damaged from an accident, like a car accident, through an illness, like an infection, or in some other way, like a fall or from a knife wound.
Such damage causes 2 things:
- loss of physical movement known as paralysis
- loss of sensation (physical feeling) in your body below the
level of injury

3. What does the spinal cord do?
The spine is made up of bones, ligaments (tissue that connects the bones),discs, nerves and the spinal cord.
The spinal cord is a collection of nerves that carry messages from the brain to the rest of the body.
You can think of the spinal cord as a big electrical cable made up of lots of wires that sends information to and from the brain. It is protected by rings of bone called vertebrae which go round the spinal cord. There are 33 of these bones (or vertebrae) in the spine.

4. The vertebrae of the spinal cord
7 cervical – in the neck
12 thoracic – in the chest or upper back
5 lumbar – in the lower back
5 sacral – in the pelvic region
4 coccyx – tailbone of the spine
Your spinal cord injury is here
Injury Level ______
These vertebrae or bones are separated by discs or shock absorbers and make up the curved structure of the spine.

5. This picture shows the areas of the body that are affected by your level of injury

6. What are the effects of a spinal cord injury?
When the spinal cord is damaged, the messages from the brain cannot get carried past the damaged part and so can’t tell your muscles to move.
Being paralysed or paralysis means a loss of physical feeling and movement.
Spinal cord injury affects how our limbs (our arms and legs) work. It can also affect all of our bodily systems because our spinal cord carries all the information between the brain and the rest of the body.

7. This diagram shows how information about touch, pain and pressure travels to and from the brain through the sensory nerves, the spinal cord and the motor nerves.
When the spinal cord is damaged it may have difficulty in transmitting information.

8. Organs such as our stomach, bladder, bowel and lungs can be affected.
Other problems include not being able to sweat or control our temperature properly, having low blood pressure and experiencing constant pain.
The higher the injury, the more someone’s body is effected. That means that if your injury happens higher up your back or neck, you will experience more loss of physical feeling and movement.
Loss of movement also depends on whether the spinal cord is completely severed or only partly damaged. Very high injuries in the neck may affect the nerves to and from the diaphragm (a muscle near the lungs), so breathing will need to be helped with a ventilator.

9. Understanding spinal cord injury
‘What does the word ‘‘Tetraplegia’’ mean?’
If the spinal cord has been damaged in your neck area (known as the cervical region), you are said to be tetraplegic.
Tetraplegia (also known as Quadraplegia) means that the legs, arms, stomach and some chest muscles are paralysed.
For example, C4 Tetraplegia means that your body is paralysed below the neck. C6 Tetraplegia means that your hands and arms and lower body are partially paralysed.

10. Understanding spinal cord injury
‘What does the word ‘’Paraplegia’’ mean?’
Paraplegia means that the legs and possibly some stomach muscles are paralysed but you will be able to move your arms.
For example, T6 Paraplegia means that your body is paralysed below the chest. L1 Paraplegia means that your body is paralysed below the waist.

11. Spinal cord injury can occur at any level or multiple levels of the spinal cord

12. What does ‘Complete’ and ‘Incomplete’ injury mean?
In hospital, we use a special scale called the ASIA Impairment Scale to describe the type of spinal injury you have. ASIA stands for American Spinal Injury Association.
Using this scale, spinal injury can be described as Complete, Incomplete Sensory, Incomplete Motor, and Normal.

13. Complete
A complete injury is when the spinal cord has been fully damaged at any level so that you can not move or feel anything below the level of your injury, then your injury is said to be complete. Both sides of the body are effected in the same way.

14. Incomplete
An incomplete injury is when some messages to and from the brain can still get past the damaged area so that you can move or feel some parts of your body below the level of your injury.
There are two types of incomplete injury: sensory incomplete and motor incomplete:
Sensory incomplete means that you are able to feel some parts of the body that cannot be moved.
Motor incomplete means that you are able to move some parts of the body that cannot be felt. You may be able to move one limb and not the other and have more use on one side than the other.

15. Autonomic Dysreflexia
Autonomic Dysreflexia (or AD for short) is unique to spinal cord injuries.
What is AD?
It is a sudden and dangerous rise in blood pressure triggered by an exaggerated response to painful stimuli, below the level of spinal cord damage.
If AD is not treated or the cause remains unresolved, then it could be fatal.
AD can happen any time from the start of spinal paralysis. It happens in both complete and incomplete injuries but usually only affects those with an injury at the level T6 and above.

16. What happens to the body during an episode of AD?
Symptoms:
severe pounding headache
flushed appearance of the skin
above the level of injury
profuse sweating above the
level of the lesion
nasal congestion
feeling unwell
blurred vision
increase in spasm
continued severe hypertension
(raised blood pressure)
Faecal impaction

17. Common causes of Autonomic Dysreflexia (AD)
blocked catheter
constipation
a broken bone
ingrowing toenail
pressure ulcer
erection
menstrual problems
pregnancy/labour

18. Treatment of Autonomic Dysreflexia (AD)
AD needs to be treated urgently because it can be fatal. It is
important to find and treat the cause as soon as possible.
First things to do are:
Treat the high blood pressure whilst identifying the cause
Sit up to lower the blood pressure
Check for possible causes so that the pain stimulus can be removed
If the pain stimulus cannot be removed take 10mg Nifedipine under the tongue. (Nifedipine patches are available and can be removed when the symptoms are relieved).
Seek prompt medical advice if the cause cannot be identified or the blood pressure cannot be controlled

19. Prognosis in spinal cord injury
‘Why won’t my doctor tell me my prospects of recovery?’
When a spinal cord injury happens there may be some swelling around the spinal cord. After days or weeks the swelling should go down and some function may return.
Those who damage only part of the spinal cord may recover some movement or feeling following the wearing off of the shock to the spine.
It can take up to two years for your body to recover from a spinal cord injury so a clear prognosis is difficult to give, especially with incomplete spinal cord injury.

20. ‘How long will I have to be in hospital?’
It depends on your injury. People with Tetraplegia may need to stay in hospital for up to 9 months and those with Paraplegia may need to stay in hospital for up to 5 months. Rehabilitation can take a long time and this depends on many factors.
‘Is there a cure for spinal cord injury?’
Although spinal doctors are able to fix the damage to the bones of the spine, at the moment there is no way to repair the spinal cord itself. Once the nerve cells of the spinal cord have been destroyed they cannot repair themselves. You can access the most accurate research findings on the following websites: