SPINAL CORD INJURY

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. Both sides of the body are equally affected. An incomplete injury means that there is some functioning below the primary level of the injury. A person with an incomplete injury may be able to move one limb more than another, may be able to feel parts of the body that cannot be moved, or may have more functioning on one 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 incomplete injuries there will be some variation in these prognoses. Cervical (neck) injuries usually result in quadriplegia. Injuries above the C-4 level may require a ventilator for the person to breathe. C-5 injuries often result in shoulder and biceps control, but no control at the wrist or hand. C-6 injuries generally yield wrist control, but no hand function. Individuals with C-7 and T-1 injuries 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 to T-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 good abdominal muscle control. Sitting balance is very good. Lumbar and Sacral injuries yield decreasing 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. Sexual functioning is frequently affected: men with SCI may have their fertility affected, while women’s fertility is generally not affected. Very high injuries (C-1, C-2) can result in a loss of many involuntary functions including the ability to breathe, necessitating breathing aids such as mechanical ventilators or diaphragmatic pacemakers. Other effects of SCI may include low blood pressure, inability to regulate blood pressure effectively, reduced control of body temperature, inability to sweat below the level of injury, and chronic pain.

A person can “break their back or neck” yet not sustain a spinal cord injury if only the bones around the spinal cord (the vertebrae) are damaged, but the spinal cord is not affected. In these situations, the individual may not experience paralysis after the bones are stabilized. When a SCI occurs, there is usually swelling of the spinal cord. This may cause changes in virtually every system in the body. After days or weeks, the swelling begins to go down and people may regain some functioning. With many injuries, especially incomplete injuries, the individual may recover some functioning as late as 18 months after the injury. In very rare cases, people with SCI will regain some functioning years after the injury. However, only a very small fraction of individuals sustaining SCIs recover all functioning. Currently there is no cure for SCI. There are many researchers attacking this problem, and there have been many advances in the lab. Many of the most exciting advances have resulted in a decrease in damage at the time of the injury. Steroid drugs such as methylprednisolone reduce swelling, which is a common cause of secondary damage at the time of injury. The experimental drug Sygen®appears to reduce loss of function, although the mechanism is not completely understood.