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Spinal Cord Injuries - Ammons Law

Spinal Cord Injuries

Spine-Book

Rob Ammons

An injury to the spine can damage vital nerves that help you walk, use your arms, and perform everyday functions that so many take for granted. Victims of spinal cord injuries may in one day lose their ability to perform their jobs, to care for their families, and to enjoy their favorite pastimes.

Spinal cord injuries often happen as a result of a traumatic accident. A veering 18-wheeler, a falling construction beam, or even a wet floor can cause the kind of impact that leaves someone paralyzed for life.

For the vast majority of people, treatment costs can simply be too much to take on. In one year alone, many families accumulate $300,000, $500,000, even $800,000 or more in treatment costs. Spinal cord surgeries are extremely expensive, not to mention the yearly treatment needed. A spinal cord injury victim will often need a lifetime of specialized medical care.

If a serious accident has left you or your family with mounting medical bills and an uncertain future, you have recourse. Many times, these injuries stem from someone else’s error.  It isn’t rare for individuals to suffer the adverse effects of a spinal cord injury through no fault of their own. Perhaps a car tire was made poorly and sold to the public even when a company knew of its dangers. Or maybe a construction company didn’t follow its own safety procedures, in an effort to cut operating costs.

About Spinal Cord Injuries

A spinal cord injury (SCI) damages the nerve roots that control the body’s movements and sensation. Causes of spinal cord injuries include accident trauma, developmental disorders, tumors, and diseases. Though there is currently no cure for spinal cord injuries, many people experience improved motor function thanks to effective treatment and rehabilitation.

Spinal Cord Injuries can be life-altering, not for only the injured person, but for family and friends as well. Sometimes, a family’s primary income provider suddenly loses the ability to work. Meanwhile, family members may need to put aside their own careers and provide full-time care for an SCI victim.

Types of Spinal Cord Injuries

Approximately 40 million people in the United States experience spinal cord injuries each year. Fortunately, only a fraction of these cases warrant hospitalization. (Lesser spinal cord injuries include whiplash and injuries that cause temporary loss of function.)

There are many different types of severe Spinal Cord Injury, each with distinct characteristics. Doctors determine the type of SCI through a combination of X-rays, CT Scans, MRI, and Myelography (x-ray after injection dye is used).

Depending on the injury, some patients can recover function, so SCI classifications are not necessarily permanent.
The American Spinal Injury Association (ASIA), in conjunction with leading medical experts, has refined the classification system which is used by most medical organizations.

The following is a breakdown of the specific criteria used by ASIA and doctors.

Complete Spinal Cord Injury

This type of spinal cord injury is, as the name infers, the most debilitating. Most complete spinal cord injuries result in paraplegia or quadriplegia/tetraplegia. With time, some complete SCI victims may recover some motor functions.

Incomplete Spinal Cord Injury

Incomplete SCI encompasses several different complications. Injury victims typically retain varying levels of movement and function below the location of their injury. Doctors tend to examine whether patients have enough mobility to provide force against objects, or if patients can only lift their limbs against gravity.

Other classifications for incomplete SCI include:

  • Anterior Cord Syndrome: Damage is towards the front of the spinal cord, which is commonly associated with loss of temperature and pain sensation below the location of the injury.
  • Brown-Sequard Syndrome: Damage is limited to one side of the spine, which causes loss of function on one side of the body and weakness and loss of function on the other side.
  • Central Cord Syndrome: Damage is located in the center of the spine, often resulting in loss of function in the upper body, and weakness in the lower regions.
  • Posterior Cord Syndrome: This rare type of SCI is characterized by difficulty in movement coordination, but general function is retained.

Impairment Scale

The American Spinal Cord Injury Association further classifies SCI under the letters A-E.

  • A – Complete. No motor or sensory function.
  • B – Incomplete. Sensory but no motor function is available.
  • C – Incomplete. Motor function is preserved and more than half of key muscles have severely limited use.
  • D – Incomplete. Motor function is preserved and more than half of key muscles have basis functionality.
  • E – Normal. Sensory and motor functions are functioning normally.

Motor and Sensory Levels

Your spine consists of vertebrae intertwined with nerves that control different bodily functions. An alpha numerical system classifies the specific vertebrae and muscle function affected by the injury.
These are as follows:

  • C-1 to C-7 – Cervical Region
  • T-1 to T-12 – Thoracic Region
  • L-1 to L-5 – Lumbar Region
  • S-1 – Sacral Region

Keep in mind that an injury to one area of the spinal cord tends to affect the entire body from that point below. So injuries to the neck-level cervical vertebrae (C-1 to C-7) can be the most dangerous of all. Injuries to the C-4 may result in quadriplegia, or a loss of motor function in the legs and arms. Injuries to the higher up C-1 or C-2 could result in breathing difficulties.

Health Issues resulting from SCI

The human spinal cord is an extremely delicate and complicated system. Damage to any part of it may cause impairments from temporary loss of sensation to complete limb paralysis. A severe spinal cord injury will affect different functions of your body, depending on the extent and location of the injury.

Paralysis

Paralysis refers to the complete loss of muscle function in one or more areas of the body. Most cases of paralysis are caused by direct injury to the spinal cord and the central nervous system.
Nerves that control much of the body’s function use the spinal cord as a sort of pathway, sending messages from the brain to various muscle systems. Different segments of the spinal cord control different muscle functions and sensory skills. So damage to lower segments of the spine could result in paralysis of the legs, while damage to upper segments of the spine can also result in paralysis of the arms.
Paralysis can be a temporary or permanent state. The extent of the nerve damage and the placement of the lesion (injury) are among factors that determine if the condition is permanent.

Paraplegia

Roughly 11,000 people each year are diagnosed with paraplegia. Paraplegia is generally the result of a spinal cord injury, birth defect, or degenerative disease. This life-altering condition refers to the loss of function in one’s lower extremities due to spinal cord injury. This typically includes the legs and trunk area, though the level of function loss can differ.
Different sections of your spinal cord are responsible for controlling specific bodily sensations and functions. The sections that can result in paraplegia if damaged are the thoracic, lumbar, and sacral regions. On the human body, this would roughly range from the middle of the shoulder blades to the top of the pelvis.

Complete Paraplegia

Contrary to what many people think, “complete” paraplegia does not imply that the spinal cord was severed. Complete paraplegia means that function at the T-1 level of the spinal cord or below is limited or absent. Also, despite what the name implies, “complete” paraplegia does not necessarily mean that all function is lost.

In severe instances of complete paraplegia, respiratory function may become complicated. This can require the use of a ventilator. In other cases, paraplegia may result in sleep apnea, which can cause abnormal breathing patterns at night.

Incomplete Paraplegia

When a person has incomplete paraplegia, they experience a partial loss of sensory and motor functions to their lower body.
In some cases, individuals with complete paraplegia will regain sensory and bodily function to the affected regions. Their symptoms will be diagnosed as incomplete paraplegia instead. However, it is currently not possible for doctors to predict gains in function for those with paraplegia.

Complications

The spinal cord is the central pathway that many important signals use to travel throughout the body. A severe spinal cord injury can lead to complications beyond the loss of lower bodily function.
Fortunately, the current medical treatment and prevention practices can minimize some of the effects that would have been life threatening decades ago.
Common complications for those with paraplegia, both complete and incomplete, include:

  • Bowel and bladder dysfunction
  • Male infertility
  • Tissue inflammation and chronic pain
  • Low blood pressure
  • Skin breakdowns
  • Osteoporosis
  • Bone fractures
  • Respiratory infections (common in injuries T-4 and above)
  • Phantom pain
  • Autonomic dysreflexia

Treatment

Unfortunately, there is currently no cure for paraplegia. Short term treatment is geared towards preserving function of the spine. This includes surgery and immediate rehabilitation, which is intended to reduce the swelling of tissue. Each spinal cord injury case is different; therefore treatment is tailored towards the patient’s specific symptoms.

Many patients with paraplegia end up using a wheelchair for their entire lives. However, some patients can use leg braces, which allow for greater freedom of movement. Some people regain enough muscle control to walk with a cane or otherwise unassisted.
Long term treatment is intended to allow the patient to regain function. Physical and emotional therapy is used to help the patient adjust to everyday life again. Studies have shown that the best hope for recovery includes early physical therapy.

Quadriplegia and Spinal Cord Injury (Also known as Tetraplegia)

Quadriplegia is partial or complete paralysis that affects both the arms and the legs. It typically results from injuries to vertebrae near the neck (cervical vertebrae). By contrast, paraplegia only affects the lower extremities of the body, notably the legs.
While the spinal cord is protected by bones called vertebrae, it can be put at risk through trauma or disease. Patients that experience damage to their upper back or neck may experience quadriplegia, and possibly lose function in the arms, legs, trunk, and in some cases, the neck.

With injuries located towards the very top of the cervical vertebrae (C-4 or above), respiratory function may be severely impaired. In these cases, patients may require a respiratory machine. As a general rule of thumb, injuries that are located higher in the spine cause a deeper level of paralysis.

A common misconception is that people with quadriplegia lose control of all muscle function. This is simply not true. Some quadriplegics may lose all function below the neck. Others may retain function at the neck area and even control their hand movements. (Hence the rise of athletic activities for those with quadriplegia, such as “Quad Rugby.”)

Causes

One of the leading causes of quadriplegia is motor vehicle accidents. Collisions, no matter the speed, place pressure and strain on the cervical vertebrae.
Other causes of quadriplegia/tetraplegia include traumatic injuries that stem from sports accidents, falls, workplace accidents, and recreational activities. Quadriplegia can also be caused by diseases, such as polio or spina bifida.

  • Complications
  • Autonomic Dysreflexia
  • Bowel and Bladder Complications
  • Involuntary Spasms
  • Low Blood Pressure
  • Osteoporosis
  • Respiratory Problems
  • Skin Sores

Treatment

Unfortunately, there is no cure for quadriplegia. Immediately after the injury, doctors often focus on minimizing swelling and preserving as much of the nerve function as possible.
Treatment is tailored to each patient, as each patient will have a different set of symptoms and complication. Additionally, studies have shown that immediate physical therapy and rehabilitation gives patients the best hope of preserving nerve function and for regaining fine motor skills.

Hemiplegia

Hemiplegia can result when a part of the spinal cord is lacerated, as with a puncture wound. This condition can be the result of disease, but it can also happen as a result of a serious accident or other physical trauma.
Hemiplegia notably causes patients to experience loss of motor function and sensation to just one side of the body. This rare condition is also known as Brown-Séquard Syndrome.
The paralysis is only in one side of the body, the opposite of the side that was injured. For example, if the left side of the spinal cord was injured, symptoms would manifest on the right side. These symptoms include experience loss of muscle control, pain and temperature. This seemingly odd result reflects the fact that nerves that control movement cross the spinal cord, rather than run along the same side.


Other symptoms can include:

  • Behavioral issues
  • Bladder and bowel difficulty
  • Depression
  • Difficulty balancing and moving
  • Loss of fine motor control
  • Muscle spasms
  • Seizures
  • Speech impediments

In rare cases, Hemiplegia can develop into complete paralysis. This paralysis may be temporary or permanent, depending on the initial cause of the injury.  Hemiparesis is a milder form of Hemiplegia. This refers to a different type of SCI, in which half of the body is left weakened, not paralyzed.

Treatment

After a spinal cord injury, the immediate goal is to reduce swelling and repair the injury site. With traumatic injuries, the goal may also be to repair damage to other parts of the body.  Long-term and short-term treatment tends to be similar to other types of serious spinal cord injury.

Other Spinal Cord Injury Symptoms

Paralysis is one of the most prominent and well known effects of a spinal cord injury. However, the spinal cord injury (SCI) goes beyond loss of motor function. It can cause several other complications and problems in the human body.

Autonomic Dysreflexia (also known as “Hyperreflexia”)

The spinal cord is the main conduit in which nerves use to pass information from the brain to various parts of the body. When a part of the body below the level of injury experiences pain, it is unable to communicate this to the brain. The blood vessels tighten reflexively, causing the blood pressure to rise. Left uncontrolled, Autonomic Dysreflexia can lead to stroke, seizure, or death.

Bowel and Bladder Complications

The nerves located sacral portion of the spine helps regulate bowel and bladder function. These nerves are located at the very base of the spine and affect most spinal cord injuries. Unless carefully regulated, this can result in flaccid bladder, where the bladder functions sluggishly, or spastic bladder, where the bladder constantly empties itself.
Hemorrhoids, constipation, rectal bleeding, and impaction can also affect a person with paralysis. Medication, a well balanced diet, and regular bowel routines are vital to maintaining a healthy system. In the most extreme cases, surgery may be required to regulate bowel and bladder problems.

Deep Vein Thrombosis

This condition refers to blood clots in critical veins and arteries. Patients with paralysis in the arms or legs are especially at risk for deep vein thrombosis. This blood clot is caused by immobility, low blood pressure, and trauma to skin tissue.
Warning signs of deep thrombosis include swollen limbs and veins, skin problems, and extreme discomfort. Treatment includes medication, special compression stockings, and surgery (in the most serious cases). Left unchecked, deep vein thrombosis greatly increases the risk of stroke, heart attack, and pulmonary embolism (blockage of the lung’s main artery).

Osteoporosis


Through inactivity and lack of regular exercise, the body’s bones grow weak. The bones lose vital calcium and phosphorus over time, making them unable to bear weight. Most people with paralysis from spinal cord injuries lose bone density and develop osteoporosis. While there is no way to reverse osteoporosis, medication and specially designed physical therapy can help stimulate bone movement, helping the patient maintain healthy bones.

Pressure Sores

These sores are the result of excessive pressure on the back and lower body. Patients with especially limiting forms of paralysis are unable to move. After a spinal cord injury, the pattern of blood supply also shifts. Without proper care, the skin loses its elasticity and muscle tone. The body grows unable to withstand pressure of sitting or lying.
Because the spinal cord injury disrupts the body sending a message to the brain to move, the condition may worsen. Skin may deaden, grow infected, and rupture, resulting in a pressure sore. This condition is combated by special pressure-reducing seats, medication, and physical therapy.

Respiratory Problems

Spinal cord injuries that are located in the cervical vertebrae (C-4 or higher) often result in respiratory complications. The nerve pairs located in these segments have additional control of respiratory function. They help regulate the neck muscles, abdominal muscles, diaphragm muscles, and the intercostals muscles. In severe cases, a ventilator may be required to help assist breathing.
Additional complications include pneumonia, atelectasis (lung collapse), pulmonary embolism (blood clot in the lungs), diseases of pulmonary circulation, and sleep apnea.

Spasticity

This condition is common after a paralyzing spinal cord injury. The spinal cord is responsible for regulating automatic body functions, such as reflexes. After an SCI, the signal that results in a muscle reflex is blocked. The body, however, still is stimulated to contract. Without regulation from the brain, this contraction is often an exaggerated motion, called a spasm.
These spasms can occur without warning and are exacerbated by skin conditions and other bodily infections. Regular muscle stimulation through physical therapy, along with medications, can help lessen these spasms.

Sexual Function

A spinal cord injury can affect the sexual function for both men and, in smaller cases, women. While women generally have no fertility issues, they are equally susceptible towards anxiety and depression. There are many support groups, medical specialists, and even prescription drugs that help counter the mental and physical roadblocks towards sex.
On a biological level, the brain sends a signal to the sexual organs indicating arousal. This signal is sent through the spinal cord. If damaged, this signal will not reach the lower extremities. In men, this may lead to erectile dysfunction. Men who want to father children often have no choice but to pursue fertility treatments.

Spinal Cord Injury Rehabilitation

Thousands of people in the United States experience paralyzing spinal cord injuries each year. While there is currently no cure for spinal cord injury (SCI), modern rehabilitation programs help SCI victims regain everyday functionality and prevent potentially fatal complications.

Physical Therapy

The goal of physical therapy for SCI patients is to prevent complications from developing. Through inactivity, people suffering from a spinal cord injury can develop severe skin complications, blood clots, bone deficiencies, spasticity, and a host of other issues.
Physical therapy also gives patients the chance to recover some muscle function. While full recoveries are rare, it is possible for a patient to regain fine motor skills and function by strengthening muscles.

An effective physical therapy regimen is coordinated by an interdisciplinary team of medical experts. This typically includes specialists in pulmonary medicine, rehabilitation, internal medicine, neurology, neuropsychology, nutrition, and psychology. These specialists may work together to help a patient regain function through daily and weekly sessions.

Common practices in physical therapy include:

  • Cyrotherapy and Kneading
  • High Intensity Electric Stimulation
  • Muscle strengthening exercises
  • Prophliac Heat
  • Sexual Rehabilitation
  • Recreational Therapy (i.e. static bicycling, underwater walking)

The ideal rehabilitation program is tailored to the patient’s individual needs. It incorporates the patient’s specific form of paralysis, medicinal history, and practical goals. When choosing a rehabilitation center, seek ones that offer a well-rounded approach to long-term care.


Assistive Devices


A wide array of devices may help people with paralysis complete basic functions. These devices include everything from communication software to the following:

  • Ventilators (portable or bedside) – Aids quadriplegics with impaired respiratory functions.
  • Pressure Relief Cushions – Helps combat unhealthy skin pressure that can lead to pressure sores.
  • Abdominal Binders and Stockings – Artificially increases abdominal strength, easing upright movement.
  • Phrenic Nerve Pacemakers – Assists breathing with more ease than a ventilator.
  • FES Systems – A new type of device used to help regulate bowel and bladder function.
  • Voice Recognition Software – Provides a medium for people with impaired diaphragms to communicate.
  • Mobility – A large number of people with SCI use a wheel chair (electric or manual) to gain mobility. Those with greater muscle function may choose to use arm braces, walkers, canes or crutches.
  • Household Items – The amount of assistive devices around the household has increased throughout the years. These items include everything from bathroom accessories to kitchen tools.
  • Vehicle Adjustments – Driving is still an option for many people with impaired function in the lower limbs. Through the use of specially designed hand controls, they can effectively accelerate and break.

Counseling

Feelings of hopelessness and depression are common and perfectly normal after a traumatic SCI injury. Support groups, behavioral therapy, and individual therapy can be invaluable in a person’s recovery.