Spinal cord injury

Diagnosis

Healthcare professionals in the emergency room do an exam, test for sensory function and movement, and ask questions about the accident. They may be able to rule out a spinal cord injury based on this evaluation.

But emergency diagnostic tests may be needed. They should be done if the injured person has neck pain, isn't fully awake, or has obvious weakness or neurological injury.

These tests can include:

• X-rays. X-rays can reveal damage to the bone surrounding the spinal cord, known as the vertebrae. They also can find tumors, fractures or changes in the spine.
• CT scan. A CT scan can provide a clearer image compared with an X-ray. This scan uses computers to form a series of cross-sectional images that can define bone, disk and other changes.
• MRI. MRI uses a strong magnetic field and radio waves to produce computer-generated images. This test is helpful for looking at the spinal cord to find herniated disks, blood clots or other masses that might compress the spinal cord.

A few days after the injury, when some of the swelling might have gone down, a more comprehensive neurological exam may be done. The exam looks at the level and completeness of the injury. This involves testing muscle strength and your ability to sense light touch and pinprick sensations.

Treatment

There's no way to reverse damage to the spinal cord. But researchers are continually working on new treatments. They include prostheses and medicines that might promote nerve cell regeneration or improve the function of the nerves that remain after a spinal cord injury.

In the meantime, spinal cord injury treatment focuses on preventing further injury and empowering people to return to an active and productive life.

Emergency actions

Urgent medical attention is critical to minimize the effects of a head or neck injury. Therefore, treatment for a spinal cord injury often begins at the accident scene.

Emergency personnel typically immobilize the spine as gently and quickly as possible. This is done using a rigid neck collar and a rigid carrying board during transport to the hospital.

Early stages of treatment

In the emergency room, medical care focuses on:

• Maintaining your ability to breathe.
• Preventing shock.
• Immobilizing your neck to prevent further spinal cord damage.
• Avoiding possible complications. Potential complications include stool or urine retention, respiratory or cardiovascular conditions, and the formation of deep vein blood clots.

People with a spinal cord injury often are admitted to the intensive care unit for treatment. Or they may be transferred to a regional spine injury center. Spine injury centers have a team of specialists trained in spinal cord injuries. The team may include neurosurgeons, orthopedic surgeons, neurologists, physician medicine and rehabilitation specialists, psychologists, nurses, therapists, and social workers.

• Medicines. Methylprednisolone (Solu-Medrol), given through a vein in the arm, has been used as a treatment option after a spinal cord injury in the past. But recent research has shown that it has potential side effects such as blood clots and pneumonia that outweigh the benefits. Because of this, methylprednisolone is no longer recommended for routine use after a spinal cord injury.
• Immobilization. You might need traction to stabilize or align your spine. Traction involves gently pulling your head to create the proper alignment of your spine. Traction may be done using a soft neck collar or a brace.
• Surgery. Often surgery is necessary to remove fragments of bones, foreign objects, herniated disks or fractured vertebrae that may compress the spine. Surgery also can stabilize the spine and prevent future pain or complications.
• Experimental treatments. Scientists are trying to figure out ways to stop cell death, control inflammation and promote nerve regeneration. For example, lowering body temperature significantly — a condition known as hypothermia — for 24 to 48 hours might help prevent damaging inflammation. More study is needed.

Ongoing care

As the condition stabilizes, medical care focuses on preventing other medical conditions that may arise. A spinal cord injury can lead to a decline in physical functioning, known as deconditioning. Or it can lead to stiff muscles due to lack of use, known as muscle contractures. People with a spinal cord injury also may experience pressure ulcers, bowel and bladder issues, respiratory infections, and blood clots.

The length of your hospital stay depends on your condition and medical issues. Once you're well enough to participate in therapies and treatment, you might transfer to a rehabilitation facility.

Rehabilitation

Rehabilitation team members begin to work with you while you're in the early stages of recovery. Your team might include a physical therapist, an occupational therapist, a rehabilitation nurse, a rehabilitation psychologist and a social worker. The team also may include a doctor who specializes in physical medicine and rehabilitation, known as a physiatrist, or a doctor who specializes in spinal cord injuries. And you may work with a dietitian and a recreation therapist.

During the early stages of rehabilitation, therapists work on maintaining and strengthening muscle function and redeveloping fine motor skills. They also help you learn ways to adapt to do day-to-day tasks.

You may learn about the effects of a spinal cord injury and how to prevent complications. The team also works to build your quality of life and independence.

You're taught many new skills, often using equipment and technologies that can help you live on your own as much as possible. You can learn how to enjoy your favorite hobbies, participate in social and fitness activities, and return to school or the workplace.

Medications

Medicines can manage some of the side effects of spinal cord injury. These include medicines to control pain and muscle spasticity. Medicines also can help improve bladder control, bowel control and sexual functioning.

New technologies

Inventive medical devices can help people with a spinal cord injury become more independent and more mobile. These include:

• Modern wheelchairs. Improved, lighter weight wheelchairs are making people with spinal cord injuries more mobile and more comfortable. Some people need an electric wheelchair. Some wheelchairs can even climb stairs, travel over rough ground and elevate a user to reach high places without help.
• Computer adaptations. Computers can be hard to use if you have limited hand function. Computer adaptations range from simple to complex, such as key guards and voice recognition.
• Electronic aids to daily living. Any device that uses electricity can be controlled with an electronic aid to daily living. Devices can be turned on or off by switch or voice-controlled and computer-based remotes.
• Electrical stimulation devices. Often called functional electrical stimulation systems, these devices use electrical stimulators. The stimulators help control arm and leg muscles to allow people with spinal cord injuries to stand, walk, reach and grip.

Prognosis and recovery

Your healthcare professional might not have an expected outlook of your recovery right away. Recovery, if it occurs, usually relates to the level of the injury. The fastest rate of recovery usually happens during the first six months. But some people make small improvements for up to 1 to 2 years.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Coping and support

An accident that results in paralysis is a life-changing event, and adapting is no easy task. You may wonder how your spinal cord injury will affect you in the long term.

Recovery takes time, but many people who are paralyzed lead productive and fulfilling lives. It's essential to stay motivated and get the support you need.

Grieving

If your spinal cord injury is recent, you and your family may experience a period of mourning. The grieving process is a healthy part of your recovery. It's natural — and important — to grieve. But it's also necessary to set new goals and find ways to go forward.

You may have concerns about how the injury may affect your lifestyle, finances and relationships. Grieving and having emotional stress are common.

If your grief is affecting your care or causing you to isolate or misuse alcohol or drugs, talk to someone. You might reach out to a social worker, psychologist or psychiatrist. Or you might find it helpful to join a support group of people with spinal cord injuries.

Talking with others who understand what you're going through can be encouraging. You also might find good advice on adapting areas of your home or workspace to better meet your needs. Ask your healthcare professional or rehabilitation specialist if there are support groups in your area.

Taking control

One of the best ways to regain control of your life is to educate yourself about your injury and your options for gaining more independence. A range of driving equipment and vehicle modifications is available today.

The same is true of home modification products. Ramps, wider doors, special sinks, grab bars and easy-to-turn doorknobs make it possible for you to live more autonomously.

You might have access to economic assistance or support services from the state or federal government or from charitable organizations. Your rehabilitation team can help you identify resources in your area.

Talking about your disability

Some friends and family members may not be sure how to help. Being educated about your spinal cord injury and willing to educate others can benefit all of you.

Explain the side effects of your injury and what others can do to help. But don't hesitate to tell friends and loved ones when they're helping too much. Talking about your injury can strengthen your relationships with family and friends.

Dealing with intimacy, sexuality and sexual activity

Your spinal cord injury might affect your body's sexual responsiveness. However, you're a sexual being with sexual desires. A fulfilling emotional and physical relationship is possible but requires communication, experimentation and patience.

A professional counselor can help you and your partner communicate your needs and feelings. Your healthcare professional can provide the medical information you need regarding sexual health. You can have a satisfying future complete with intimacy and sexual pleasure.

Looking ahead

As you learn more about your injury and treatment options, you might be surprised by all you can do. Thanks to new technologies, treatments and devices, people with spinal cord injuries play basketball and participate in track meets. They paint and take photographs. They get married, have and raise children, and have rewarding jobs.

Advances in stem cell research and nerve cell regeneration give hope for greater recovery for people with spinal cord injuries. And new treatments are being investigated for people with long-standing spinal cord injuries.

No one knows when new treatments will be available, but you can remain hopeful about the future of spinal cord research while living your life to the fullest today.

Preparing for your appointment

Traumatic spinal cord injuries are emergencies. People who are injured might not be able to participate in their care at first.

A number of specialists are involved in stabilizing your condition. They may include a doctor who specializes in nervous system disorders, known as a neurologist. They also may include a surgeon who specializes in spinal cord injuries and other nervous system conditions, known as a neurosurgeon.

Your rehabilitation team is led by a doctor who specializes in spinal cord injuries and includes a variety of specialists.

Here's what you can do if you or someone you're with may have a spinal cord injury.

What you can do

• Be prepared to provide information about the event that caused the injury, including anything that may seem unrelated.
• Have another family member or friend join you when you speak with healthcare professionals, if possible. Someone who accompanies you can help you remember the information you're given.
• Write down questions to ask the healthcare team.

For a spinal cord injury, some basic questions to ask your healthcare professional include:

• What is the outlook of my condition?
• What will happen in the short term? What will happen over the long term? What treatments are available, and which do you recommend?
• Could surgery help?
• What type of rehabilitation might help?
• What research is being done to help this condition?
• Do you have brochures or other printed material? What websites do you recommend?

Don't hesitate to ask other questions you have.

What to expect from the doctor

You'll likely be asked questions that may include:

• What led to your injury?
• When did it occur?
• What do you do for work and leisure?
• With whom do you live?
• Do you live in a house or apartment? How many stairs does your home have?
• Do you or anyone in your family have a history of blood clots?
• Do you have any other medical conditions?