What can I expect after spinal cord injury?

What happens to the spinal cord after an Injury?

Whether the damage to the spinal cord is caused from a traumatic injury to the vertebral column, or by a disease, the end result is that the backbone pinches the spinal cord, causing it to become bruised or swollen. Sometimes the injury may tear the spinal cord and/or its nerve fibers. An infection or a disease can result in similar damage.

After an injury to the spinal cord, all the nerves above the level of injury keep right on working. The site of the injury is like a washout on a road that blocks traffic from going either way. The washout may be complete, or it may be partial, so that some traffic can get through. The spinal cord nerves at the site of the injury and below can no longer send messages between the brain and parts of the body they connect with as they could before the injury.

A doctor examines an individual to evaluate the damage to the spinal cord. An X-ray may show where the damage to the vertebrae is located. The doctor does a pin prick test (just what it sounds like) to see what feeling the person has in various parts of the body. The doctor will ask the patient what parts of the body s/he can move, and test the strength of important muscle groups. These examinations help the doctor and treatment team know what nerves and muscles are still working.

Treatment of spinal cord injuries

An injury to the spinal cord caused by trauma is a medical emergency that requires immediate treatment. Outcome and the degree of function preserved are directly affected by how promptly treatment is started.

Corticosteroids, such as dexamethasone or methylprednisolone, are now administered after most traumatic injuries to the spinal cord. They can reduce swelling that may further damage the spinal cord, but they must be administered within 8 hours after the injury. If the spinal cord is compressed by a hematoma (a pooling of blood from internal bleeding) or a fragment of bone, these must be surgically removed as promptly as possible to prevent further damage to the spinal nerves. These treatments may reduce or prevent paralysis in some cases. Traction may be instituted to reduce spinal compression in lower back injuries. Anticoagulants are essential in preventing blood clots which can produce further complications.

After the acute injury is treated and the patient is stabilized, the patient should be evaluated by a neurologist and a physiatrist to asses the damage and develop a rehabilitation plan. The patient will be transferred to an intensive rehabilitation unit, which may be in the same hospital where the initial care was given, or may be in a different facility.

In an intensive rehabilitation unit, both the person with SCI and his/family are seen as important members of the rehab team. The team also includes professionals in physical medicine, nursing, occupational and physical therapy, social work, psychology and recreation who will develop a comprehensive, multidisciplinary approach to the person's care. The goal of rehabilitation is to help the newly injured person learn how to care for a body that now functions very differently, to cultivate health practices that will reduce the secondary complications of SCI and to enable the person to rebuild his/her life into one of satisfaction and dignity.

A rehab stay may last weeks or months, depending on the injury and the specific rehab goals. Most improvement and recovery of function will occur in the first six months following the injury. That's the statistical picture. Nonetheless, many people with spinal cord injury report continuing gains in function months and even years after the initial period.