Spinal Cord Injuries and Disorders

Overview

The majority of spine-related problems result from normal degeneration of the bones, ligaments and disks of the spine. For some people, allowing time to recuperate is all that is needed. For others, medication and physical therapy may do the trick. But if the pain does not respond to one of these therapies, your doctor may recommend surgery.

The spinal column and vertebrae serve to protect the delicate nerves of the spinal column. To help illustrate the area being described, the four major areas of the spine include: cervical (C1 – C7) or neck area, thoracic (T1 – T12) or chest area, lumbar (L1 – L5) or lower back, and the sacral (S1 – S5) or area of the buttocks. The type and intensity of the pain patients feel depends in large part on the location of the vertebrae involved.

Herniated or slipped disks, spinal stenosis (narrowing of the canal through which the spinal cord travels), scoliosis and kyphotic deformities (abnormal curvature or bending of the spine) and spondylolisthesis (slipping of the bones of the spine) are common problems we hear about from patients.

Congenital defects are problems that result from abnormal growth or development of the spine and spinal cord, and include spina bifida (incomplete closure of the spinal cord or myelomeningocele), scoliosis (bending or twisting of bony spine), tethered spinal cord and diastematomyelia (abnormal division of the spinal cord associated with a bony spur).

Trauma to the spinal and spinal cord result in approximately 10,000 new spinal cord injuries per year in the United States. Most injuries result from motor vehicle crashes, violent acts and falls. More than 80 percent of injuries occur in males. A spinal cord injury happens as a result of damage to the nerves in the spinal cord. For this to occur, usually the bones protecting the spinal cord have also been injured, either broken or dislocated.

Tumors of the spinal cord may be benign or malignant and are generally primary tumors, not metastatic lesions. Examples of spinal cord tumors are astrocytomas, ependymomas, meningiomas, schwannomas, and epidermoids.

Vascular lesions such as an arterio-venous malformation may also be found in the spinal cord. These lesions may cause symptoms that are similar to tumors and may even cause spinal cord strokes. Surgery may be warranted for removal or tumors, vascular lesions, and infection. In some cases, radiation and chemotherapy may be required.

Symptoms

Generally, symptoms related to spinal injuries and other disorders include:
  • Pain traveling down from the neck into arms and hands
  • Pain traveling from the back down the legs
  • Abnormal or loss of sensation in the arms, hands, legs, or feet
  • Weakness of the arms, hands, legs or feet
  • Difficulty passing stool or urinating
  • Balance problems
  • Change in walking style
  • Difficulty breathing
  • Abnormal posture
Surgery to correct these problems may be needed if the symptoms are directly related to structural problems. Alternatively, medications, change in lifestyle and physical therapy may be needed.

  • Disk herniations and ruptures are often referred to as pinched nerves or ruptured disks. The pain caused by a herniated or ruptured disk of the spinal column may lead to chronic pain and lifestyle limitations. In some cases, a ruptured disk may cause numbness or weakness.
  • Congenital defects include abnormal curvature of the spine or abnormal posture, leg pain and urinary difficulties. In most cases, congenital abnormalities require surgical correction.
  • Tumors of the spinal cord may cause symptoms such as weakness, loss of sensation and bowel and bladder problems. These symptoms result from tumors interrupting spinal cord function.
  • Cervical spine injury at this level may affect strength and feeling in arms, the trunk and legs. It may affect ability to breathe without support or cause difficulty in the ability to cough and take full, deep breaths. Control of urination and bowel movements may also be affected. Complete injury is called tetraplegia or quadriplegia.
  • Thoracic spine injury may affect movement and feeling in chest, abdomen and legs. Muscles in the chest and abdomen help to support coughing and breathing deeply, so a doctor will work with you on ways to avoid respiratory infections. Control of urination and bowel function may also be affected. The complete injury is called paraplegia.
  • Lumbar spine injury may affect strength and feeling in the legs and control of urine and bowel function. Complete injury in the upper part of the lumbar spine may still be considered paraplegia.
The primary problem with sacral or coccygeal spine injuries may be function of bowel and bladder, although some movement of the feet and feeling in parts of the feet and legs may be affected.

Risk Factors

Spine and spinal cord injuries generally result in devastating loss of neurological function, although occasionally injuries affect only the bone and spare the spinal cord.

While surgery may be required to repair fractures, stabilize the bony spine, stop bleeding or repair torn membranes, it usually cannot repair or restore function to the spinal cord itself. Thus, the goal of surgery is to prevent additional injury from occurring and maximize the opportunities for patients to participate in rehabilitation and physical therapy.

Diagnosis

Some congenital defects are recognized at or before birth and must be surgically treated within a few days of their diagnosis. Other problems may not be obvious until a patient experiences a growth spurt or develops symptoms or signs related to that problem.

For the first few days after a spinal cord injury, it is usually hard to tell how much of the damage may be temporary and how much may be permanent. Sometimes the injury causes swelling in the spinal cord that may last for days or weeks. Also, the spinal cord may go into shock right after the injury.

Injuries are described as complete or incomplete. Incomplete means the signals between the body and brain are partially interrupted. Complete means all signals between the body and brain are cut off at the level of the injury.

Spinal shock is a period of time when all of the functions of the spinal cord below the injury are stunned and do not work. This does not happen to everyone, but if it does happen, it may last for a few days up to a week or so.

Recovery

The long-term result of a spinal cord injury depends on the location and severity of the injury. Rehabilitation will play a big role for almost everyone with a spinal cord injury. At UW Medicine, rehabilitation starts in the hospital intensive care unit and continues in other settings. The health-care team works with patients and families to achieve as much independence as possible.

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