The spinal cord is part of the central nervous system. It transmits information from the brain to the body. In simple terms – the brain issues a command, the spinal cord transmits and shapes that command, and the body carries it out.

A similar thing happens with stimuli: When someone touches our shoulder from behind, nerve fibers transmit this sensory information to the brain via the spinal cord. The brain issues the command “turn around.”

If the spinal cord is injured, transmitting nerves can no longer perform their functions. Signals from the brain (efferent) to the body and/or from the body to the brain (afferent) are transmitted only in part or not at all.

If motor nerve fibers are affected, the results are various forms of weakness or paralysis. If sensory fibers are affected, sensations like pain, pressure, or temperature are dulled or not felt at all.

The result of partial or complete spinal cord damage is called paraplegia (if only the torso and legs are affected) or tetraplegia (if the torso, arms, and legs are affected).

In a complete spinal cord injury, the spinal cord is damaged so severely that any function or sensation below the injury site stops. The affected body regions are paralyzed.  

In an incomplete spinal cord injury, the spinal cord is usually bruised or contused. Some residual motor and sensory capabilities are maintained. The location and the severity of the injury determine which impairments occur and how severe they are.

The closer the damage to the spinal cord is to the head, the more extensive the consequences are for the patient.

Spinal cord injuries along the cervical spine are particularly catastrophic. Injuries at the first thoracic nerve and above (C1-T1) affect the arms, legs, and torso. Some patients with injuries to the uppermost cervical spinal cord (C1-C4) will depend on ventilation devices. Cervical spinal cord injuries result in tetraplegia (paralysis of arms, legs, and torso, or complete tetraplegia) or tetraparesis (weakness of the arms, legs, and torso, or incomplete tetraplegia).

If the injury occurs between the second and twelfth thoracic nerves (T2-T12), the patient retains use of their arms and hands and has limited control of their torso. The legs are fully or partially paralyzed. This is called paraplegia (paralysis of the torso and legs, or complete paraplegia) or paraparesis (weakness of the torso and legs, or incomplete paraplegia).

If the spinal cord injury occurs along the lumbar spine (L1-L5), the patient retains limited control of the hips and legs. Some patients may be able to cover short distances using walking aids, even if the injury is severe or complete.

Injuries in the sacral area (S1-S5, between the pelvis and coccyx) reduce the function of hips, legs, ankles, and feet. However, these patients are usually able to walk and climb stairs independently, likely with some bracing and/or walking aids.

Any spinal cord injury is a major event with various consequences. In addition to paralysis, patients may also experience problems with autonomic functions such as digestion, defecation, circulation, temperature regulation, and sexual functions.

There is also a risk of additional complications such as spasticity, excessive reflexes, pressure sores or bedsores, increased risk of infection, and osteoporosis.

The social, financial, and psychological effects of living with a disability are often not discussed. The entire social network around the patient and the patient him- or herself must learn how to handle the new situation. Housing, transportation, leisure activities, and mobility are affected. Professional help can be invaluable support for getting used to a new life.

Every spinal cord injury is unique, which means that rehabilitation differs from patient to patient. The main goals in the early stages are stabilizing vital body functions like breathing and circulation. 

After the acute phase, the patient is usually referred to a rehabilitation institution where a team of physicians, PTs, OTs, nurses, psychologists, social workers, and nutritionists look after the patient. Depending on the severity of the limitations, the goal is ultimately to enable the patient to lead as independent a life as possible.

• Maintaining and strengthening existing muscle function and recovery of gross and fine motor function through occupational and physical therapy, medical training therapy, and technology-based therapy
• Learning strategies for coping with everyday tasks
• Using aids to increase independence and mobility
• Learning about and preventing secondary complications
• Receiving counseling and support in managing the new life situation (home environment, school, work, leisure activities, etc.)

As of today, there is no cure for spinal cord injuries. However, it is known that injured nerve cells in the spinal cord are capable of regeneration. Based on this, science and technology are well on their way to offering patients ever more independent lives and one day finding a cure for spinal cord injury.

Sources:

De Gruyter, W. (2017). Pschyrembel. Klinisches Wörterbuch. 267. Auflage. Berlin / Boston

Gratzl O, Merlo A, Rückenmarksverletzungen, in: Siewert J R, Chirurgie, Springer Medizin Verlag Heidelberg; 2006. 203-204.

International Perspectives on Spinal Cord Injury, 2013

Wings for Life – Spinal cord research foundation