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What is a Traumatic Spinal Cord Injury?

A traumatic spinal cord injury is an injury from sudden physical trauma that results in a fracture, dislocation, or compression of one or more spinal vertebrae and the bruising or tearing of any part of the spinal cord or cauda equina, the bundle of nerve roots at the lower end of the spinal canal. This type of an injury occurs more commonly in men. Significant trauma is usually needed to cause spinal cord injuries in a young and healthy individual.

Classification of Traumatic Spinal Cord Injuries

Traumatic spinal cord injuries may be classified as:

  • Incomplete Traumatic Spinal Cord Injury: In this type, you retain some level of function and sensation below the location of the spinal cord injury.
  • Complete Traumatic Spinal Cord Injury: In this type, all sensory and motor function is lost below the location of the spinal cord injury.

Causes of Traumatic Spinal Cord Injury

Traumatic spinal cord injuries can occur in a variety of settings including:

  • Motor vehicle accidents
  • Falls
  • Diving in shallow water
  • Acts of violence such as gunshot or knife wounds

Risk Factors for Traumatic Spinal Cord Injury

Older patients and those with preexisting conditions may have weakened bones that increases the risk for traumatic spinal cord injury. These conditions include:

  • Rheumatoid arthritis
  • Ankylosing spondylitis
  • Osteoporosis
  • Advanced cervical spondylosis

Symptoms of Traumatic Spinal Cord Injury

Depending on the location of the spinal cord injury, the following signs and symptoms may occur:

  • Altered sensation
  • Loss of movement
  • Exaggerated reflexes
  • Muscle spasms
  • Difficulty breathing 
  • Burning and stinging pain due to nerve damage
  • Loss of bowel or bladder function 

Diagnosis of Traumatic Spinal Cord Injury

Your doctor will discuss your symptoms and conduct a careful inspection and examination of the injured area. If you have a head injury and are experiencing any spinal pain, dizziness, weakness, altered sensation, or are not fully conscious, a spinal cord injury will be assumed until proven otherwise. Your doctor will order X-rays to look for vertebral damage and/or advanced imaging studies such as CT or MRI to look for soft tissue abnormalities that may be impinging on the spinal cord.

Management of Traumatic Spinal Cord Injury

Management of traumatic spinal cord injury focuses on minimizing risk of further injury. This involves immobilization by using a cervical collar in case of neck injury or securing the patient to a rigid backboard with head supports. Special consideration will be given for airway management in cervical spine injuries. High cervical cord injuries may result in the inability to breathe due to diaphragmatic paralysis requiring immediate ventilatory support and feeding tube insertion for nutrition and medicines. Surgery may be indicated to remove fragments of bone or foreign objects impinging on the spinal cord. 

Following initial stabilization, your doctor will monitor the vital signs to look for signs of neurogenic shock which can occur with injuries to the spinal cord above the 6th thoracic vertebrae, which manifest as hypotension and bradycardia depending upon how high the injury occurs in the spine. Treatment might include fluid resuscitation and vasopressors (medications to increase blood pressure). 

In cases of lumbar level spinal cord trauma, there may be loss and bowel or bladder control and function in the lower extremities.  Injuries to the lumbar spinal cord are rarely life-threatening and most patients can regain independence with mobility assistance devices and rehabilitation programs.