About spinal injuries

In the UK, around 2,500 people are left paralysed after a spinal injury each year and there are around 50,000 people currently living with a spinal cord injury.

The spinal cord carries signals from the brain to the rest of the body. Separate vertebrae surround the spinal cord and prevent it from injury. Spinal cord injuries can affect anyone at any age and sadly, spinal injuries can lead to paralysis.

Damage to the spinal cord can result from a direct trauma to the cord itself, or trauma to the bones and muscles surrounding it and pressing onto the spinal cord. The results of spinal injury can include a loss of mobility and feeling in most parts of the body.

For most people who sustain a spinal cord injury, their spinal cord remains intact. Back pain and spinal injuries can sometimes be confused, but there is a clear difference between the two. Back injuries can be caused by vertebrae moving out of place, or pinching nerves. These can occur without causing any damage to the spinal cord.

There are several signs that a spinal cord injury has occurred. These can include:

• Difficulty walking.
• The loss of control of bowels or bladder.
• Paralysis of the arms or legs.
• Numbness and tingling feelings spreading through the limbs.
• Unconsciousness.
• Headaches.
• Neck pain or stiffness in the neck.
• Shock.
• The head adopting an unnatural position.

If you think you have sustained a spinal injury it is important that you seek immediate medical assistance. You should attend your nearest emergency department as soon as possible.

Once you arrive at hospital, you may have to undergo some tests to determine the extent of the spinal cord injuries so you can receive the most appropriate treatment.

Tests to determine the extent of spinal cord injuries can include:

• Neurological examination.
• CT scan or MRI of the spine.
• Spine X-rays.  

Different parts of the spine and spinal cord

There are 3 main areas of the spine where injury occurs. These are:

• The cervical vertebrae – these are at the top of the spine and make up the neck.
• The thoracic vertebrae – these are in the chest area.
• The lumbar vertebrae – these are in the lower back.

The cervical vertebrae are the bones which support the brain and skull. They have a wide range of movement and can pivot up and down, as well as side to side.

The thoracic vertebrae are larger than the cervical vertebrae but smaller than the lumbar vertebrae. They are the only vertebrae attached to the ribcage, which protects the main internal organs. There are 12 thoracic vertebrae and they do not have much movement.

The lumbar vertebrae are larger again than the thoracic and cervical vertebrae. This is the part of the spine that supports most of the weight of the body, as well as helping with lifting and carrying. These vertebrae can move more than the thoracic vertebrae, but not as much as the cervical vertebrae.

Nerves called the spinal nerves or nerve roots come off the spinal cord. There are 4 main nerves which are:

• Cervical nerves – these aid with breathing as well the movement of the head, shoulders, neck, arms and hands.
• Thoracic nerves – these connect the muscles in the back, chest and upper abdomen to the brain.
• Lumbar nerves – these connect muscles in the lower back and the thighs and legs.
• Sacral nerves – these control the buttocks, as well as the bladder and bowels. They also control the sexual region and some of the legs and feet.  

Categories of spinal injuries

There are two categories of spinal injuries. These are either complete or incomplete.

Complete spinal injuries

Complete injuries are where the spinal cord has been totally damaged. This means there is a complete loss of sensory and function below where the injury has occurred. These can lead to either complete paraplegia (impairment in motor or sensory function of the lower extremities) or complete tetraplegia (paralysis which results in the partial or total loss of use of all limbs and the torso).

Complete damage to the spinal cord below the neck usually results in complete paraplegia. This will usually leave the injured person with no function of the legs or sensory feelings, but they may still have function of their body and arms. How much of the body is affected will depend on where the spinal cord injury is. The higher up the spinal cord the injury has occurred, the more function will be lost in the lower part of the body.

Complete tetraplegia is the result of the spinal cord being injured in the neck area. This is the most serious spinal injury and usually results in loss of function and sensation in the arms, body and legs. Again, depending on where the injury has occurred will depend on how much function is lost in the arms.

Incomplete spinal injuries

Incomplete injuries are where there is not total damage to the spinal cord. The spinal cord can still transport messages between the brain and the rest of the body. People with incomplete spinal injuries may still have sensory function.

These are much more common than complete injuries. The injured person will usually retain some function, mobility or sensation (or both). Spinal shock will sometimes show symptoms of complete injury just after the injury has occurred, but the injured person will usually gain some movement or sensation as time goes on.

The type of spinal injury that has occurred will be put into one of the following 5 categories:

1. Anterior cord syndrome – this is an injury to the front of the spinal cord.
2. Central cord syndrome – this is an injury to the centre of the spinal cord.
3. Posterior cord syndrome – this is an injury to the back of the spinal cord.
4. Brown-sequard syndrome – this is an injury to one side of the spinal cord.
5. Cauda equina syndrome – this is an injury to the group of nerves at the bottom of the spinal cord.