Spinal Cord Injury

Diagnosis

Healthcare professionals in the emergency room begin diagnosis with a physical examination. They test sensory function and movement and ask questions about how the injury occurred. Based on this initial evaluation, a spinal cord injury may sometimes be ruled out.

Emergency diagnostic tests are needed if the injured person has neck pain, is not fully awake, or has obvious weakness or signs of neurological injury. These tests help identify damage to the spine or spinal cord.

X-rays may be used to detect damage to the vertebrae, including fractures, tumors, or structural changes in the spine.

A CT scan provides more detailed images than X-rays. It uses computer-processed cross-sectional images to identify bone injuries, disk problems, or other spinal changes.

MRI uses strong magnetic fields and radio waves to create detailed images of the spinal cord. This test is especially useful for detecting herniated disks, blood clots, or masses that may be pressing on the spinal cord.

A few days after the injury, once swelling has decreased, a more detailed neurological exam may be done. This exam evaluates the level and completeness of the spinal cord injury by testing muscle strength and the ability to sense light touch and pinprick sensations.

Treatment

There is currently no way to reverse damage to the spinal cord. Research continues on new treatments, including nerve regeneration therapies, prosthetic devices, and medicines that may improve nerve function. Current treatment focuses on preventing further injury and helping people regain independence and quality of life.

Emergency actions begin at the scene of the accident. Urgent medical care is critical for head or neck injuries.

Emergency personnel immobilize the spine as carefully and quickly as possible using a rigid neck collar and a firm transport board to prevent further damage during transfer to the hospital.

In the emergency room, early treatment focuses on stabilizing vital functions and preventing complications.

Care priorities include:

• Maintaining adequate breathing

• Preventing shock

• Immobilizing the neck to limit spinal cord movement

• Avoiding complications such as blood clots, breathing problems, or bowel and bladder retention

Many people with spinal cord injuries are treated in an intensive care unit or transferred to a specialized spine injury center. These centers have teams trained in spinal cord injury care, including neurosurgeons, orthopedic surgeons, neurologists, rehabilitation specialists, nurses, therapists, psychologists, and social workers.

Medicines were once commonly used in early treatment. Methylprednisolone, given through a vein, was used in the past. However, studies have shown that its risks, including infections and blood clots, outweigh potential benefits. It is no longer recommended for routine treatment.

Immobilization techniques such as traction may be used to stabilize and align the spine. Traction gently pulls the head using a brace or collar to maintain proper spinal alignment.

Surgery is often required to remove bone fragments, herniated disks, or foreign objects that compress the spinal cord. Surgery may also stabilize fractured vertebrae and reduce the risk of long-term complications.

Experimental treatments are under study. These include techniques to control inflammation, reduce cell death, and promote nerve regeneration. One example is temporarily lowering body temperature to reduce inflammation, though more research is needed.

As the condition stabilizes, ongoing care focuses on preventing secondary complications. These may include muscle stiffness, loss of conditioning, pressure injuries, breathing infections, bowel and bladder problems, and blood clots.

Hospital stay length varies depending on injury severity and complications. Once medically stable, many people transfer to a rehabilitation center.

Rehabilitation begins early, often while still in the hospital. The rehabilitation team may include physical therapists, occupational therapists, rehabilitation nurses, psychologists, social workers, physiatrists, dietitians, and recreation therapists.

Early rehabilitation focuses on maintaining muscle strength, improving movement, and relearning fine motor skills. Therapists also teach strategies for performing daily activities and adapting to physical limitations.

Education is a key part of rehabilitation. People learn about their injury, how to prevent complications, and ways to improve independence and quality of life.

Medications are often used to manage symptoms such as pain, muscle spasticity, and bladder or bowel dysfunction. Some medicines may also help improve sexual functioning.

New technologies can significantly improve independence and mobility. These may include:

• Advanced wheelchairs that are lighter, powered, or capable of climbing stairs

• Computer adaptations such as voice recognition or modified keyboards

• Electronic aids that control household devices using switches or voice commands

• Electrical stimulation devices that activate muscles to assist standing, walking, reaching, or gripping

Recovery and outlook vary widely. Your healthcare professional may not be able to predict recovery early on. Improvement often depends on the level and severity of the injury. The greatest recovery usually occurs within the first six months, though smaller improvements may continue for one to two years.