Spinal Cord Society of Australia

Spinal Cord Injury (SCI) is a sudden and unexpected injury that is both devastating physically and psychologically. Its consequences are costly both in human and social terms. In 2005, new injuries have increased the total world population of people living with spinal cord injury induced paralysis to over 2.5 million. Spinal cord injury affects about 12,000 Australians, with between 300-400 new cases each year. A Spinal Cord Injury (SCI) is damage or trauma to the spinal cord that results in a loss or impaired function causing reduced mobility or feeling. Common causes of damage are trauma (car accident, gunshot, falls, sports injuries, etc.) or disease (Transverse Myelitis, Polio, Spina Bifida, Friedreich's Ataxia, etc.). The spinal cord does not have to be severed in order for a loss of functioning to occur. In most people with SCI, the spinal cord is intact, but the cellular damage to it results in loss of functioning. SCI is very different from back injuries such as ruptured disks, spinal stenosis or pinched nerves. It is possible for a person to "break their back or neck" yet not sustain a spinal cord injury where the bones (the vertebrae) around the spinal cord are damaged, but the spinal cord is not affected.

What is the spinal cord and the vertebra?

The spinal cord is about 18 inches in length and extends from the base of the brain, surrounded by the vertebral bodies, down the middle of the back, to about the waist. The nerve trunks within the spinal cord carry messages back and forth from the brain to the body. The bundles of nerves that branch off the cord are called spinal nerves. These spinal nerves exit and enter at each vertebral level and communicate with specific areas of the body. The sensory portions of the spinal nerves carry messages about sensation from the skin such as pain and temperature, and other body parts and organs to the brain. The motor portions of the spinal nerves send messages from the brain to the various body parts to initiate actions such as muscle movement.

The spinal cord is the major bundle of nerves that carry nerve impulses to and from the brain to the rest of the body. The brain and the spinal cord constitute the Central Nervous System. Motor and sensory nerves outside the central nervous system constitute the Peripheral Nervous System, and another diffuse system of nerves that control involuntary functions such as blood pressure and temperature regulation are the Sympathetic and Parasympathetic Nervous Systems.

The spinal cord is surrounded by rings of bone called vertebra. These bones constitute the spinal column (back bones) [Link 2]. In general, the higher in the spinal column the injury occurs, the more dysfunction a person will experience. The vertebra are named according to their location. The eight vertebra in the neck are called the Cervical Vertebra. The top vertebra is called C-1, the next is C-2, etc. Cervical SCI's usually cause loss of function in the arms and legs, resulting in quadriplegia. The twelve vertebra in the chest are called the Thoracic Vertebra. The first thoracic vertebra, T-1, is the vertebra where the top rib attaches.

Injuries in the thoracic region usually affect the chest and the legs and result in paraplegia. The vertebra in the lower back between the thoracic vertebra, where the ribs attach, and the pelvis (hip bone), are the Lumbar Vertebra. The sacral vertebra run from the Pelvis to the end of the spinal column. Injuries to the five Lumbar vertebra (L-1 thru L-5) and similarly to the five Sacral Vertebra (S-1 thru S-5) generally result in some loss of functioning in the hips and legs

What are the effects of SCI?

The effects of SCI depend on the type of injury and the level of the injury. SCI can be divided into two types of injury - complete and incomplete. A complete injury means that there is no function below the level of the injury; no sensation and no voluntary movement. Both sides of the body are equally affected. An incomplete injury means that there is some functioning below the primary level of the injury. A person with an incomplete injury may be able to move one limb more than another, may be able to feel parts of the body that cannot be moved, or may have more functioning on one side of the body than the other. With the advances in acute treatment of SCI, incomplete injuries are becoming more common.

The level of injury is very helpful in predicting what parts of the body might be affected by paralysis and loss of function. Remember that in incomplete injuries there will be some variation in these prognoses.

Cervical (neck) injuries usually result in quadriplegia. Injuries above the C-4 level may require a ventilator for the person to breathe. C-5 injuries often result in shoulder (deltoid) and biceps control, but no control at the wrist or hand. C-6 injuries generally yield wrist control (wrist extensors), but no finger hand function. Individuals with C-7 and T-1 injuries can straighten their arms (triceps) but still may have dexterity problems with the hand and fingers. Injuries at the thoracic level and below result in paraplegia, with the hands not affected. At T-1 to T-8 there is most often control of the hands, but poor trunk control as the result of lack of abdominal muscle control. Lower T-injuries (T-9 to T-12) allow good truck control and good abdominal muscle control. Sitting balance is very good. Lumbar and Sacral injuries yield decreasing control of the hip flexors and legs.

Paralysis also has other effects as well as a loss of sensation or motor functioning Individuals with SCI also experience other neurological changes. For example, the person may experience dysfunction of the bowel and bladder,. Sexual functioning is frequently affected in men with SCI, as they may have their fertility affected, while women's fertility is generally not affected. High spinal injuries injuries (C-1, C-2) can result in a loss of many involuntary bodily functions, including the ability to breathe. Breathing aids such as mechanical ventilators or diaphragmatic pacemakers may be needed to regulate a persons breathing in these cases. Other effects of SCI may include low postural blood pressure (Postural Hypotension), inability to regulate blood pressure effectively , reduced control of body temperature (poikilothermic), inability to sweat below the level of injury, and chronic pain.