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Spinal Injuries
What are the symptoms?
Injury to the spinal cord is an extremely severe blow to the body's central nervous system. The body responds by going into 'shock' for a period which can last from a few hours to six weeks. During this period loss of sensation will be almost complete. While the doctors will know, from x-rays and by testing the reflexes, the approximate location and extent of the injury, they won't know for sure how serious the effects will be.
If the spinal injury has been produced by an accident (trauma), affected people will not be allowed to sit up or get out of bed for some weeks after the period of spinal shock is over, in case unhealed bones cause further damage to the spinal cord.
Paralysis
If the spinal cord is damaged, the nerves which join the spinal cord below the point of damage may be partially or completely cut off from the brain. Nerves joining above the point of damage should be intact and will continue to operate normally. Nerves below the damage point will continue to conduct messages, but the messages won't get through to the brain and messages from the brain will not reach their destination.
Injury to the human spinal cord causes paralysis, the inability to deliberately move or feel particular parts of the body. In general, the higher the level of the injury, the more limbs will be paralysed and the more the disruption to normal bodily functions.
Paraplegia
If the spine is injured below the level of the neck a person is said to be a paraplegic and will be paralysed to some degree in the legs and abdomen. Movement in the trunk and chest will depend on how high the lesion is.
Tetraplegia
If the neck is broken or if there is injury to the spine in the cervical region, the arms also will be partially or fully paralysed. Hence all four limbs are affected, and a person is said to be tetraplegic or quadriplegic. The chest muscles will also be affected, and there may be difficulty with breathing, coughing and clearing the chest.
Autonomic paralysis
As well as the parts of the nervous system that control movement and transmit sensation, the body has another system which controls the involuntary functions of internal organs and glands. This is known as the autonomic nervous system. It is outside of but close to and connected with the spinal cord. Its messages control the bowel and bladder, male (but not female) sexual function, blood circulation and pressure and sweating. Damage to the spinal cord will usually affect the autonomic nervous system also.
Level of lesion
The level of the lesion (injury) is the exact point along the spinal cord where the injury occurred, measured by counting the nerves in the four regions of the spinal cord. The level of the lesion determines which of the limbs and functions are affected because the nerves which control the muscles and bodily functions and provide sensation are each connected to the spinal cord at a particular point.
The extent of paralysis and the degree to which specific bodily functions are affected depends on the completeness of the lesion. If the spinal cord is only partly damaged, some messages may continue to pass between the brain and the muscles and organs. This explains why some spinal cord injured people retain some leg movement, and a few are able to walk to some degree.
Spinal cord injured people are often described by the level and completeness of their lesion. Someone who broke their neck in a diving accident might be a tetraplegic and a 'C4 complete', meaning that their spinal cord was damaged at the level of the fourth cervical nerve, and that the damage was complete. Someone who broke their back while horse riding might be a 'T12 incomplete', meaning that their cord was injured at the level of the 12th thoracic nerve, but that they retain some function in lower nerves.
There are a number of different types of incomplete spinal cord injury:
Anterior cord syndrome: damage is to the front of the cord, usually leading to partial or complete loss of pain, temperature and touch sensations below the level of lesion, but leaving some pressure and joint sensation. Some people injured in this way will recover movement.
Central cord syndrome: damage is to the centre of the cord, with a lot of swelling there. There is usually complete loss of arm movement, but some sparing of leg function. Bladder and bowel function are often partially spared. There may be recovery, starting gradually from the lower legs and progressing upwards.
Posterior cord syndrome: damage to the back of the cord, which may leave good power and pain and temperature sensation, but leave the injured person with great difficulty co-ordinating movement.
Brown-Séquard syndrome: damage mainly to one side of the cord, often as a result of stab injuries. Power is reduced or absent on the injured side, but pain and temperature sensation are relatively normal. The opposite is true on the non-injured side: power is normal, but pain and temperature sensation are reduced or absent.
Cauda equina lesion: the cauda equina is the mass of nerves which fan out from the base of the spinal cord. Injury here will cause patchy loss of motor power and sensation. If the nerve roots are not completely crushed, they can regrow and functional recovery can occur over a period of twelve to eighteen months.
Other factors
The precise nature and effect of paralysis will vary in each individual, and depend on age and weight, general state of health and life-style before injury, whether other injuries are involved; it also depends on the psychological state of the affected individual and the extent to which they are able to adapt to life with the injury.
Background
| What are the causes? 
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