Acute Spinal Cord Injury
What is an acute spinal cord injury?
Your spine is made of many bones called vertebrae. Your spinal cord runs downward
through a canal in the center of these bones. The spinal cord is a bundle of nerves
that carries messages between the brain and the rest of the body for movement and
Acute spinal cord injury (SCI) is due to a traumatic injury that bruises, partially
tears, or completely tears the spinal cord. SCI is a common cause of permanent disability
and death in children and adults.
What causes an acute spinal cord injury?
Many things can cause SCI. The more common injuries occur when the area of the spine
or neck is bent or compressed, as in the following:
- Motor vehicle accidents (automobiles, motorcycles, and being struck as a pedestrian)
- Sports injuries
- Diving accidents
- Trampoline accidents
- Violence (gunshot or stab wounds)
- Infections that form an abscess on the spinal cord
- Birth injuries, which typically affect the spinal cord in the neck area
What are the risk factors for acute spinal cord injury?
Some people are at higher risk for SCI than others. Average age at the time of injury
has increased over the past few decades and is currently 42 years. Most people who
suffer SCIs are male. Non-Hispanic whites are at higher risk for SCI than any other
What are the symptoms of an acute spinal cord injury?
Symptoms of an acute SCI can vary widely. The location of the injury on the spinal
cord determines what part of the body is affected and how severe the symptoms are.
Right after a spinal cord injury, your spine may be in shock. This causes loss or
decrease in feeling, muscle movement, and reflexes. But, as swelling eases, other
symptoms may appear depending on the location of the injury.
Generally, the higher up the level of the injury is to the spinal cord, the more severe
the symptoms. For example, an injury to the neck, the first and second vertebrae in
the spinal column (C1, C2), or the mid-cervical vertebrae (C3, C4, and C5) affects
the respiratory muscles and the ability to breathe. A lower injury, in the lumbar
vertebrae, may affect nerve and muscle control to the bladder, bowel, and legs, and
- Quadriplegia is loss of function in the arms and legs.
- Paraplegia is loss of function in the legs and lower body.
The extent of the damage to the spinal cord determines whether the injury is complete
- A complete injury means that there is no movement or feeling below the level of the injury.
- An incomplete injury means that there is still some degree of feeling or movement below the level of the
These are the most common symptoms of acute spinal cord injuries:
- Muscle weakness
- Loss of voluntary muscle movement in the chest, arms, or legs
- Breathing problems
- Loss of feeling in the chest, arms, or legs
- Loss of bowel and bladder function
The symptoms of SCI may look like other medical conditions or problems.
How are acute spinal cord injuries diagnosed?
Acute SCI is a medical emergency. Emergency evaluation is needed anytime there is
a suspected injury to the spinal cord.
The effects of an SCI may not be clear at first. A full medical evaluation and testing
are needed. The diagnosis of SCI starts with a physical exam and diagnostic tests.
During the exam, the healthcare provider will ask about your medical history and how
the injury occurred. A spinal cord injury can cause ongoing neurological problems
that require further medical follow-up. Sometimes, surgery is needed to stabilize
the spinal cord after acute SCI.
Diagnostic tests may include:
- Blood tests
- X-ray. This test uses invisible electromagnetic energy beams to produce images of internal
tissues, bones, and organs onto film.
- Computed tomography scan (also called a CT or CAT scan). An imaging test that uses X-rays and computer technology to produce detailed images
(often called slices) of the body. A CT scan shows images of any part of the body,
including the bones, muscles, fat, and organs. CT scans are more detailed than general
- Magnetic resonance imaging (MRI). This test uses large magnets, radiofrequencies, and a computer to produce detailed images
of organs and structures within the body.
How is an acute spinal cord injury treated?
SCI requires emergency medical attention on the scene of the accident or injury. After
an injury, your head and neck will be immobilized to prevent movement. This may be
very hard when you are frightened after a serious accident.
Specific treatment for an acute spinal cord injury is based on:
- Age, overall health, and medical history
- Extent of the SCI
- Type of SCI
- How you respond to initial treatment
- The expected course of the SCI
- Your opinion or preference
There is currently no way to repair a damaged or bruised spinal cord. But, researchers
are actively seeking ways to stimulate spinal cord regeneration. The severity of the
SCI and the location determines if the SCI is mild, severe, or fatal.
Surgery is sometimes needed to evaluate the injured spinal cord, stabilize fractured
backbones, release the pressure from the injured area, and to manage any other injuries
that may have been a result of the accident. Your treatment may include:
- Observation and medical management in the intensive care unit (ICU)
- Medicines, such as corticosteroids (to help decrease the swelling in the spinal cord)
- Mechanical ventilator, a breathing machine (to help you breathe)
- Bladder catheter. A tube that is placed into the bladder that helps to drain urine
into a collection bag.
- Feeding tube (placed through the nostril to the stomach, or directly through the abdomen
into the stomach, to provide extra nutrition and calories)
Recovery from a SCI often requires long-term hospitalization and rehabilitation. An
interdisciplinary team of healthcare providers, including nurses, therapists (physical,
occupational, or speech), and other specialists work to control your pain and to monitor
your heart function, blood pressure, body temperature, nutritional status, bladder
and bowel function, and attempt to control involuntary muscle shaking (spasticity).
Can acute spinal cord injuries be prevented?
There is no sure way to prevent SCI, but there are many steps you can take that might
lower your risk, including:
- Don’t drive when you are under the influence of alcohol or drugs.
- Always wear a seat belt while in a vehicle.
- Take precautions to avoid falls around your home.
- Keep firearms unloaded and locked away.
- Wear a helmet when riding a motorcycle or participating in any sports or activities
that may result in head injury (bike riding, skiing, hockey, football, etc)
Living with an acute spinal cord injury
Recovery from a SCI often requires long-term hospitalization and rehabilitation. Physical
therapy will likely be a very important part of your rehabilitation. In this treatment,
specialists will work with you to prevent muscle wasting and contractures, and to
help you retrain other muscles to aid in mobility and movement. Another type of therapy
is occupational therapy, which helps you learn new ways of doing everyday tasks in
spite of your new physical limitations.
A traumatic event that results in a SCI is devastating to both you and your family.
The healthcare team will help educate your family after hospitalization and rehabilitation
on how to help care for you at home and understand the specific problems that require
immediate medical attention.
You will need frequent medical evaluations and testing after hospitalization and rehabilitation
to monitor your progress.
It’s important to focus on maximizing your capabilities at home and in the community.
You may feel sad or depressed after your injury. If this happens to you or a loved
one, your healthcare provider may recommend that you see a mental health professional.
Antidepressants and psychotherapy, or “talk therapy,” are both available to help treat
When should I call my healthcare provider?
Depending on the severity of the injury, some people might recover some of their lost
function, but others might continue to have long-term problems. Be sure to talk with
your healthcare provider about when you would need to call them.
Your healthcare provider will likely advise you to call them if any problems you are
having become worse, including weakness, numbness or other changes in sensation, or
changes in bladder or bowel control.
People who have serious long-term effects from a spinal cord injury can also develop
a number of other complications. Your healthcare provider might advise you to call
them if you have problems such as:
- Skin sores or infections
- Trouble breathing
- Fever, cough, or other signs of infection
- Severe headache
- Not urinating regularly or having severe diarrhea or constipation
- Severe muscle cramps or spasms
- Increasing pain
- An acute spinal cord injury is caused by trauma to the spinal cord. It is a medical
emergency that needs to be treated right away.
- The severity of symptoms (such as weakness, paralysis, and loss of feeling) depends
on how badly the spinal cord is damaged and where on the cord the injury occurs. Damage
to the cord in the middle of the back might affect only the legs, whereas damage to
the spinal cord in the neck might also affect the arms and even the breathing muscles.
- Treatment might include surgery, medicine , and other treatments as needed. Some people
might recover some function over time, but others might continue to have long-term
problems. Physical and occupational therapy can help you adapt to new ways of doing
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also
know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that
- Know how you can contact your provider if you have questions.