What is a SCI

The Electronic Directory for People with Spinal Cord Injury

"Because no one should cope with a Spinal Cord Injury (SCI) alone"

What is Spinal Cord Injury

Spinal Cord Injury (SCI) is damage to the spinal cord that results in a loss of function such as mobility and/or feeling. In order for the loss of function to occur, the spinal cord does not have to be completely severed. In most individuals with SCI, the spinal cord is intact, but it's the damage to it that results in the loss of functioning.

The Location of the Injury

Knowing the exact level of the injury on the spinal cord is important when predicting what parts of the body might be affected by paralysis and loss of function.

Below is a list of typical effects of spinal cord injury by location. Please keep in mind that while the prognosis of complete injuries are predictable, incomplete injuries are very variable and may differ from the descriptions below.

Cervical (neck) injuries (C1 - C8)

	C1 or atlas: The Atlas is the topmost vertebra, and – along with C2 – forms the joint connecting the skull and spine. Its chief peculiarity is that it has no body, and this is due to the fact that the body of the atlas has fused with that of the next vertebra.
	C2 or axis: Forms the pivot upon which C1 rotates. The most distinctive characteristic of this bone is the strong odontoid process (dens) which rises perpendicularly from the upper surface of the body. The body is deeper in front than behind, and prolonged downward anteriorly so as to overlap the upper and front part of the third vertebra.
	C4 (cervical vertebra): The fourth cervical (neck) vertebra from the top. Injuries above the C-4 level may require a ventilator for the person to breathe properly.
	C5 5th cervical vertabrae down from the base of the skull, found in the neck. C5 injuries often maintain shoulder and biceps control, but have no control at the wrist or hand.
	C6 (cervical vertebra): The sixth cervical (neck) vertebra from the top. The next-to-last of the seven cervical vertebrae. An injury to the spinal cord between C6 and C7 vertebrae is called a C6-7 injury. These injuries generally allow wrist control, but no hand function.
	C7 or vertebra prominens: The most distinctive characteristic of this vertebra is the existence of a long and prominent spinous process, hence the name vertebra prominens. In some subjects, the seventh cervical vertebra is associated with an abnormal pair of ribs, known as cervical ribs. These ribs are usually small, but may occasionally compress blood vessels (such as the subclavian artery) or nerves in the brachial plexus, causing unpleasant symptoms. C-7 and T-1 can straighten their arms 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.
	C8 Although there are seven cervical vertebrae (C1-C7), there are eight cervical nerves (C1-C8). All nerves except C8 emerge above their corresponding vertebrae, while the C8 nerve emerges below the C7 vertebra. In other words C8 is a nerve root not a vertebrae.

Thoracic Vertebrae (T1 – T12)

Damage or SCI's above the T1 vertebra affects the arms and the legs. Injuries below the T1 vertebra affect the legs and trunk below the injury, but usually do not affect the arms and hands. Paralysis of the legs is called paraplegia. Paralysis of the arms and legs is called quadriplegia.

	T-1 to T-8 most often control of the hands, but poor trunk control as the result of lack of abdominal muscle control.
	T-9 to T-12 allow good trunk control and abdominal muscle control. Lumbar and Sacral injuries yield decreasing control of the hip flexors and legs. Individuals with SCI also experience other changes. For example, they may experience dysfunction of the bowel and bladder.

Lumbar Vertebrae (L1 – L5)

Some individuals have four lumbar vertebrae, while others have six. Lumbar disorders that normally affect L5 will affect L4 or L6 in these individuals.

	L1 The first lumbar vertebra is at the level as the ninth rib. This level is also called the important transpyloric plane, since the pylorus of the stomach is at this level.
	L3 - L5 A lot of motion in the back is divided between these five motion segments with segments L3 - L4 and L4 - L5 taking most of the stress. L3 - L4 and L4 - L5 segments are most likely to breakdown from wear and tear causing such conditions as Osteoarthritis.
	L4 - L5 and L5 - S1 are the most likely to herniate (herniated disc, bulging disk, compressed disk, herniated intervertebral disk, herniated nucleus pulposus, prolapsed disk, ruptured disk, slipped disk). The effects of this can cause pain and numbness that can radiate through the leg and extend down to the feet (sciatica).

Sacral Spine (s1 - S5)

Back pain or leg pain (sciatica) can typically arise due to injury where the lumbar spine and sacral region connect (at L5 - S1) because this section of the spine is subjected to a large amount of stress and twisting.

People with rheumatoid arthritis or osteoporosis are inclined to develop stress fractures and fatigue fractures in the sacrum.

In addition to a loss of sensation and motor function below the point of injury, individuals with spinal cord injuries will often experience other complications of spinal cord injury:

	Bowel and bladder function is regulated by the sacral region of the spine, so it is very common to experience dysfunction of the bowel and bladder, including infections of the bladder, and anal incontinence.
	Sexual function is also associated with the sacral region, and is often affected.
	Injuries of the C-1, C-2 will often result in a loss of breathing, necessitating mechanical ventilators or phrenic nerve pacing.
	Inability or reduced ability to regulate heart rate, blood pressure), sweating and hence body temperature.
	Spasticity (increased reflexes and stiffness of the limbs).
	Neuropathic pain.
	Autonomic dysreflexia or abnormal increases in blood pressure, sweating, and other autonomic responses to pain or sensory disturbances.
	Atrophy of muscle.
	Osteoporosis (loss of calcium) and bone degeneration.
	Gallbladder and renal stones.

Complete and Incomplete Spinal cord injuries (SCI)

Complete Spinal Cord Injury:

Generally persons with a complete spinal cord injury suffer a loss of sensation and motor ability caused by bruising, loss of blood to the spinal cord, or pressure on the spinal cord; cut and severed spinal cords are rare. Generally, complete spinal cord injuries result in total loss of sensation and movement below the site of the injury.

Incomplete Spinal Cord Injury:

	An incomplete spinal cord injury does not result in complete loss of movement and sensation below the injury site. These injuries are usually classified as:
	a) Anterior cord syndrome: Damage to the front of the spinal cord, affecting pain, temperature and touch sensation, but leaving some pressure and joint sensation. Often motor function is unaffected.
	b) Central Cord Syndrome: Form of incomplete spinal cord injury in which some of the signals from the brain to the body are not received, characterized by impairment in the arms and hands and, to a lesser extent, in the legs. Sensory loss below the site of the spinal injury and loss of bladder control may also occur. This syndrome, usually the result of trauma, is associated with damage to the large nerve fibers that carry information directly from the cerebral cortex to the spinal cord. These nerves are particularly important for hand and arm function. Symptoms may include paralysis and/or loss of fine control of movements in the arms and hands, with relatively less impairment of leg movements. The brain's ability to send and receive signals to and from parts of the body below the site of trauma is affected but not entirely blocked.
	c) Brown-Sequard syndrome: Injury to the lateral half of the spinal cord. The condition is characterized by the following clinical features found below the level of the lesion - contralateral hemisensory anesthesia to pain and temperature, ipsilateral loss of propioception, and ipsilateral motor paralysis. Tactile sensation is generally spared.
	d) Spinal contusions: The most common type of spinal cord injury. The spinal cord is bruised but not severed. Inflammation and bleeding occurs near the injury as a result of the injury.
	e) Injuries to individual nerve cells: Loss of sensory and motor functions in the area of the body to which the injured nerve root corresponds.

The most common causes of damage to the spinal cord are:

	Motor vehicles 48%
	Falls 21%
	Sports 14% (66% of which are caused in diving accidents)
	Violence 15%
	Other 2%
	32 injuries per million population or 7800 injuries in the US each year.
	Researchers estimate that an additional 20 cases per million (4860 per year) die before reaching the hospital.
	82% male, 18% female
	Highest per capita rate of injury occurs between ages 16-30
	Average age at injury - 33.4
	Median age at injury - 26
	Mode (most frequent) age at injury 19
	Motor vehicle accidents are the leading cause of SCI (44%), followed by acts of violence (24%), falls (22%) and sports (8%), other (2%)
	2/3 of sports injuries are from diving
	Falls overtake motor vehicles as leading cause after age 45.
	Acts of violence and sports cause less injuries as age increases.
	Acts of violence have overtaken falls as the second most common source of spinal cord injury.

Marital status at injury:

	Single 53%
	Married 31%
	Divorced 9%
	Other 7%

5 years post-injury:

	88% of single people with SCI were still single vs.
	65% of the non-SCI population
	81% of married people with SCI were still married vs.
	89% of the non-SCI population

Employment status among persons between 16 and 59 years of age at injury

	Employed 58.8%
	Unemployed 41.2%
	(includes: students, retired, and homemakers)

Employed 8 years post-injury:

	Paraplegic 34.4%
	Quadriplegic 24.3%

Since 1988, 45% of all injuries have been complete, 55% incomplete. Except for the incomplete-Preserved motor (functional), no more than 0.9% fully recover, although all can improve from the initial diagnosis.

Overall, slightly more than 1/2 of all injuries result in quadriplegia. However, the proportion of quadriplegics increase markedly after age 45, comprising 2/3 of all injuries after age 60 and 87% of all injuries after age 75.

92% of all sports injuries result in quadriplegia.

Most people with neurologically complete lesions above C-3 die before receiving medical treatment. Those who survive are usually dependent on mechanical respirators to breathe.

50% of all cases have other injuries associated with the spinal cord injury.

	Quadriplegia, incomplete 31.2%
	Paraplegia, complete 28.2%
	Paraplegia, incomplete 23.1%
	Quadriplegia, complete 17.5%

It is now known that the length of stay and hospital charges for acute care and initial rehabilitation are higher for cases where admission to the SCI system is delayed beyond 24 hours.

Average length of stay:

	Quadriplegics 95 days
	Paraplegics 67 days
	All 79 days

Average charges (1990 dollars)

	Quadriplegics $118,900
	Paraplegics $ 85,100
	All $ 99,553

Source of payment acute care:

	Private Insurance 53%
	Medicaid 25%
	Self-pay 1%
	Vocational Rehab 14%
	Worker's Comp 12%
	Medicare 5%
	Other 2%

Ongoing medical care: (Many people have more than one source of payment.)

	Private Insurance 43%
	Medicare 25%
	Self-pay 2%
	Medicaid 31%
	Worker's Compensation 11%
	Vocational Rehab 16%

Overall, 85% of SCI patients who survive the first 24 hours are still alive 10 years later, compared with 98% of the non-SCI population given similar age and sex.

The most common cause of death is respiratory ailment, whereas, in the past, it was renal failure. An increasing number of people with SCI are dying of unrelated causes such as cancer or cardiovascular disease, similar to that of the general population.

Mortality rates are significantly higher during the first year after injury than during subsequent years.

Treatment

Treatment for acute traumatic spinal cord injuries have consisted of giving high dose methylprednisolone if the injury occurred within 8 hours. The recommendation is primarily based on the National Acute Spinal Cord Injury Studies (NASCIS) II and III. Some of the claims of the studies have been challenged as being from faulty interpretation of the data.

Breakthrough medical research shows stem cell transplants could have the potential to help or cure paralysis caused by spinal injury. Stem cells are primal cells found in all multi-cellular organisms. They can be made to differentiate into a range of specialized cells including nerve cells, which can be transplanted into the body.

Cure

Currently there is no cure for SCI. There are many researchers attacking this problem, and there have been many advances in the lab. Many of the most exciting advances have resulted in a decrease in damage at the time of the injury. Steroid drugs such as methylprednisolone reduce swelling, which is a common cause of secondary damage at the time of injury. The experimental drug Sygen®appears to reduce loss of function, although the mechanism is not completely understood.

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This web site was designed and is maintained by Silas S. Slade