How do you care for a spinal cord injury patient?

Follow-up with a spinal cord injury (SCI) expert is important throughout your lifetime. Your spinal cord injury physician knows about your specific injury and all of the problems that you may have experienced related to your injury.

All persons with spinal cord injury should plan to follow-up with a spinal cord injury physician in the first few weeks after being discharged from the hospital. This includes:

• Patients with new spinal cord injuries.
• Patients who have been discharged to another facility.

After a new spinal cord injury, it is often important to see a SCI specialist in clinic every few months. Over time, it may only be necessary to see your spinal cord injury physician once a year.

Anytime you are discharged from the hospital or are seen in an outpatient clinic, it is important to save any discharge instructions  to reference at home. This information should also be shared with your primary care physician, personal care assistants, caregivers, therapists, or any other health care worker who is involved in your care. The more information that is shared between your health care team, the better they are able to help you.

Spinal Cord Injury Physicians at UPMC

The spinal cord injury physicians at UPMC Rehabilitation Institute are all fellowship-trained in Spinal Cord Injury Medicine, after completing residencies in Physical Medicine and Rehabilitation. Patients can seek ongoing care through our outpatient spinal cord injury clinic at UPMC Mercy. 

Our team:

• Is specialty trained to treat persons with SCI.
• Can make referrals to outpatient therapy programs with expertise in treating spinal cord injury.
• Welcomes contact with you, your caregivers, your family, or other health care providers so that we can collaborate on your care.
• Can act as the central point of contact for any concerns related to your spinal cord injury health care.
• Help patients who live outside of Pittsburgh find primary care, spinal cord injury medicine, and therapy follow-up.

Outpatient Physical and Occupational Therapy

After spinal cord injury, it is often important to continue physical and occupational therapy after leaving the hospital. Home health care can be an easy way to access therapy after SCI; however, there can be limitations to what home care therapists can do in your home.

It is recommended that patients with SCI transition to outpatient therapy as soon as possible, and that they receive treatment at an outpatient rehabilitation site where the therapists have knowledge about, and experience with, spinal cord injury. Our spinal cord clinic at UPMC Mercy can make referrals to outpatient therapy programs with expertise in treating spinal cord injury.

Overview

What is a spinal cord injury?

The spinal cord relays messages between the brain and the rest of the body. Layers of tissue called meninges and a column of vertebrae (spinal bones) surround and protect the spinal cord. Most spinal cord injuries come from a sudden, traumatic blow to the vertebrae. The fractured (broken) bones then damage the spinal cord and its nerves. In rare cases, an injury can completely sever, or split, the spinal cord.

How does a spinal cord injury affect the body?

The body loses many essential functions if an injury means nerves can’t communicate with the brain. A damaged spinal cord can affect:

• Bladder and bowel (intestinal) function.
• Breathing.
• Heart rate.
• Metabolism, or the body’s process of converting food into energy.
• Muscle movement.
• Reflexes.
• Sensations.

Is a spinal cord injury the same as a back injury?

A spinal cord injury isn’t the same as a back injury. Back injuries may damage bones or soft tissues in the spine, but they don’t affect the spinal cord.

What are the types of spinal cord injuries?

Spinal cord injuries can be complete or incomplete (partial):

• Complete: A complete injury causes total paralysis (loss of function) below the level of the injury. It affects both sides of the body. A complete injury may cause paralysis of all four limbs (quadriplegia) or the lower half of the body (paraplegia).
• Incomplete: After an incomplete injury, some function remains on one or both sides of the body. The body and brain can still communicate along certain pathways.

Symptoms and Causes

How do spinal cord injuries happen?

Some possible causes of spinal cord injuries (from most to least common) include:

• Motor vehicle accidents.
• Falls.
• Gunshot wounds.
• Sports injuries.
• Surgical complications.

What are the symptoms of a spinal cord injury?

Spinal cord injury symptoms depend on the type (complete or incomplete) and location of the damage. Get immediate medical attention if you notice any of the following issues after an injury:

• Weakness in the arms and or legs.
• Decreased sensation in the arms and or legs.
• Loss of bladder or bowel control.
• Severe pain or pressure in the neck or back.
• Unusual lumps along the spine.
• Difficulty breathing.

Diagnosis and Tests

How is a spinal cord injury diagnosed?

In an emergency, a healthcare provider makes sure a spinal cord injury isn’t affecting your breathing or heart rate. Next, they’ll assess how well your nerves are working. The provider checks:

• Motor function, or your ability to move parts of your body.
• Sensory function, or your ability to feel touch.

Certain imaging tests can help diagnose a spinal cord injury:

• CT scan, to see broken bones, blood clots or blood vessel damage.
• MRI, to see the spinal cord or soft tissues.
• X-ray, to show broken bones or dislocations (bones knocked out of place).

A healthcare provider may also use an electromyogram (EMG) to check electrical activity in muscles and nerve cells if there are co-exist peripheral nerve injury. (EMG is usually not necessary in a spinal cord injury.)

Management and Treatment

What is the immediate treatment for a spinal cord injury?

You may need emergency surgery for a spinal cord injury if there’s trauma to another area of the body. Surgery can also address spinal cord damage from broken bones, blood clots or damaged tissue.

Some research suggests that a corticosteroid injection may help spinal cord injuries. The medication should be given within eight hours after the injury occurs. This treatment may:

• Improve blood flow.
• Preserve nerve function.
• Reduce inflammation.

What is the long-term treatment for a spinal cord injury?

Long-term goals of spinal cord injury treatment include:

• Enhancing independence and quality of life.
• Reducing the risk of chronic (ongoing) health conditions.
• Restoring some nerve function in partial injuries.

Long-term complications of a spinal cord injury may include:

• Inability to regulate blood pressure or body temperature.
• Increased risk of heart or lung problems.
• Loss of bladder or bowel control.
• Paralysis in the arms or legs.
• Persistent pain.
• Spasticity, joint contracture.
• Sexual dysfunction.

Will I need rehabilitation after a spinal cord injury?

Most people with a spinal cord injury will need some form of physical rehabilitation, or therapy. You may need inpatient (during a hospital stay) or outpatient (after a hospital stay) rehabilitation. A rehabilitation team can help you:

• Learn to use assistive devices such as walkers or wheelchairs.
• Regain strength and mobility in areas of the body with nerve function.
• Recover the skills needed for activities of daily living (ADL), including dressing and using the toilet.

What are neural prostheses and how can they help a spinal cord injury?

Neural prostheses (artificial body parts) are a potential new treatment for spinal cord injuries. A neural prosthesis replaces lost nerve function like how an arm or leg prosthesis replaces a lost limb. An electrical device connects to nerves that are still functioning. You use those nerves to control the prosthesis, which helps you move immobile parts of your body.

Prevention

How can I prevent a spinal cord injury?

You can reduce your risk of a spinal cord injury by:

• Avoiding fall hazards such as ladders.
• Driving safely and wearing a seatbelt in motor vehicles.
• Wearing appropriate protective gear during sports.

Outlook / Prognosis

Are spinal cord injuries permanent?

Complete spinal cord injuries are usually permanent. Incomplete spinal cord injuries may allow for some functional improvement over time.

Living With

When should I contact my healthcare provider about a spinal cord injury?

Contact your healthcare provider right away if you develop:

• Autonomic dysreflexia (sudden, uncontrollable high blood pressure).
• Deep vein thrombosis (DVT), a type of clot.
• Pneumonia.
• Pressure injuries (bedsores).

A note from Cleveland Clinic

Spinal cord injuries can have a profound effect on your life. If you’re dealing with a spinal cord injury, it’s important to have a strong support system. This support system may include your healthcare providers, family members, friends and community organizations. You can all work together to improve your health and quality of life.

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