This article was previously published on SpinalCord.com by Zawn Villines.
Though about 12,500 people survive spinal cord injuries each year, few people learn much about these catastrophic injuries until they are injured or must care for an injured loved one.
Most spinal cord injuries are preventable, and knowing the causes of these injuries can help you avoid becoming a victim. And if you or someone you love already deal with the frustration and pain of a spinal cord injury, knowing the most common sources of these injuries can help you feel a bit less alone.
Each year, the National Spinal Cord Injury Statistical Center at the University of Alabama-Birmingham compiles an assortment of statistics on spinal cord injuries. It’s interesting to note that, in almost all category of injuries, men are more likely to be injured than women.
Men account for more than 80% of SCI victims, and the reason for this is quite clear: men are more likely to take risks and play sports that cause SCI. Spinal cord injuries are especially prevalent among younger men, who may be more prone to playing dangerous sports or engaging in risky activities such as high-speed driving.
In 2014, the latest year for which statistics are available, the 10 leading causes of spinal cord injuries, and their percentage of the total number of injuries, were as follows.
Leading Causes of Spinal Cord Injuries, Explained
Auto Accidents
Car accidents are a leading cause of death nationwide, and people under the age of 34 are more likely to die in car accidents than any other single cause. Nationwide, car accidents claim more than 32,000 lives annually. Unsurprisingly, then, car accidents are the leading cause of spinal cord injuries, accounting for 7,205 (29.3%) male injuries and 2,402 (48.3%) female injuries in 2014.
Find out what to do after a car accident.
Falls
You don’t have to be elderly or infirm to suffer a fall. A misplaced step as you navigate stairs, a fight near a flight of stairs, or even a medical event, such as a seizure or fainting, can all lead to catastrophic falls. Such falls were the second-leading cause of SCI in 2014, accounting for 5,406 (22%) male injuries and 1,262 (21.5%) female injuries.
Gunshot Wounds
Gunshot wounds can quickly destroy a body, and even a grazing by a bullet can sever or compress the spinal cord. Gun-related injuries accounted for 4,163 (16.9%) male SCIs in 2014, and 572 (9.1%) female injuries.
Diving Injuries
Propelling head first into the water is an inherently dangerous activity. If the water is too shallow, the diver inexperienced, or there are objects or people in the diver’s way, the injuries can be immediate and catastrophic. 1,718 (7%) men suffered spinal cord injuries due to diving accidents in 2014, with 122 (2.1%) female divers experiencing SCI.
Motorcycle Accidents
Though motorcyclists account for a fraction of motorists on the road, the lack of external protection means that even minor motorcycle collisions can be deadly. In 2014, 1,695 (6.9%) men suffered spinal cord injuries while on motorcycles, with a mere 145 (2.5%) women experiencing such injuries.
Falling Objects
You might not think much about falling objects in your daily life, but collisions with such objects can produce lifelong injuries. Construction sites, falling rock, and even large icicles or hail can damage the brain and spine, particularly when victims are hit at high speeds or at particularly dangerous angles.
Those in industries where falling objects are common are especially vulnerable; this is why construction hats and similar safety gear factor so prominently in the prevention of spinal cord injuries. 822 men (3.3%) and 37 women (.6%) experienced spinal cord injuries due to falling objects in 2014.
Medical and Surgical Complications
Doctors, pharmacists, and other medical experts are on the front lines of the fight against spinal cord injuries. These providers can help you recover from even the most severe injuries, but there is also a dark side to medical care. Medical errors are frighteningly common, killing as many as 440,000 people each year. Even when such errors are not fatal, they can cause catastrophic spinal cord injuries.
Likewise, surgical complications, including infections, can compress the spinal cord. Choosing the right doctor, following his or her post-surgical care advice, reading provider reviews, and carefully monitoring any unusual symptoms can all help you avoid a medically induced SCI. 537 (2.2%) men suffered spinal cord injuries due to medical complications in 2014.
Among women, the numbers were similar, with 298 women experiencing such injuries. But because women are less likely than men to experience traumatic spinal cord injuries, medically induced SCI accounts for a higher proportion (5.1%) of female SCI than male SCI. Among women, medically induced SCIs are the fourth-leading cause of such injuries.
Pedestrian Injuries
Aggressive, distracted, and speeding motorists all contribute to a dangerous walking climate. It’s not just motorists who put people at risk, though. Ample research suggests that pedestrians are often distracted by phones and other devices, and many such pedestrians are in denial about the extent of their distraction. In 2014, 357 (1.5%) men suffered pedestrian-related spinal cord injuries, with 131 women (2.2%) meeting a similar fate.
Bicycle Accidents
Bicycle accidents change lives, especially when the cyclist collides with a car, hits a large object, or is not wearing a helmet. Helmets—even if you are only cycling in your own driveway, and even though you might not like the way helmets look—save lives. Over time, fatal bicycle accidents have generally declined, suggesting that helmet laws are working to keep cyclists safe. Nevertheless, 409 men (1.7%) and 49 women (.8%) suffered bicycling-related spinal cord injuries in 2014.
‘Person-to-Person’ Contact
Person-to-person contact injuries are a cause of spinal cord injuries that, as the name implies, result from contact with another person. In most cases, these injuries are the result of violent altercations, such as when one person pushes another into a heavy object. 234 men (1%) and 66 women (1.1%) suffer spinal cord injuries due to such contact each year.
Other SCI Injury Sources
Though the above-mentioned sources account for the overwhelming majority of spinal cord injury causes, there are many other possibilities. The next 10 leading causes of injury, in order from most to least prevalent, are as follows:
- Unclassified, which includes injuries that don’t fit neatly into a single category, or for which adequate data is not available.
- Penetrating wounds, such as an object entering the brain or spinal cord.
- All-terrain vehicle (ATV) accidents.
- Accidents in other vehicles, such as jet skis and boats.
- Snow skiing.
- Football.
- Winter sports such as snowboarding.
- Horseback riding.
- Surfing, including body surfing.
- Other sports-related injuries.
An estimated 12,500 spinal cord injuries occur in the U.S. every year, leaving the injured people, their friends, and their family, to cope with the aftermath of the catastrophe. For many, navigating the challenges of the health care system can feel a bit like going to medical school. Suddenly you’re learning a veritable cornucopia of new terms, and may be spending endless hours Googling spinal cord anatomy to fill in the gaps in your knowledge.
An educated patient is better equipped to advocate for his or her needs and interests. An education in spinal cord anatomy helps you understand what your doctor is saying, ask intelligent questions, and detect medical errors before they endanger your health.
Spinal Cord Anatomy: The Basics
Though you might think of your spinal cord as one single piece, it’s actually a column of nerves protected by a sheath of myelin and then further secured by 31 butterfly-shaped vertebrae (singular: vertebra).
Medical providers divide the spinal cord into four distinct regions. Knowing the region in which the injury is located is often the key to understanding diagnosis and treatment. The four spinal cord regions are:
- The cervical spinal cord: This is the topmost portion of the spinal cord, where the brain connects to the spinal cord, and the neck connects to the back. This region consists of eight vertebrae, commonly referred to as C1-C8. All spinal cord numbers are descending, so C1 is the highest vertebra, while C8 is the lowest in this region.
- The thoracic spinal cord: This section forms the middle of the spinal cord, containing twelve vertebrae numbered T1-T12.
- The lumbar spinal cord: This is a lower region of the spinal cord, where your spinal cord begins to bend. If you put your hand in your lower back, where your back bends inward, you’re feeling your lumbar region. There are five lumbar vertebrae, numbered L1-L5.
- The sacral spine: This is the lower, triangle-shaped region of the spine, also with five vertebrae. While the lumbar cord bends inward, the vertebrae of the sacral region bend slightly outward. There is no actual spinal cord in this section, it is made up of nerve roots which exit the spine at their respective vertebral levels.
- The coccygeal region, sometimes known as the coccyx or tail bone, consists of a single vertebra at the very base of the spinal cord.
Types of Spinal Cord Injuries
All spinal cord injuries are divided into two broad categories: incomplete and complete.
- Incomplete spinal cord injuries: With incomplete injuries, the cord is only partially severed, allowing the injured person to retain some function. In these cases, the degree of function depends on the extent of the injuries.
- Complete spinal cord injuries: By contrast, complete injuries occur when the spinal cord is fully severed, eliminating function. Though, with treatment and physical therapy, it may be possible to regain some function.
Incomplete spinal cord injuries are increasingly common, thanks in part to better treatment and increased knowledge about how to respond—and how not to respond—to a suspected spinal cord injury. These injuries now account for more than 60% of spinal cord injuries, which means we’re making real progress toward better treatment and better outcomes.
Some of the most common types of incomplete or partial spinal cord injuries include:
- Anterior cord syndrome: This type of injury, to the front of the spinal cord, damages the motor and sensory pathways in the spinal cord. You may retain some sensation, but struggle with movement.
- Central cord syndrome: This injury is an injury to the center of the cord, and damages nerves that carry signals from the brain to the spinal cord. Loss of fine motor skills, paralysis of the arms, and partial impairment—usually less pronounced—in the legs are common. Some survivors also suffer a loss of bowel or bladder control, or lose the ability to sexually function.
- Brown-Sequard syndrome: This variety of injury is the product of damage to one side of the spinal cord. The injury may be more pronounced on one side of the body; for instance, movement may be impossible on the right side, but may be fully retained on the left. The degree to which Brown-Sequard patients are injured greatly varies from patient to patient.
Knowing the location of your injury and whether or not the injury is complete can help you begin researching your prognosis and asking your doctor intelligent questions. Doctors assign different labels to spinal cord injuries depending upon the nature of those injuries. The most common types of spinal cord injuries include:
- Tetraplegia: These injuries, which are the result of damage to the cervical spinal cord, are typically the most severe, producing varying degrees of paralysis of all limbs. Sometimes known as quadriplegia, tetraplegia eliminates your ability to move below the site of the injury, and may produce difficulties with bladder and bowel control, respiration, and other routine functions. The higher up on the cervical spinal cord the injury is, the more severe symptoms will likely be.
- Paraplegia: This occurs when sensation and movement are removed from the lower half of the body, including the legs. These injuries are the product of damage to the thoracic spinal cord. As with cervical spinal cord injuries, injuries are typically more severe when they are closer to the top vertebra.
- Triplegia: Triplegia causes loss of sensation and movement in one arm and both legs, and is typically the product of an incomplete spinal cord injury.
Injuries below the lumbar spinal cord do not typically produce symptoms of paralysis or loss of sensation. They can, however, produce nerve pain, reduce function in some areas of the body, and necessitate several surgeries to regain function. Injuries to the sacral spinal cord, for instance, can interfere with bowel and bladder function, cause sexual problems, and produce weakness in the hips or legs. In vary rare cases, sacral spinal cord injury survivors suffer temporary or partial paralysis.
SOURCE: SpinalCord.Com
From the initial phases of living with a SCI to finding ways to adjust daily routines as an adult is truly challenging. The new diagnosis of a SCI for a child can be just as or even more overwhelming. From a physical standpoint, a child’s systems is not fully developed and, therefore, has a higher potential paraplegia or a complete SCI. Also, parents are often left to navigate care and make crucial decisions for their child’s long term health all while remaining positive and encouraging their child who may be in a wheelchair now but doesn’t understand why.
But where does one begin to provide care for a child with a SCI? Which type of rehabilitation center should you use? How do you comfort a child when they feel alone? What will happen when they are able to return to school? Though there are many excellent resources concerning kids with new injuries, we turn to the Christopher and Dana Reeve Foundation to assist answering these questions. It is important to note that the child’s age will play a key role throughout the process.
The Initial Phase
When you are introduced to a new life with s SCI, it seems like many events happen all at once. To understand the initial phase, please read our “Spinal Cord Injury: The Initial Phase.” Though the article is based off of the immediate care of an adult with a SCI, the immediate care of a child is similar. This article will include a description of how the care of the spinal cord begins, a list the general of spinal cord injures, and what happens when surgery is an option. For further general information about a newly developed pediatric SCI, please visit the United Spinal Association and download their guide sheet.
Rehabilitation
Choosing the right rehabilitation facility and therapy is crucial as it provides the basis for successfully living with a SCI. According to The National Spinal Cord Injury Association, “The goal of rehabilitation is to help the child and family learn how to care for a body that now works differently, maintain a high level of wellbeing that avoids the resulting health difficulties of SCI…and help the child, once again, become a full member of the community” (United Spinal Association). This decision begins with researching rehabilitation centers that have the ability to take pediatric cases. The Commission on Accreditation of Rehabilitation Facilities (CARF) provides a list of facilities that are accredited and are equipped to meet the needs of young children. Most major hospital systems also have the ability to provide rehab for pediatric SCI cases.
Important questions to consider while interviewing and researching rehab centers include:
1. How many children/adolescents with spinal cord injuries or diseases does the facility admit and care for each year?
2. What is the staff to patient ratio?
3. Is the facility accredited and meet the professional standards to provide the proper care?
4. How far away is the facility from school and home?
5. Is an after-school or learning program so the child can continue their class work provided?
6. Does the facility provide training for the parent(s)?
7. Are there therapeutic programs for children on a ventilator?
8. Does the facility offer support for the child as well as family members?
9. Does the facility allow siblings and friends to visit?
10. Can a tour of the facility be arranged?
To learn more about choosing a rehabilitation routine, please read our “Spinal Cord: Rehabilitation Phase” article.
Life Outside of Therapy
Understanding the SCI
For a child, it can be hard to understand why they cannot move parts of their body like they could before or why they may not be able to participate in the same activities as their peers. This realization can be frustrating for a parent but possibly even more so for the child. To aid in the explanation, The Christopher & Dana Reeve Foundation suggest turning to books, videos, online tools, and events involving children with the same disabilities. The Reeve Foundation Paralysis Resource Center Library offers book and video rentals for children and adolescences to educate their SCI and other spinal cord injuries and diseases. Also, download the United Spinal Association’s tips to caring for a child and encouraging them throughout this process.
Education
Going back to school can be a scary thought to the child with a new SCI. From peer acceptance to figuring out how to navigate the busy hallways with crutches, there will be many challenges they will most likely face. The most important aspect to continuing their education will be communication. Parents should keep in constant contact with school officials and educators about their new learning needs, rehab schedule, transportation needs, and/or eating, bathroom, and medication needs. Before returning to school, there are a few notes to consider to ease the transition and encourage the child.
1. Set up an initial meeting with parents, teacher(s), principle, school nurse or secretary, guidance counselor, and the child. It might be helpful to continue these meetings, especially
throughout the first year of a newly developed SCI. An end of the year meeting is highly suggested to prepare for the next academic year.
2. Determine the type of vehicle needed to get to school. It may be easier for the parent or a caregiver to drive the child to and from school. A wheelchair accessible school bus might also be a
good option for transportation.
3. Functional school supplies might need to be purchased before returning to school. The Christopher & Dana Reeve Foundation suggests testing pencils, markers, scissors, etc. to make sure the child can have a good grip on the tools. It will also be important to think about the type of desk needed for the child, whether or not they need a more accessible locker, and an extra set of textbooks to aid the weight load of the child’s backpack.
4. At first, the child’s peers, athletic coaches, or club leaders might see the disability rather than the person. The SCI and people’s view towards it should not stop the child from being active
with school or community functions. It might be a good idea to get involved with an organization where the child can have a chance to be surrounded by others with a SCI. One great
example of an organization like this is the Paralympic Games. It could be encouraging to the child to see others like them and know they are not alone as well as being able to set goals to
compete in a Paralympic Sport Club.
For more information on Spinal Cord Injuries, we encourage you to use The Christopher & Dana Reeve Foundation Paralysis Resource Center. To learn how Dobson Healthcare can provide family support, staffing, or care for a loved on with a Spinal Cord Injury,
please call 866-866-8984.
The Reeve Foundation Paralysis Resource Center. Back-to-School. (n.d.). Retrieved January 26, 2016.
The Reeve Foundation Paralysis Resource Center. Books and Videos for Children and Teens. (n.d.). Retrieved January 26, 2016.
The Reeve Foundation Paralysis Resource Center. Kids with New Injury. (n.d.). Retrieved January 26, 2016.
United Spinal Association. Pediatric Spinal Cord Injury General Information. (n.d.). Retrieved January 26, 2016.
“I seemed to have paralysis all over my body…
My taste buds were affected; my eyes refused to focus correctly;
my mind wandered; and lung muscles were also stricken.
At the end of six weeks, I lifed my head off the pillow and was able
to sneeze slightly. Three weeks [later] I managed to turn myself on
my side. By this time I was able to carry on a conversation without
running out of breath. In December, my feet returned for the most
part to a normal condition.”
~Mrs. V. A. Pahl, Smithsonian NMAH
Many events happen during the initial phase of a Spinal Cord Injury (SCI). You might have seen a loved one rushed to the emergency room after an accident and placed in a brace, immobilizing their body. Or you, yourself, may have been taken into surgery and upon waking up, you may have felt numb or you couldn’t move a part of your body. So many questions come whizzing into your head during the initial phase. Questions like, What will life be like now? What challenges will my family member or friend face? Will I ever be able to walk again?
The news that you have an SCI can be overwhelming. And each SCI has a different road to recovery with different adjustments made to your daily routine. But don’t be discouraged when the time comes to make decisions to put the pieces of your life back together. The next step you’ll be taking is choosing a rehabilitation process with therapies that fit your needs. Use the following discussion as a guide to picking the best rehab for you.
Rehabilitation Location
There are both inpatient and outpatient rehab center options for SCI treatment. When choosing a facility, it will be important to make sure they can provide the level of services you require. You will also want to make sure they have the equipment, professional staff, and experience with your particular SCI diagnosis. Other questions to ask when choosing the facility include:
1. Does the facility provide treatments for adults, pediatric cases, or both?
2. How many SCI patients with your condition do they see every year?
3. What is the staff to patient ratio?
4. Does the facility offer support for family members and friends?
5. Is the facility accredited and meet the professional standards to provide the proper care?
Another question to ask yourself is, How far am I willing to travel to receive treatment? Home healthcare agencies, like Dobson Healthcare, can provide high-quality care and rehabilitation therapies in the comfort of your home.
Professional Staff
There should be many professional staff members on the rehabilitation team at an inpatient or outpatient facility. Among them should be a Physiatrist (the doctor specializing in treating a wide range of medical conditions affecting the brain and spinal cord) who coordinates the long-term rehab care for SCI patients. Rehabilitation Nurses should also be on the rehab team. Among their many supportive tasks, they provide education for the patient and family members as well as monitor the rehab treatment and recovery process. Finally, there should be a variety of therapists, such as occupational therapists and physical therapists, on the team. Each staff member should have the proper educational background and professional experience to assist in the rehab process.
Therapy
It is important for the facility to provide care with a variety of therapy options while also utilizing cutting-edge technology. Common therapies include Occupational Therapy, Physical Therapy, and Speech Therapy. These therapies assist with learning or relearning day-to-day activities, motor and sensory movements, how to operate a wheelchair, how to communicate, how to swallow, and so much more. A special type of therapy increasingly being used is called Aquatherapy. This involves an Aquatic Therapist assisting exercises within a heated therapy pool. Lastly, the facility might suggest the use of Functional Electrical Stimulation (FES). By using a FES system, such as the FES bike or surgical implants, small electrical pulses are sent to paralyzed muscles to assist with exercising, moving, and improving muscle and organ functions.
Know that throughout this healing process you are not alone. There are many great sources, like the United Spinal Association, the Christopher & Dana Reeve Foundation, and the Paralyzed Veterans of America, that can provide answers to your questions. If you need help caring for a loved one with an SCI or want to talk to a nurse about care options, please call us at 866-866-8984.
Christopher & Dana Reeve Foundation. (n.d.). Functional Electrical Stimulation. Retrieved January 14, 2016
Christopher & Dana Reeve Foundation. (n.d.). Overview-How to Pick a Rehab. Retrieved January 14, 2016
Christopher & Dana Reeve Foundation. (n.d.). Rehabilitation Centers. Retrieved January 14, 2016
Figure 1: University of Maryland Medical Center. (n.d.). Rehabilitation. Retrieved January 14, 2016
Winter time in Michigan can be filled with fun activities like skiing, snowboarding and snowmobiling. While many Dobson Healthcare clients have sustained their Spinal Cord Injuries (SCI) from auto accidents or accidents on the job, this isn’t the only way to injury your spine. Without the proper handling of equipment or safety precautions, several of your favorite wintertime activities could result in a Spinal Cord Injury.
When an injury is sustained, life stops and you have to figure out the next best option for care for you or your loved one. You may have many questions if the event occurs so the following excerpt is information we gathered from various sources on what you need to know when you’re dealing with the emergency phase and a newly diagnosed spine injury.
Stabilizing the Injured Person
After the injury, the first task of emergency respondents is to check and stabilize the person’s heart rate, blood pressure, and breathing. This is to understand how the body reacted, determine if intubation is necessary, and to prevent inflammation. They will also place the patient into a special brace to secure the spinal cord to prevent further damage. Whether the injury is traumatic or non-traumatic, the person will most likely be taken to the nearest trauma care center.
Once in the hospital, medications may be used to “control the extent of the damage to the spinal cord, alleviate pain, treat infections, and other issues related to the injury” (“Emergency Management”). It is very likely that the patient will also use a traction technique, such as a brace or body harness, to inhibit movement. Neuroprotective therapies may be administered as the first medical treatment. These can be in the form of a steroid drug called methylprednisolone and/or therapeutic hypothermia (either with injected saline or special blankets combined with cold packs) to reduce swelling.
Classifying the Injury
Using x-rays, MRI’s, CT scans, and neurological examinations, doctors can determine the type of SCI and whether it is a complete or incomplete injury. The location of the SCI also dictates which parts of the body are affected.
- Spinal Contusions
This is the most common type of SCI. It is caused by damage to nerve cells which can create bruising, loss of sensory and motor functions, and inflammation and bleeding near the spinal cord. This type of SCI, however, usually only has temporary effects with a quick recovery period.
- Cervical Spinal Cord Injuries
This is also known as quadriplegia or tetraplegia. With this injury, areas from the point of the injury (at the top of the back) down are affected. This usually includes the back of the head, neck, shoulders, arms, and diaphragm. This SCI requires the patient to be placed in a brace or stabilizing device.
- Thoracic Spinal Cord Injuries
The muscles of the back and part of the abdomen are affected at the Thoracic level. It can cause paralysis, weakness of the legs, and bowel and bladder dysfunction with most patients only wearing a brace for extra support. Because of the rib cage offering protection, this is the least common SCI.
- Lumbar Spinal Cord Injuries
Like Thoracic SCI’s, the back muscles and abdomen are affected with this SCI. Again, paralysis, weakness of the legs, and bowel and bladder dysfunction is common. However. the buttocks and parts of the legs are also included. At the Lumbar level, surgery and external stabilization tools are often required.
- Sacral Spinal Cord Injury
With a Sacral SCI, the hips, legs, feet, and genital organs can become weak or be in a state of paralysis. The functioning of the bowel and bladder may also be lost. Most patients after the injury must learn to utilize a wheelchair.
Surgical Interventions
Finally, once they are in a stable condition, the patient will meet with a surgeon on what to do next. Surgery is often recommended for a number of reasons. The patient may require the removal of bone fragments or foreign objects near the spine. Blood clots or tumors might have formed and need to be removed. The vertebrae cold be fractured or need realigning. However, if the vertebrae appears to be unstable, a spinal fusion using metal plates or rods might be performed.
For more information on Spinal Cord Injuries, we encourage you to use the Christopher & Dana Reeve Foundation Paralysis Resource Center. To learn how Dobson Healthcare can provide staffing or care for a loved on with a Spinal Cord Injury, please call 866-866-8984.
“Emergency Management.” Christopher & Dana Reeve Foundation.
“Spinal Cord Injury Treatment.” Brain and Spinal Cord Injury Rehabilitation.
“Spinal Cord Injury Types.” Christopher & Dana Reeve Foundation.
Figure 1: Nordic Valley Ski Resort. (2015). Risks of Skiing. Retrieved January 13, 2016
On October 9th, 2010 Dobson was an exhibitor at the Spinal Cord Injury Symposium, sponsored by Mary Freebed Rehabilitation Hospital and held in Grand Rapids, Michigan.