Spinal cord injury, spinal injury, acute spinal cord injuries, and their effects on the brain and body

Medical professionals define a spinal cord injury as an injury to the spinal cord or its immediate surroundings. Unlike spinal injuries, such as a vertebral fracture, spinal cord injuries are often irreversible, depending on their severity, and lead to paralysis.

The spinal cord acts as the communication link between the brain and other organs of the body @ bilderzwerg /AdobeStock

Depending on the severity and extent of the spinal cord injury, three stages are distinguished:

1. Spinal Concussion (Commotio spinalis)
2. Spinal contusion (Contusio spinalis)
3. Spinal cord compression (Compressio spinalis)

• Spinal Concussion

Spinal concussion is the “simplest” form of spinal cord injury. A force applied to the spine and spinal cord results in a temporary (reversible) disruption of nerve conduction.

A characteristic feature of spinal concussion is that functional deficits occur without any detectable changes on imaging studies. The exact nature of the functional deficits depends on the severity and location of the spinal cord injury.

The following symptoms may occur for up to 48 hours:

• Sensory disturbances
• Bladder dysfunction
• Reflex disturbances

However, none of these are accompanied by signs of paralysis.

• Spinal Contusion

Unlike the aforementioned spinal cord concussion, a spinal cord contusion is an irreversible spinal cord injury. The force involved is stronger and more direct than in the case of a spinal cord concussion.

This leads to contusion or bruising of the spinal cord, hence the name “spinal cord contusion.” In addition, bleeding or edema may also occur. Depending on the severity, symptoms range from mild motor and sensory nerve deficits to partial or complete paraplegia.

• Spinal Cord Contusion

Spinal cord contusion is the most severe form of spinal cord injury. It usually occurs after direct pressure is applied to the spinal cord. Such pressure can result, for example, from an accident, or from vertebral fragments, hematomas (bleeding), herniated discs, or tumors.

Acute spinal cord contusions often lead to:

• Symptoms of neurological deficit
• Neurological deficits as well as
• Continence disorders

In contrast, subacute or chronic cases are primarily characterized by back pain. A spine that is tender to percussion may also indicate tumors or hematomas in the area of the spinal cord.

Doctors make a presumptive diagnosis of a spinal cord injury based on the symptoms.

The following symptoms typically occur:

• Sensory disturbances
• Nerve deficits
• Pain, as well as
• signs of paralysis

These are often detected during a neurological examination. To confirm the diagnosis, the doctor usually performs a magnetic resonance imaging (MRI) scan. This allows for the visualization of soft tissues, such as nerves and the spinal cord, in cross-sectional images. An X-ray may also be necessary to rule out fractures following an accident.

To rule out other causes of nerve deficits, such as infections or meningitis, a lumbar puncture may be recommended. During this procedure, doctors withdraw spinal fluid (cerebrospinal fluid or CSF) for laboratory analysis.

X-ray of the spinal cord @ Anastasiia /AdobeStock

What treatment options are available for spinal cord injuries?

Treatment options for a spinal cord injury depend primarily on its severity. A spinal cord concussion, for example, primarily requires plenty of rest and physical conservation.

In contrast, the effects of a spinal cord contusion are not always reversible. Doctors treat only the associated symptoms—such as edema, cysts, vertebral fractures, or herniated discs—either conservatively or surgically. The goal is to reduce pressure on the spinal nerves.

If the compression did not last too long, the nerve pathways can regenerate, and sensation and mobility can return.

In contrast, partial paralysis—or even complete paraplegia—cannot be cured with current medical methods. However, various assistive devices, physical therapy, and exercise programs enable those affected to lead relatively independent lives.

Prognosis for Spinal Cord Injury

The prognosis is closely linked to the type of spinal cord injury. For example, a spinal cord concussion has a good prognosis. With rest, the damage is reversible within a few days to weeks.

On the other hand, spinal cord contusion tends to have a poor prognosis. This condition leads to irreversible damage to the spinal cord that cannot be cured with current medical treatments. Patients are often dependent on assistance and, depending on the extent of their paralysis, may also need to use a wheelchair. As a result, their health often deteriorates further, as muscle groups are no longer sufficiently exercised and atrophy. Added to this are psychological problems, such as depression, as well as difficulties in social interactions and within their circle of friends.

Through appropriate physical therapy and as individuals come to terms with their situation, their living conditions and quality of life improve. It is possible to lead a fulfilling life with this condition.

Studies show that maintaining an optimistic outlook on life despite these limitations improves quality of life even with paraplegia.

Which doctors treat spinal cord injuries?

Since spinal cord injuries very often occur in connection with accidents, emergency physicians are the first experts on the scene.

In addition, depending on the type and severity of the neurological deficits, the following specialists may be involved:

• Neurologists
• Neurosurgeons or
• Specialists in general surgery

Conclusion

A spinal cord injury represents a severe acute impairment, as the spinal cord—as part of the central nervous system—transmits signals between the brain and the body; worldwide, approximately 500,000 people suffer a spinal cord injury, often as a result of car accidents, falls, or acts of violence.

Depending on the severity, the level of the lesion—for example, at Th6 or in the cervical spine—as well as compression of the spinal cord or damage to the spinal canal, this can lead to paraplegia, paralysis, loss of motor function, limited control of the trunk and legs, bladder and bowel function, and sexual function—though incomplete injuries often still allow for some residual function.

During the acute phase, immobilization is typically performed, along with surgical intervention if necessary, to stabilize the spine and prevent further damage to the spinal cord or vertebrae, as untreated compression—even in cases of non-traumatic causes or osteoporosis—can exacerbate the loss of function.

The pathophysiology distinguishes traumatic spinal cord injuries from non-traumatic forms; depending on the severity, the location below the injury, and the extent of neurological impairment, the prognosis, ability to walk, and muscle function can vary greatly.

In the early phase, physical therapy, physiotherapeutic interventions, psychological support, as well as counseling and assistance from social workers and nutritionists are essential—often accompanied by a referral to a rehabilitation clinic to promote mobility, trunk control, and motor and sensory functions below the injury as much as possible.

Recovery depends on many factors and is partially reversible, particularly in cases of incomplete injury; however, further damage, limited independence in the home environment, impacts on leisure activities, etc., as well as the long-term prognosis, require individualized, interdisciplinary treatment extending over hours to days.