Frequently Asked Questions (FAQ's) about Spinal Cord Injury (SCI)
- What is Spinal Cord Injury?
- What are the spinal cord and the vertebra?
- What are paraplegia, quadriplegia, and tetraplegia?
- What is the significance of the "level of injury"?
- What are "complete" and "incomplete" injuries?
- Is there a cure for SCI?
- Do people with SCI ever get better?
- Does SCI always necessitate a wheelchair?
- Do people with SCI die sooner?
- Do people with SCI work?
- How does SCI affect sexuality and fertility?
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 or feeling. The spinal cord does not have to be severed in order for a loss of functioning to occur. In fact, most people with SCI have an intact spinal cord, but damage to it has resulted in loss of functioning.
Car accidents, gunshot wounds, and falls are the most frequent causes of traumatic SCI.
Atraumatic spinal cord injuries include
- Aortic aneurysms and related surgery
- Tumors, both spinal and those that have metastasized from elsewhere
- Complications from high dose radiation used to treat lung and breast cancers
- Infections (such as tuberculosis, polio, AIDS)
What are the spinal cord and the vertebra?
The body has several nervous systems.
- Central Nervous System: The brain and the spinal cord.
- Peripheral Nervous System: The motor and sensory nerves outside the central nervous system.
- Sympathetic and Parasympathetic Nervous Systems: A diffuse system of nerves that control involuntary functions such as blood pressure and temperature regulation.
Within the Central Nervous System, the spinal cord is the major nerve bundle that carries impulses to and from the brain to the rest of the body. It is surrounded by rings of bone called vertebra. Vertebra constitute the spinal column (back bones). In general, the higher in the spinal column the injury occurs, the more dysfunction a person will experience.
The vertebra are named and numbered according to their location.
- Cervical Vertebra: The eight vertebra in the neck. The top vertebra is called C-1, the next is C-2, etc.
- Thoracic Vertebra: The twelve vertebra in the chest. The first thoracic vertebra, T-1, is the vertebra where the top rib attaches.
- Lumbar Vertebra: The vertebra in the lower back-between the thoracic vertebra, where the ribs attach, and the pelvis (hip bone).
- Sacral Vertebra: The vertebra from the pelvis to the end of the spinal column.
What are paraplegia, quadriplegia, and tetraplegia?
Paraplegia is paralysis from approximately the waist down.
Quadriplegia, or tetraplegia, is paralysis from approximately the shoulders down. Slightly more than half of spinal cord injuries result in quadriplegia. After age 45, the proportion increases markedly. It has been reported that 92% of all sports injuries result in quadriplegia.
What is the significance of the "level of injury"?
The level of injury is very helpful in predicting what parts of the body might be affected by paralysis and loss of function. (In incomplete injuries, there will be some variation in the following prognoses)
- Cervical (neck) injuries usually result in quadriplegia.
- Injuries above the C-4 level may require a ventilator for the person to breathe.
- C-5 injuries often result in shoulder and biceps control, but no control at the wrist or hand.
- C-6 injuries generally yield wrist control, but no hand function.
- C-7 and T-1 injuries often mean the person can straighten their arms but might still have dexterity problems with the hand and fingers.
- Injuries at the Thoracic level and below result in paraplegia, with the hands not affected.
- At T-1 to T-8 there is most often control of the hands, but poor trunk control as the result of lack of abdominal muscle control.
- Lower T-injuries (T-9 to T-12) allow good trunk control and good abdominal muscle control. Sitting balance is very good
- Lumbar and Sacral injuries yield decreasing control of the hip flexors and legs.
Individuals with SCI may experience dysfunction of the bowel and bladder. Sexual functioning is frequently affected: men with SCI may have their fertility affected, while women's fertility is generally not affected.
Very high injuries (C-1, C-2) can result in loss of many involuntary functions including the ability to breathe, necessitating breathing aids such as mechanical ventilators or diaphragmatic pacemakers. Other effects of SCI may include low blood pressure, inability to regulate blood pressure effectively, reduced control of body temperature, inability to sweat below the level of injury, and chronic pain.
What are "complete" and "incomplete" injuries?
SCI can be divided into two types of injury: complete and incomplete.
A complete injury means that there is no function below the level of the injury—no sensation and no voluntary movement. Both sides of the body are equally affected.
An incomplete injury means that there is some functioning below the primary level of the injury. A person with an incomplete injury may be able to move one limb more than another, may be able to feel parts of the body that cannot be moved, or may have more functioning on one side of the body than the other. With the advances in acute treatment of SCI, incomplete injuries are becoming more common.
Is there a cure for SCI?
Currently there is no cure for SCI, but there have been advances in the lab. The most exciting 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.
Do people with SCI ever get better?
There is usually swelling of the spinal cord when SCI occurs, and the swelling can cause changes in virtually every system in the body. As the swelling begins to subside after days or weeks, people may regain some functioning.
The improvement that most people experience is that, within a year, their "level of injury" descends at least one level and sometimes two. This is more likely if they received methylprednisolone after injury.
With many injuries, especially incomplete injuries, the individual may recover some functioning as late as 18 months after the injury. In very rare cases, people with SCI will regain some functioning years after the injury. However, only a very small fraction of individuals sustaining SCIs recover all functioning.
Does SCI always necessitate a wheelchair?
No. First of all, wheelchairs are simply a tool for mobility, so no one is "wheelchair bound." People who use wheelchairs do many of their activities out of the chair, such as driving, swimming, gardening, skiing, or sleeping.
High C-level injuries usually require the individual to use a power wheelchair. Injuries at or below the low C-level usually allow use of a manual chair. Advantages of manual chairs are that they cost less, weigh less, disassemble into smaller pieces, and are more agile. However, for the person who needs a powerchair, the independence afforded by them is worth the limitations.
Some people are able to use braces and crutches for ambulation. These methods of mobility do not mean that the person will never use a wheelchair. Many people who use braces still find wheelchairs more useful for longer distances. However, the therapeutic and activity levels allowed by standing or walking briefly may make braces a reasonable alternative for some people.
Do people with SCI die sooner?
Yes. Before World War II, most people with SCI died within weeks of their injury due to urinary dysfunction, respiratory infection, or bedsores. Now antibiotics, materials such as plastics and latex, and better procedures for dealing with the everyday issues of living with SCI enable many people to approach the lifespan of non-disabled individuals.
Other than level of injury, the type of rehab facility used is the greatest indicator of long-term survival. This highlights the importance of going to a facility that specializes in SCI.
People who use ventilators are at some risk of dying from pneumonia or respiratory infection, but technology is improving that. Pressure sores are another common cause of hospitalization, and if not treated, death.
Do people with SCI work?
Statistics show that by 8-10 years after injury, roughly one-third of paraplegic persons and one-fourth of tetraplegic persons are working.
People who return to work in the first year after injury are usually returning to the same job for the same employer. People who return to work after the first year post-injury tend to be those who go to work for a different employer or those who were students that found work.
The Americans with Disabilities Act (ADA) promotes the mainstream inclusion of people with SCI. People with disabilities may need some changes to their workplace, but surveys indicate that in 70% of cases, the cost of making accommodations is $500 or less.
For more information on working with an injury, please refer to the following:
- Vocational goals
- Trial work periods
- Legislation affecting vocational rehabilitation
- Legislation affecting employment
How does SCI affect sexuality and fertility?
Although SCI frequently affects sexual functioning, there are many therapies that allow people with SCI to have an active and satisfying sex life. In general, experts encourage each person to determine his/her level of function by learning how their own body and mind react in certain situations. Complete and open communication and exploration between partners is recommended.
Fertility is frequently affected in men with SCI. There are two causes of this infertility: poor semen quality and ejaculatory dysfunction. The problem with ejaculatory dysfunction has largely been solved with use of electroejaculation. However, poor semen quality, particularly sperm motility, is an unresolved problem. It is generally accepted that a significant number of SCI men have abnormalities of spermatogenesis as well.
Methods similar to those used for non-disabled men with fertility problems have allowed many men with SCI to father their own children. Adoption is another option.
The fertility of women with SCI may be affected in the first months after injury. However, most women regain the ability to become pregnant. Many women with SCI are able to carry babies to full term. It is very important that these women consult a physician experienced in SCI.
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