Spinal injuries

Most spinal cord injuries are caused by trauma, including from:

• motor vehicle or motor cycle crashes
• falls
• sport or recreational injuries
• acts of violence.

Some are caused by illness, such as an infection or tumour.

Around 200 spinal cord injuries happen in Aotearoa New Zealand each year.

Your spinal cord is the main pathway for nerve signals between your brain and the rest of your body. Damage to your spinal cord can disrupt:

• motor signals (these allow movement)
• sensory signals (these allow feelings of touch, pressure and pain)
• autonomic functions (these include bladder control and breathing control).

The symptoms you have after a spinal cord injury depend on:

• where on the spinal cord the injury happened
• how bad the injury is.

The lowest part of the spinal cord that is not damaged is known as the neurological level of the injury.

You can think of it as a 'road block' in the ability of your nerves to communicate with your body below this point.

If the injury happens higher up, more areas of your body might be affected. And lower down, fewer areas are likely to be affected.

Symptoms you might have include:

• loss of feeling (numbness) or tingling
• not feeling hot or cold
• loss of movement (paralysis) or power
• losing control of your bowel or bladder (incontinence)
• loss of sexual function
• pain in your neck or back
• problems with balance
• difficulty breathing if your injury is high up in your neck.

How types of injury and paralysis are described

The completeness of the injury refers to how much feeling, known as sensation, and movement is lost.

• Complete — if all feeling and all ability to control movement are lost below the spinal cord injury, the injury is called complete.
• Incomplete — if some feeling and control of movement remain below the affected area, the injury is called incomplete (there are varying degrees of incomplete injury).

Loss of feeling and control of movement is known as paralysis. Paralysis from a spinal cord injury can be also referred to as tetraplegia and paraplegia.

• Tetraplegia means the hands, arms, body, legs, bladder and bowel functions are all affected (it is sometimes called quadriplegia).
• Paraplegia means all or part of the body, legs, bladder and bowel functions are affected, but the arms and hands are not.

Tetraplegia is typically caused by injury to the cervical spinal cord (upper spine). Paraplegia results from damage to the thoracic, lumbar, or sacral regions of the spinal cord (mid to lower spinal cord).

If you have an accident and it is suspected you have a spinal cord injury, you will be taken to a hospital emergency department.

At the hospital, they will check:

• your breathing
• your muscle tone
• your strength
• your reflexes
• whether you can feel being touched.

You will then likely need x-rays, a CT scan or an MRI scan.

Scans and x-rays

These tests will help confirm your injury and the position of the injury in your spine.

The treatment of a spinal cord injury depends on what kind of injury you have and what part of your spine it is in (the level of the injury).

With the right help, most people with a spinal cord injury can lead full and independent lives.

Immediate treatment

This involves keeping still and not allowing any movement of the spine. Braces or surgery may be needed to keep the injured part from moving and to prevent further injury.

If your chest and stomach muscles have been affected it can be hard to breathe and cough. You may have chest physiotherapy and learn how to keep your lungs clear of mucus.

Depending on your injury, you may need to wear an abdominal binder (like a supportive belt) around your tummy. This is to to help with your breathing, your blood pressure or both.

Rehabilitation

Rehabilitation is different for each person and depends on the injury. It may involve working with a: 

• physiotherapist
• occupational therapist
• speech-language therapist
• psychologist or counsellor
• dietitian.

Rehabilitation can take a long time. Rehabilitation goals will be personal and depend on your symptoms, function and what is most important to you. Rehabilitation may aim to help you regain:

• communication skills
• movement and strength
• work and recreational skills.

Some people need to use aids for communication such as computers. Some people need mobility aids such as wheelchairs.

Long-term care

Long-term care is aimed at preventing and managing any complications that the injury can cause. Complications can happen any time after your injury, even years later and can include:

• depression
• infections such as a chest infection or a wee (urine) infection
• pain
• constipation
• loss of sexual function
• pressure sores
• muscle stiffness and spasms (spasticity)
• blood clots such as deep vein (leg) thrombosis or a pulmonary (lung) embolus
• respiratory (lung) problems
• autonomic dysreflexia — a potentially life-threatening sudden rise in blood pressure.

Your healthcare provider will be able to help with these issues.

Depending on the type and level of spinal injury, you may have lifelong challenges. You will need time to adjust to what may be a very different lifestyle.

Your hospital team will make sure you and your whānau are well educated about your injury and what to expect before you go home. 

Self care includes:

• maintaining a healthy lifestyle, including getting enough sleep and eating well
• maintaining links with friends, colleagues and the community
• making sure you have the equipment you need in your home and workplace — this will help with independence and with reducing your risk of infections and pressure sores
• knowing how often you need to change position in your bed or chair — if you have lost some sensation, you may not be able to feel when you have an injury to your skin or bones due to pressure sores, injuries or an infection
• being aware of early signs of a problem such as a fever or funny smelling wee.