Spinal cord injury refers to any damage to the spinal cord, whether from trauma, disease, or a degenerative disorder. The spinal cord is a bundle of nerves that transmits messages between the brain and the rest of the body. It is protected by the spinal column, consisting of cervical, thoracic, lumbar, sacral and coccygeal vertebrae. Thirty-one pairs of spinal nerves emerge segmentally from the spinal cord and extend to the various parts of the body.
After a spinal cord injury, nerves above the level of injury keep working as they did before. But below the level of injury, messages from the brain to the body may become fully or partially blocked. The higher the level at which the spinal cord damage occurs, the greater the degree of impairment. For example, injuries to the upper cervical region can result in respiratory, arm, leg, bowel, bladder, and sexual function loss. In contrast, people with thoracic injuries and lower may retain full use of their arms and hands.
Every year approximately 17,700 Americans acquire a spinal cord injury. Roughly 78% are men, and their average age is 43. Most spinal cord injuries happen as a result of a vehicle accident (39.3%), followed closely by falls (31.8%), trailed by violence (13.2%), sports (8%), and medical/surgery (4.3%). For more information on the spinal cord, see the Model Systems of Knowledge Translation Center’s factsheet, Understanding SCI Part I: The Body Before & After Injury.
Common Secondary Health Complications
Depression is common in the spinal cord injury population, affecting up to 37% of people with SCI. It is important to get help from a qualified mental health professional knowledgeable about physical disability.
Chronic pain can also negatively impact the quality of life of many people with SCI. It is often related to nerve damage or musculoskeletal problems after SCI. Treatments range from medications such as gabapentin and pregabalin to meditation techniques.
People with SCI are at high risk for developing pressure injuries. These occur when underlying tissue becomes damaged due to loss of blood flow to the area. Eventually, this damage breaches the skin. Up to 80% of people with SCI will have a pressure sore during their lifetime, and 30% will have more than one. Do regular skin checks and shift your weight regularly to help avoid these.
About 65%–78% of the SCI population have some amount of spasticity, or the uncontrolled tightening or contracting of the muscles. SCI disrupts the normal flow of signals from the spinal cord, and the messages do not reach the brain. Instead, the signals are sent back to the motor cells in the spinal cord and cause a reflex muscle spasm. This misfire can result in a twitch, jerk or stiffening of the muscle. Many find relief in medications such as baclofen and stretching exercises.
Spinal cord injury can also change bowel and bladder function, impacting the ability to voluntarily empty the bowels and bladder. Some complications associated with neurogenic bowel include constipation and impaction, incontinence, nausea, bloating, and autonomic dysreflexia (a potentially dangerous spike in blood pressure). SCI may also impair voluntary control over bladder emptying, and the bladder may become overactive or retain urine. Uncontrolled bladder contractions or urinary retention can lead to urinary tract infection, a frequent complication of SCI. There are several bowel and bladder management options following SCI, each with advantages and disadvantages.
Depending on the level of injury, respiratory issues may also occur. There may be loss or weakness of diaphragm function for those with high cervical injuries that may require a tracheostomy or a ventilator. Individuals with injuries to the lumbar region may also have some impairment of respiratory function. Abdominal and intercostal muscles are involved with respiratory function. There may be impairment of respiratory function for those with cervical or thoracic injuries due to some degree of abdominal muscles and intercostal muscle paralysis. The impact on respiratory function depends on the location and extent of spinal cord damage. No matter your level of injury, regular exercise can help preserve or increase lung function.
Sexuality after SCI can be impacted by changes in muscle function, including an altered sense of touch and changes in sexual reflexes. How these changes affect arousal, orgasm, and fertility depends on the level and completeness of injury. However, the brain controls pleasure and even orgasms. Although sex, arousal and intimacy may feel different after SCI, it can still be thrilling and fulfilling.
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