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Archive for the ‘Spinal Cord Injury’ Category

Researchers compare direct gene vs. blood cell-mediated …

October 9, 2015 At the 30th postoperative day after conducting the BBB (Basso, Beattie and Bresnahan) behavioral test on the animals and morphometric studies on their spinal cord, equal positive locomotor recovery in rats was observed after both direct and cell-based GDNF therapy. Credit: Inna Basyrova

Spinal cord injury (SCI) leads to complex pathological changes that include the death of neurons and glial cells and degeneration of nerve fibers.

One promising approach for preventing neurodegeneration involves locally treating the site of injury. One such approach particularly suitable for SCI treatment is glial cell-derived neurotrophic factor (GDNF).

Previous studies of KFU researchers on direct gene therapy for spinal cord injuries indicated that the treatment resulted in the preservation of nervous tissue and functional recovery. Similarly, cell-based gene delivery has been shown to promote the growth of motor axons after partial and complete spinal cord transections.

The group of scientists from the Institute of Fundamental Medicine and Biology at Kazan Federal University developed special umbilical cord blood mononuclear cells, the main positive action of which was that they facilitated targeted delivery of the therapeutic molecules to motor neurons and thereby prolonged their survival. UCB-MCs have been used for gene delivery because of their suitability for low immunogenicity, accessibility and ease of production and storage, and because of the lack of legal, ethical and religious concerns related to using these cells.

A rat SCI model was used to examine the efficacy of the two methods.

At the 30th postoperative day after conducting the BBB (Basso, Beattie and Bresnahan) behavioral test on the animals and morphometric studies on their spinal cords, equal positive locomotor recovery in rats was observed after both direct and cell-based GDNF therapy.

Compared with direct gene injection, cell-mediated GDNF gene delivery led to considerably more pronounced preservation of myelinated fibers in the remote segments of the spinal cord (5 vs 3 mm from the epicenter), and this might depend on the expansion of the therapeutic influence in cell-mediated therapy over long distances as a result of the migration of the transplanted cells. UCB-MCs are suitable for cell therapy because they can potentially differentiate into not only blood cells, but also other types of cells such as myoblasts of heart and skeletal muscle tissues, hepatocytes, vascular endothelial cells, neurons, oligodendrocytes and astrocytes.

Transplantation of UCB-MCs is a promising strategy for enhancing posttraumatic spinal cord regeneration. Delivery of the GDNF gene into the site of injury holds considerable potential as a therapeutic intervention in SCI.

Explore further: Stem cell scarring aids recovery from spinal cord injury

More information: Y O Mukhamedshina et al. "Adenoviral vector carrying glial cell-derived neurotrophic factor for direct gene therapy in comparison with human umbilical cord blood cell-mediated therapy of spinal cord injury in rat," Spinal Cord (2015). DOI: 10.1038/sc.2015.161

Provided by: Kazan Federal University

In a new study, researchers at Karolinska Institutet in Sweden show that the scar tissue formed by stem cells after a spinal cord injury does not impair recovery; in fact, stem cell scarring confines the damage. The findings, ...

Delivering a single injection of a scar-busting gene therapy to the spinal cord of rats following injury promotes the survival of nerve cells and improves hind limb function within weeks, according to a study published April ...

Most research on spinal cord injuries has focused on effects due to spinal cord damage and scientists have neglected the effects on brain function. University of Maryland School of Medicine (UM SOM) researchers have found ...

New research from Uppsala University shows promising progress in the use of stem cells for treatment of spinal cord injury. The results, which are published in the scientific journal Scientific Reports, show that human stem ...

Researchers at the Hong Kong University of Science and Technology (HKUST) have found a way to stimulate the growth of axons, which may spell the dawn of a new beginning on chronic SCI treatments.

Researchers at Rush University Medical Center are exploring a new therapy using stem cells to treat spinal cord injuries within the first 14 to 30 days of injury. Rush is only the second center in the country currently studying ...

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For the first time, scientists can use skin samples from older patients to create brain cells without rolling back the youthfulness clock in the cells first. The new technique, which yields cells resembling those found in ...

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Neuro-Spinal Scaffold for Repair of Spinal Cord Injuries …

InVivo Therapeutics, a company in Cambridge, MA, is developing a new way to treat patients with acute thoracic spinal cord injuries, a patient population that has never had any viable therapeutic options for recovery. We caught up with Mr. Mark Perrin, CEO and Chairman of the Board of InVivo Therapeutics, who took over leadership of the company last year on a mission to fill that treatment void and become the leader in developing innovative products for spinal cord injury.

Rachel Kessler, Medgadget: I understand that the new treatment you are advocating could potentially change the standard of care for spinal cord injury (SCI) patients. What is this new treatment?

Mr. Perrin: The new treatment includes both a new surgical approach as well as the use of our Neuro-Spinal Scaffold. Following the injury, a myelotomy (surgical incision of the spinal cord) is performed to remove the liquefied necrotic material, which both reduces the pressure in the spinal cord and creates a cavity for our Neuro-Spinal Scaffold. The Neuro-Spinal Scaffold is a biomaterial based on proprietary technology developed by MIT professor Dr. Robert Langer. The Neuro-Spinal Scaffoldis surgically implanted at the epicenter of the wound. Once the scaffold is surgically implanted it is designed to act as a physical substrate to promote neural repair. Appositional healing to spare spinal cord tissue, decreased post-traumatic cyst formation, and decreased spinal cord tissue pressure have been demonstrated in preclinical models of spinal cord contusion injury. Further, the scaffold safely biodegrades within the body over the time course of weeks to months.

Medgadget: Tell us about the clinical study for acute spinal cord injuries. What is your development plan?

Mr. Perrin: We have enrolled five patients in our initial pilot trial, which was the original clinical plan approved by the FDA. Given our progress, we will continue to enroll patients under the Emergency Use Expanded Access Mechanism on a case-by-case basis, and the safety and outcomes data from these patients will be included in our application for approval. Furthermore, we have also filed an amendment with the FDA to expand the number of patients in the pilot trial. Finally, we are in discussions with the FDA regarding the transition to the pivotal probable benefit study, and our plan is to incorporate the pilot study patients and the Emergency Use patients into the pivotal probable benefit study. We expect to use this single study as the basis for our Humanitarian Device Exemption (HDE) application for product approval, which would allow us to dramatically reduce the time to approval and commercialization.

Medgadget: Sounds like this is showing great promise.

Mr. Perrin: Yes, the first three patients treated with the Neuro-Spinal Scaffold have already experienced significant improvement in motor, sensory, and bowel and/or bladder function. Severity of injuries are measured by specific classifications with complete paralysis being classified as AIS A, which indicates no motor or sensory function below the level of injury. The first of our treated patients with a lower thoracic injury went from AIS A to AIS C at one month, which happens in only about five percent of patients according to the large U.S. and European databases and indicates preserved motor and sensory function below the level of injury. Our third patient with a high thoracic injury went from AIS A to AIS B with preserved sensory function below the level of injury at one month which happens in only about four percent of patients. This is extremely promising as the probability for two out of three patients to make these AIS grade conversions is less than one percent. Our goal is to address the underlying pathology following acute SCI to develop treatment modalities that aim to preserve reversibly injured tissue, heal damaged tissue and ultimately restore function. So far, our initial clinical results are promising.

Medgadget: Whats in the future for InVivo?

Mr. Perrin: We are planning to initiate a clinical plan for cervical spinal cord injury patients with complete paralysis. Following that we plan to conduct a study in those patients with a spinal cord injury that results in partial or incomplete paralysis. Lastly, at the research stage, we are investigating the use of biomaterials with neural stem cells for the 275,000 chronic SCI patients.

For more information, please visit the companys ClinicalTrials.gov registration site:http://clinicaltrials.gov/ct2/show/study/NCT02138110

Link: InVivo Therapeutics homepage

Rachel Kessler

Rachel is a New York City-based writer and health advocate. She grew up in the newsroom, literally. Her parents were reporters at The Washington Post during the Watergate era, where newspaper ink was infused into her blood, like an I.V. She got her start at The Wall Street Journal and then wrote the news for WUSA-TV (Washington, DC/CBS). She later worked in the Brian Ross Unit, the investigative unit at ABC News. She has been writing about health, science and medical topics for many years on a gazillion topics and in almost every therapeutic area from arthritis and oncology to very rare diseases. She is a contributing writer at South Florida Opulence magazine, where the writing team just won First Place for Best Overall Writing/Consumer magazine. She also worked with the editors of US News + World Report on an almanac called The Practical Guide to Practically Everything, which was published by Random House. Rachel holds a B.A. degree in Political Science from Boston University and is a member of the Science Writers in New York (SWINY). Rachel loves discovering trends, clinical trials, inspiring patient stories, and anything new and completely amazing in the field of medicine, science, and health.

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Neuro-Spinal Scaffold for Repair of Spinal Cord Injuries ...

Spinal Cord Injury and Pain – WebMD

The spinal cord is the major bundle of nerves carrying nerve impulses to and from the brain to the rest of the body. Rings of bone, called vertebrae, surround the spinal cord. These bones constitute the spinal column or back bones.

Spinal cord injury can be direct trauma to the spinal cord itself or indirect damage to the bones, soft tissues, and blood vessels surrounding the spinal cord.

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Spinal cord damage results in a loss of function, such as mobility or feeling. In most people who have spinal cord injury, the spinal cord is not fully severed but is bruised or torn. Spinal cord injury is not the same as back injury, which may result from pinched nerves or ruptured disks. Even when a person sustains a break in a vertebra or vertebrae, there may not be any spinal cord injury if the spinal cord itself is not affected.

Spinal cord injuries may result from falls, diseases like polio or spina bifida (a disorder involving incomplete development of the brain, spinal cord, and/or their protective coverings), motor vehicle accidents, sports injuries, industrial accidents, gunshots and physical assaults, among other causes. If the spine is weak because of another condition, such as arthritis, minor injuries can cause spinal cord trauma.

There are two kinds of spinal cord injury -- complete and incomplete. In a complete injury, a person loses all ability to feel and voluntarily move below the level of the injury. In an incomplete injury, there is some functioning below the level of the injury.

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Spinal Cord Injury and Pain - WebMD

Taunton doctor plans Spinal Cord Injury Awareness Day at …

12,500 Approximate number of new spinal cord injury cases in the U.S. each year.

276,000 Estimated number of people in the U.S. living with spinal cord injury in 2014.

$4,724,181 Estimated total lifetime medical costs for someone who suffered the most severe type of SCI injury at age 25.

$2,596,329 The estimated total lifetime medical costs for someone who suffered the most severe type of SCI injury at age 50.

30 Percentage of SCI injuries caused by vehicle crashes, the leading cause of SCI crashes since 2010.

11 Average number of days in acute care treatment centers for people who suffered SCI.

36 Average number of days in rehabilitation for SCI injury patients.

42 Average age of injury for people with SCI in the U.S.

80 Percentage of people with SCI who are male.

23 The disproportionate percentage of SCI injuries that occur among black people, who only make up 12 percent of the general population.

Source: National SCI Statistical Center

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Taunton doctor plans Spinal Cord Injury Awareness Day at ...

What Is Spinal Cord Trauma? – Spinal Cord Injury …

Injury to the spinal cord is a medical emergency that may result in severe and permanent disability. The spinal cordwhich along with the brain comprises the central nervous systemis a bundle of nerve cells that travels almost the entire length of the spine, connecting the brain to the nerves in the rest of the body.

The vertebrae, the small bones that make up the spine, form a bony tunnel that surrounds the cord and protects it from injury. However, if a blow is severe enough, or if the bones are weakened by disease, the spinal cord is vulnerable to damage.

Destroyed nerve cells cannot regenerate; injury to the spinal cord may thus result in permanent paralysis of the legs (paraplegia) or, in the case of a neck injury, the arms, torso and legs (quadriplegia). About half of the cases of spinal cord injury involve the neck.

However, partial or complete recovery may be expected in cases when neurons in the spinal cord have been traumatized but not completely destroyed. Outcome thus depends upon both the severity and the specific location of the injury. Damage to the spinal cord will affect nerves at the level of the injury and below.

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Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference

Simeon Margolis, M.D., Ph.D., Medical Editor

Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50

Updated by Remedy Health Media

Publication Review By: the Editorial Staff at HealthCommunities.com

Published: 24 Aug 2011

Last Modified: 22 Jul 2015

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What Is Spinal Cord Trauma? - Spinal Cord Injury ...

Spinal Cord Injury Rehabilitation | BrainAndSpinalCord.org

Treatment for spinal cord injuries can be divided into to two stages: acute and rehabilitation. The acute phase begins at the time of injury, and lasts until the person is stabilized. The rehabilitation phase begins as soon as the person has stabilized and is ready to begin working toward his or her independence.

During the acute phase, it is very important that the person receive prompt medical care. The faster the person accesses treatment, the better his or her chances are at having the least amount of impairment possible. In most cases, like in the all too common suv rollover, the injured person will be sent to the closest hospital or center equipped to deal with spinal cord injuries.

The first few days of the acute stage are accompanied by spinal shock, in which the persons reflexes dont work. During this stage, its very difficult to determine an exact prognosis, as some function beyond what is currently being seen may occur later. At this stage other complications from the accident or injury will also be present, such as brain injury, broken bones, or bruising.

Once the acute phase is over and the person has been stabilized, he or she enters the rehabilitation stage of treatment. Treatment during this phase has the goal of returning as much function as possible to the person. Because all spinal cord injuries are different, a unique plan designed to help the person function and succeed in everyday life is designed. The plan often includes:

In most cases, rehabilitation occurs at an approved and accredited spinal cord injury treatment center.

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Spinal Cord Injury Rehabilitation | BrainAndSpinalCord.org

Spinal Cord Injury – Spinal Cord Injury – Paralysis Resource …

Spinal cord injury involves damage to the nerves within the spinal canal; most SCIs are caused by trauma to the vertebral column, thereby affecting the spinal cord's ability to send and receive messages from the brain to the body's systems that control sensory, motor and autonomic function below the level of injury.

The spinal cord and the brain together make up the central nervous system (CNS). The spinal cord coordinates the body's movement and sensation.

The spinal cord includes neurons and long nerve fibers called axons. Axons in the spinal cord carry signals downward from the brain (along descending pathways) and upward toward the brain (along ascending pathways). Many axons in these pathways are covered by sheaths of an insulating substance called myelin, which gives them a whitish appearance; therefore, the region in which they lie is called "white matter."

The nerve cells themselves, with their tree-like branches called dendrites that receive signals from other nerve cells, make up "gray matter." This gray matter lies in a butterfly-shaped region in the center of the spinal cord.

Like the brain, the spinal cord is enclosed in three membranes (meninges): the pia mater, the innermost layer; the arachnoid, a delicate middle layer; and the dura mater, which is a tougher outer layer.

The spinal cord is organized into segments along its length. Nerves from each segment connect to specific regions of the body. The segments in the neck, or cervical region, referred to as C1 through C8, control signals to the neck, arms, and hands.

Those in the thoracic or upper back region (T1 through T12) relay signals to the torso and some parts of the arms. Those in the lumbar or mid-back region just below the ribs (L1 through L5) control signals to the hips and legs.

Finally, the sacral segments (S1 through S5) lie just below the lumbar segments in the mid-back and control signals to the groin, toes, and some parts of the legs. The effects of spinal cord injury at different segments along the spine reflect this organization.

Several types of cells carry out spinal cord functions. Large motor neurons have long axons that control skeletal muscles in the neck, torso, and limbs. Sensory neurons called dorsal root ganglion cells, whose axons form the nerves that carry information from the body into the spinal cord, are found immediately outside the spinal cord. Spinal interneurons, which lie completely within the spinal cord, help integrate sensory information and generate coordinated signals that control muscles.

Glia, or supporting cells, far outnumber neurons in the brain and spinal cord and perform many essential functions. One type of glial cell, the oligodendrocyte, creates the myelin sheaths that insulate axons and improve the speed and reliability of nerve signal transmission. Other glia enclose the spinal cord like the rim and spokes of a wheel, providing compartments for the ascending and descending nerve fiber tracts.

Astrocytes, large star-shaped glial cells, regulate the composition of the fluids that surround nerve cells. Some of these cells also form scar tissue after injury. Smaller cells called microglia also become activated in response to injury and help clean up waste products. All of these glial cells produce substances that support neuron survival and influence axon growth. However, these cells may also impede recovery following injury.

After injury, nerve cells, or neurons, of the peripheral nervous system (PNS), which carry signals to the limbs, torso, and other parts of the body, are able to repair themselves. Injured nerves in the CNS, however, are not able to regenerate.

Nerve cells of the brain and spinal cord respond to trauma and damage differently than most other cells of the body, including those in the PNS. The brain and spinal cord are confined within bony cavities that protect them, but this also renders them vulnerable to compression damage caused by swelling or forceful injury. Cells of the CNS have a very high rate of metabolism and rely upon blood glucose for energy these cells require a full blood supply for healthy functioning. CNS cells are particularly vulnerable to reductions in blood flow (ischemia).

Other unique features of the CNS are the "blood-brain-barrier" and the "blood-spinal-cord barrier." These barriers, formed by cells lining blood vessels in the CNS, protect nerve cells by restricting entry of potentially harmful substances and cells of the immune system. Trauma may compromise these barriers, perhaps contributing to further damage in the brain and spinal cord. The blood-spinal-cord barrier also prevents entry of some potentially therapeutic drugs.

Finally, in the brain and spinal cord, the glia and the extracellular matrix (the material that surrounds cells) differ from those in peripheral nerves. Each of these differences between the PNS and CNS contributes to their different responses to injury.

Complete vs. Incomplete What is the difference between a "complete injury" and a "incomplete injury?" Persons with an incomplete injury have some spared sensory or motor function below the level of injury the spinal cord was not totally damaged or disrupted. In a complete injury, nerve damage obstructs every signal coming from the brain to the body parts below the injury.

While there's almost always hope of recovering function after a spinal cord injury, it is generally true that people with incomplete injuries have a better chance of getting some return.

In a large study of all new spinal cord injuries in Colorado, reported by Craig Hospital, only one in seven of those who were completely paralyzed immediately after injury got a significant amount of movement back. But, of those who still had some movement in their legs immediately after injury, three out of four got significantly better.

About 2/3 of those with neck injuries who can feel the sharpness of a pin-stick in their legs eventually get enough muscle strength to be able to walk. Of those with neck injuries who can only feel light touch, about 1 in 8 may eventually walk.

The sooner muscles start working again, the better the chances are of additional recovery. But when muscles come back later - after the first several weeks - they are more likely to be in the arms than in the legs.

As long as there is some improvement and additional muscles recovering function, the chances are better that more improvement is possible.

The longer there is no improvement, the lower the odds it will start to happen on its own.

Statistics Approximately 1,275,000 people in the United States have sustained traumatic spinal cord injuries. Males account for 61 percent of all SCIs and females 39 percent.

For more statistics about spinal cord injury and paralysis read: One Degree of Separation -- Paralysis and Spinal Cord Injury in the United States.

Research and cures Currently, there is no cure for spinal cord injuries. However, ongoing research to test surgical and drug therapies is progressing rapidly. Injury progression prevention drug treatments, decompression surgery, nerve cell transplantation, nerve regeneration, and complex drug therapies are all being examined as a means to overcome the effects of spinal cord injury.

Source: American Association of Neurological Surgeons, Craig Hospital, Christopher and Dana ReeveFoundation, The National Institute of Neurological Disorders and Stroke

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spinal cord injury – The New York Times

Back to TopCauses

The spinal cord contains the nerves that carry messages between your brain and body. The cord passes through your neck and back.

Spinal cord trauma can be caused by injuries to the spine, such as:

A minor injury can damage the spinal cord if the spine is weakened, such as from rheumatoid arthritis or osteoporosis. Injury can also occur if the spinal canal protecting the spinal cord has become too narrow (spinal stenosis) due to the normal aging process.

Direct injury, such as bruises, can occur to the spinal cord if the bones or disks have been weakened. Fragments of bone (such as from broken vertebrae, which are the spine bones) or fragments of metal (such as from a traffic accident or gunshot) can damage the spinal cord.

Direct damage can occur if the spinal cord is pulled, pressed sideways, or compressed. This may occur if the head, neck, or backis twisted abnormally during an accident or intense chiropractic manipulation.

Bleeding, fluid buildup, and swelling can occur inside or outside the spinal cord (but within the spinal canal). Thebuildup of blood or fluid canpress onthe spinal cord and damage it.

Most spinal cord trauma happens to young, healthy individuals. Men ages 15to 35 are mostoften affected. The death rate tends to be higher in young children with spinal injuries.

Risk factors include:

Older people with weakenedbones (from osteoporosis) or persons with other medical problems (such as stroke) that make them more likely to fallmay also have spinal cord injury.

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spinal cord injury - The New York Times

CDC – Publications – Injuries – Spinal Cord – HRQOL

Injuries Spinal Cord

Brotherton SS, Krause JS, Nietert PJ. A pilot study of factors associated with falls in individuals with incomplete spinal cord injury. J Spinal Cord Med. 2007;30(3):243-250. abstract html

Krause JS, Broderick LE, Saladin LK, Broyles J. Racial disparities in health outcomes after spinal cord injury: mediating effects of education and income. J Spinal Cord Med 2006;29(1):1725. abstract

LaVela SL, Weaver FM, Goldstein B, Chen K, Miskevics S, Rajan S, Gater DR. Diabetes mellitus in individuals with spinal cord injury or disorder. J Spinal Cord Med 2006;29(4):387395. abstract

Lavela SL, Weaver FM, Smith B, Chen K. Disease prevalence and use of preventive services: comparison of female veterans in general and those with spinal cord injuries and disorders. J Womens Health 2006;15(3):301311. abstract

Krause JS, Broderick L. Outcomes after spinal cord injury: comparisons as a function of gender and race and ethnicity. Arch Phys Med Rehabil 2004;85(3):355362. abstract

Houlihan BV, Drainoni ML, Warner G, Nesathurai S, Wierbicky J, Williams S. The impact of Internet access for people with spinal cord injuries: a descriptive analysis of a pilot study. Disabil Rehabil 2003;25(8):422431. abstract

Krause JS, Coker JL, Charlifue S, Whiteneck GG. Health outcomes among American Indians with spinal cord injury. Arch Phys Med Rehabil 2000;81(7):9241. abstract

Andresen EM, Fouts BS, Romeis JC, Brownson CA. Performance of health-related quality of life instruments in a spinal cord injured population. Archives of Physical Medicine and Rehabilitation 1999;80:877884. abstract

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Spinal Cord Injury: Treatments and Rehabilitation Symptoms …

What are the causes of spinal cord injury?

The most common cause of spinal cord injury is trauma. Nearly half of the injuries are caused by motor vehicle accidents. Other types of trauma include:

Spinal cord injury can also be caused by compression of the cord by a tumor, infection, or inflammation. Some patients have a smaller than normal spinal canal (called spinal stenosis) and are at a higher risk of injury to the spinal cord.

All tissues in your body including the spinal cord require a good blood supply to deliver oxygen and other nutrients. Failure of this blood supply to the spinal cord can cause spinal cord injury. This can be caused by an aneurysm (ballooning of a blood vessel), compression of a blood vessel or a prolonged drop in blood pressure.

The symptoms of spinal cord injury depend on where the spinal cord is injured and whether or not the injury is complete or incomplete. In incomplete injuries, patients have some remaining function of their bodies below the level of injury, while in complete injuries they have no function below the level of injury.

Injuries to the spinal cord can cause weakness or complete loss of muscle function and loss of sensation in the body below the level of injury, loss of control of the bowels and bladder, and loss of normal sexual function. Spinal cord injuries in the upper neck can cause difficulty breathing and may require the use of a breathing machine, or ventilator.

Medically Reviewed by a Doctor on 6/4/2015

Spinal Cord Injury - Causes Question: What was the cause of your spinal cord injury?

Spinal Cord Injury - Symptoms Question: What were the symptoms associated with your spinal cord injury?

Spinal Cord Injury - Treatment Question: What was the treatment for your spinal cord injury?

Spinal Cord Injury - Prognosis Question: hat is your spinal cord injury prognosis?

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Spinal Cord Injury: Treatments and Rehabilitation Symptoms ...

Spinal Cord Injury Center – Treatments, Research …

A spinal cord injury (SCI) involves damage to the spinal cord and nerve roots. Car accidents, falls, violent acts, and non-traumatic disorders can injure the spinal cord. SCI temporarily or permanently stops or alters the ability of the brain to communicate with other parts of the body.

Paralysis is a common outcome (temporary or permanent). However, spinal cord injury involves much more than damage to the spinal cord. After the primary injury, a cascade of secondary events can occur, such as inflammation, that can amplify the effects of the injury. Those secondary events can also cause pain or other symptoms. Currently, there is intense research interest in this secondary response to injury.

The National Spinal Cord Injury Statistical Center reported approximately 12,000 new cases of SCI occur each year in the United States. However, since incident studies have not been conducted since the 1990s, it is not known if this number has changed.1

Facts about Spinal Cord Injury

The severity of a spinal cord injury depends on where the spinal cord is damaged and if the injury is complete or incomplete.

Complete SCI

Incomplete SCI

There are different types of incomplete spinal cord injury. Included are: anterior cord syndrome, central cord syndrome, and Brown-Squard syndrome.

Anterior Cord Syndrome The anterior spinal cord is the front section. Symptoms may be caused when this part of the cord is compressed by a bone fragment or when there is insufficient blood supply. Symptoms include functional (motor skills) and sensory loss (i.e., light touch, pinprick) below the injury level.2

Central Cord Syndrome The central spinal cord is the middle area. These nerve fibers are large and exchange information between the spinal cord and the cerebral cortex (gray matter in the brain). The cerebral cortex is important to personality, interpreting sensation (feeling), and movement (motor function). The central spinal cord is important for hand and arm function, such as fine motor control (e.g., writing), although the lower body can be affected (e.g., loss of bladder control), too.

Brown-Squard Syndrome This syndrome affects one-half of the spinal cord, either the left or right side. If the right-hand side of the spinal cord is injured, symptoms affect the right side of the body (and if the left-hand side of the spinal cord is injured, the left side of the body is affected). It is characterized by partial loss of function or impaired function.

Spinal Levels and Areas Possibly Affected by SCI

A note about interpreting the table: Remember that a complete SCI affects all spinal cord function below the injury. For example, a thoracic injury may start at the torso and arms level, but it will also affect the low back, pelvis, groin, tailbone, legs, and toes.

Updated on: 08/28/14

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Spinal Cord Injury Center - Treatments, Research ...

Spinal Cord Injuries | Quadriplegic | Stem Cells | Stem Cell …

After 26 years in a wheel chair William Orr is walking. Granted it is with the assistance of a walker, but he is walking. Orr is walking to get his mail, he is walking to rehab from his parked car and he is planning on walking into his 35th high school reunion. The 52-year-old Aurora man has been a quadriplegic for half his life, since a car hit him while he was riding his bike back in 1986. He suffered a C6-C7 incomplete spinal cord injury and has used a wheel chair since.In August of 2010, Orr underwent what many believe is a first of its kind stem cell procedure in Naples, Florida, using bone marrow from his hip that doctors believe has regenerated damaged cells in his spinal cord. He had such a good response that a second treatment was performed in July 2012. Subsequently, Orr has gained both motor and sensory improvement, as well as having the majority of his muscle spasms dissipate.

There is a remarkable difference. The results for Mr. Orr and others in the treatment group are truly remarkable and have exceeded our expectations said Michael Calcaterra for Intercellular Sciences. Frankly, this is an area that regeneration was thought not to be possible.

I feel like a new person, said Orr. And its only going to get better. He hopes to someday be walking without the walker. Doctors believe that if his quadriceps strength continues to improve as well as his foot lift, then its a real possibility. In the meantime, hes relishing every new sensation, big or small. Its this amazing work ethic and attitude along with the stem cells, his doctor insists, that will help get this man back on his feet again.

UPDATE:

In July 2013, Mr. Orr took his first independent steps in 27 years as his spinal regeneration continues.

About Adult Stem Cells

Stem cells reside in adult bone marrow and fat, as well as other tissues and organs of the body. These cells have a natural ability to repair damaged tissue, however in people with degenerative diseases they are not released and directed enough to fully repair damaged tissue. Adult stem cells can be extracted from many areas of the body, including the bone marrow, fat, and peripheral blood. Since the stem cells come from the patient there is no possibility for rejection or tumor formation, also there is none of the moral issues involving embryonic cells. Stem cells isolated from the bone marrow or fat have the ability to become different cell types (i.e. nerve cells, liver cells, heart cells, and cartilage cells). Studies have also shown that these cells are capable of homing to and repairing damaged tissue. Studies have shown that these stem cells secrete proteins and peptides that stimulate healing of damaged tissue, including heart muscle and spinal cord. Animal studies have shown stem cells to be reparative in spinal cord injury.

About the Procedure

Spinal cord injury patients are treated utilizing stem cells from their own bodies. The procedure involves obtaining 480ml of bone marrow aspirate from the hip bone, this is done under anesthesia so the patient is completely comfortable. The sample is then put through a process that first activates and then concentrates the stem cells. The stem cells are then delivered to the area of spinal injury utilizing a novel method of intra-arterial injection in a vascular angiography suite. This is an outpatient procedure and minimally invasive. The patient is discharged later that day.

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Spinal Cord Injuries | Quadriplegic | Stem Cells | Stem Cell ...

Spinal Cord Injury – Rehabilitation Institute of Chicago

As you leave the acute-care hospital, you have to make a very important decision... This is the time to choose RIC.

For spinal cord injury recovery, you need the nations #1 rehabilitation hospital* At the Rehabilitation Institute of Chicago (RIC), wecombine science and care, to Advance Human Ability.

As a nationally recognized leader, the Rehabilitation Institute of Chicago Spinal Cord Injury Rehabilitation Program offers a comprehensive rehabilitative approach to help you maximize your recovery potential and equip you with tools to succeed when you leave.

Thousands of patients choose RIC from across the country and around the world. RIC has been ranked the No. 1 Rehabilitation Hospital in the country for more than two decades by U.S. News & World Report. Each year more than 50,000 patients travel to RIC from around the globe to advance their abilities.

And, as the Midwest Regional Spinal Cord Injury Model System Centera federal designation from the National Institute on Disability and Rehabilitation Research RIC delivers the most innovative care.

RIC offers one of the only national programs that can treat patients at all levels of spinal cord injury: Ventilator dependent Diaphragmatic pacing Complete tetraplegia Complete paraplegia Incomplete injuries

Mark Stephan, who fractured his C2 and C3 vertebrae in a bicycle accident that paralyzed him from the neck down.

After intensive inpatient rehabilitation at RIC, he walked out one month later on his own two feet.

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Spinal Cord Injury - Rehabilitation Institute of Chicago

Causes of Spinal Cord Injury (SCI) – Causes of spinal cord …

The most common causes of spinal cord injury is a broken neck or back neck (causing damage to the bones of the spine that surround the spinal cord). This often results in damage to the nerves of the spinal cord inside the spinal column. This is known as traumatic injury. Traumatic spinal cord injury may be caused by:

Road traffic accidents, domestic and work-related accidents, sports injuries, self-harm, assault or complications following surgery e.g., corrective surgery for spinal deformity e.g. scoliosis.

SCI can also be caused by so-called non-traumatic cord injury. Examples include:

Infection of the spinal nerve cells (bacterial and viral), cysts or tumours pressing on the spinal cord, interruption of the blood supply to the spinal cord (causing cord damage), congenital medical conditions (i.e. present since birth) that affect the structure of the spinal column e.g., spina bifida. Resultant Disability from these causes of spinal cord injury Quadriplegia, incomplete 31.2% - Paraplegia, complete 28.2% - Paraplegia, incomplete 23.1% - Quadriplegia, complete 17.5%

Facts and Figures from these causes of spinal cord injury Traumatic injuries account for the largest percentage of SCIs. Road traffic accidents account for the largest cause of spinal cord injuries worldwide.

In the USA violence accounts for the next largest cause of spinal cord injuries with which result primarily from gunshot wounds. This category has steadily risen over the last years there while motor vehicle crashes and sport related injuries have declined.

Falls and sporting activities make up the smallest group of causes of spinal cord injuries in the USA, However, within the sporting activity category, diving accidents cause the overwhelming majority of all spinal cord injuries that are sports related.

In the UK 2-3 people every day become paralysed as a result of spinal cord injury. That is 700+ each year adding to the 40,000 living here that are already paralysed. The figures for incomplete injuries may indeed be much higher because they don't take account of those people who have been treated by general hospitals instead of a specialist spinal injuries unit. Today advances in medical knowledge and patient management at the scene of an injury mean a lot more people will survive an SCI.

Our statistics are very similar to the USA (see chart) Road traffic accidents are still the biggest cause of traumatic cord injuries. SCI from gun crime although more prevalent today than ever is far lower than the American figure.

Since 1988, 45% of all injuries have been complete, 55% incomplete. Complete injuries result in total loss of sensation and function below the injury level. Incomplete injuries result in partial loss. "Complete" does not necessarily mean the cord has been severed. Each of the above categories can occur in paraplegia and quadriplegia.

Except for the incomplete-Preserved motor (functional), no more than 0.9% fully recover, although all can improve from the initial diagnosis. Overall, slightly more than 1/2 of all injuries result in quadriplegia. However, the proportion of quadriplegics increase markedly after age 45, comprising 2/3 of all injuries after age 60 and 87% of all injuries after age 75. 92% of all sports injuries result in quadriplegia.

Most people with neurologically complete lesions above C-3 die before receiving medical treatment. Those who survive are usually dependent on mechanical respirators to breathe.

50% of all cases have other injuries associated with the spinal cord injury.

A breakdown of the causes of sporting related spinal cord injuries worldwide reveals the following:

Diving 66.0% - Rugby & American Football 6.1% - Winter Sports 6.1% - Surfing 3.1% - Trampoline 2.6% - Wrestling 2.3% - Gymnastics 2.2% - Horseback Riding 2.0% - Other 9.6%

Tetraplegia - Paraplegia - Complete SCI - Incomplete SCI - Treatment - Complications - Causes of SCI - My Injury

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Causes of Spinal Cord Injury (SCI) - Causes of spinal cord ...

Spinal Cord Injury – Medical Disability Guidelines

ICD-9-CM: 952.00 - Spinal Cord Injury, without Evidence of Spinal Bone Injury; C1-C4 Level with Unspecified Spinal Cord Injury 952.01 - Spinal Cord Injury, without Evidence of Spinal Bone Injury; C1-C4 Level with Complete Lesion of Spinal Cord 952.02 - Spinal Cord Injury, Cervical Spine with Anterior Cord Syndrome 952.03 - Spinal Cord Injury, without Evidence of Spinal Bone Injury; C1-C4 level with Central Cord Syndrome 952.04 - Spinal Cord Injury, without Evidence of Spinal Bone Injury; C1-C4 level with Other Specified Spinal Cord Injury 952.05 - Spinal Cord Injury, without Evidence of Spinal Bone Injury; C5-C7 level with Unspecified Spinal Cord Injury 952.06 - Spinal Cord Injury, without Evidence of Spinal Bone Injury; C5-C7 level with Complete Lesion Of Spinal Cord 952.07 - Spinal Cord Injury, without Evidence of Spinal Bone Injury; C5-C7 level with Anterior Cord Syndrome 952.08 - Spinal Cord Injury, without Evidence of Spinal Bone Injury; C5-C7 level with Central Cord Syndrome 952.09 - Spinal Cord Injury, without Evidence of Spinal Bone Injury;C5-C7 level with Other Specified Spinal Cord Injury 952.10 - Thoracic Spinal Cord Injury without Evidence of Spinal Bone Injury; T1-T6 Level with Unspecified Spinal Cord Injury 952.11 - Thoracic Spinal Cord Injury without Evidence of Spinal Bone Injury; T1-T6 Level with Complete Lesion of Spinal Cord 952.12 - Thoracic Spinal Cord Injury without Evidence of Spinal Bone Injury; T1-T6 Level with Anterior Cord Syndrome 952.13 - Thoracic Spinal Cord Injury without Evidence of Spinal Bone Injury; T1-T6 Level with Central Cord Syndrome 952.14 - Thoracic Spinal Cord Injury without Evidence of Spinal Bone Injury; T1-T6 Level with Other Specified Spinal Cord Injury 952.15 - Thoracic Spinal Cord Injury without Evidence of Spinal Bone Injury; T7-T12 Level with Unspecified Spinal Cord Injury 952.16 - Thoracic Spinal Cord Injury without Evidence of Spinal Bone Injury; T7-T12 Level with Complete Lesion of Spinal Cord 952.17 - Thoracic Spinal Cord Injury without Evidence of Spinal Bone Injury; T7-T12 Level with Anterior Cord Syndrome 952.18 - Thoracic Spinal Cord Injury without Evidence of Spinal Bone Injury; T7-T12 Level with Central Cord Syndrome 952.19 - Thoracic Spinal Cord Injury without Evidence of Spinal Bone Injury; T7-T12 Level with Other Specified Spinal Cord Injury 952.2 - Lumbar Spinal Cord Injury without Evidence of Spinal Bone Injury 952.3 - Sacral Spinal Cord Injury without Evidence of Spinal Bone Injury 952.8 - Spinal Cord Injury without Evidence of Spinal Bone Injury, Multiple Sites 952.9 - Spinal Cord Injury, Unspecified

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Spinal Cord Injury - Medical Disability Guidelines

Spinal Cord Injury Network – Spinal Cord Injury

My name is Andy and my cycling accident and Spinal Cord Injury in 1994 radically changed my life. Breaking my neck took a second to do but my resulting disability (spinal cord injury) will last my lifetime. Hopefully this website will assist others in understanding the nature of spinal cord injury (SCI).

If you, a family member or a friend have recently suffered a Spinal Cord Injury then although a 'normal' life may seem impossible now, let me assure you with time and knowledge things can and will get better. Spinal Cord Injury take many forms. There is tetraplegia (called quadriplegia or quadraplegia in USA), paraplegia and there are complete or incomplete lesions too. The most severe complete Spinal Cord Injury (high neck) will result in complete body paralysis and require a ventilator to breathe. The most incomplete Spinal Cord Injury may be able to walk virtually normally again but still suffer impaired continence bodily functions as a result of the cord lesion.

Every Spinal Cord Injury and the resulting disability is unique as are the people who have suffered them. If you are SCI yourself, a relative, friend, health professional or just someone seeking further information about life with a spinal cord injury you are ALL welcome here at the Spinal Injury Network. There's a lot of useful information about spinal cord injury on this site and an active community on the Message Boards too.

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Spinal Cord Injury Network - Spinal Cord Injury

Spinal Cord Injury Levels & Classification

Wise Young, Ph.D., M.D. W. M. Keck Center for Collaborative Neuroscience Rutgers University, Piscataway, NJ

When people are injured, they are often told that they have an injury at a given spinal cord level and are given a qualifier indicating the severity of injury, i.e. "complete" or "incomplete". They may also be told that they are classified according to the American Spinal Injury Association (ASIA) Classification, as a ASIA A, B, C, or D. They may also be told that they have a bony fracture or involvement of one or more spinal segments or vertebral levels. What most people do not know is doctors are frequently confused about the definition of spinal cord injury levels, the definition of complete and incomplete injury, and the classification of spinal cord injury. In the early 1990's, when I co-chaired the committee that helped define the currently accepted ASIA Classification, there was no single definition of level, completeness of injury, or classification. In this article, I will briefly address the issue of spinal cord injury levels, the definition of "complete" spinal cord injury, and the ASIA Classification approach towards spinal cord injury.

The spinal cord is situated within the spine. The spine consists of a series of vertebral segments. The spinal cord itself has "neurological" segmental levels which are defined by the spinal roots that enter and exist the spinal column between each of the vertebral segments. As shown in the figure the spinal cord segmental levels do not necessarily correspond to the bony segments. The vertebral levels are indicated on the left side while the cord segmental levels are listed for the cervical (red), thoracic (green), lumbar (blue), and sacral (yellow) cord.

Vertebral segments. There are 7 cervical (neck), 12 thoracic (chest), 5 lumbar (back), and 5 sacral (tail) vertebrae. The thoracic vertebrae are defined by The spinal cord segments are not necessarily situated at the same vertebral levels. For example, while the C1 cord is located at the C1 vertebra, the C8 cord is situated at the C7 vertebra. While the T1 cord is situated at the T1 vertebra, the T12 cord is situated at the T8 vertebra. The lumbar cord is situated between T9 and T11 vertebrae. The sacral cord is situated between the T12 to L2 vertebrae.

Spinal Roots. The spinal roots for C1 exit the spinal column at the atlanto-occiput junction. The spinal roots for C2 exit the spinal column at the atlanto-axis. The C3 roots exit between C2 and C3. The C8 root exits between C7 and C8. The first thoracic root or T1 exits the spinal cord between T1 and T2 vertebral bodies. The T12 root exits the spinal cord between T1 and L1. The L1 root exits the spinal cord between L1 and L2 bodies. The L5 root exits the cord between L1 and S1 bodies.

The Cervical Cord. The first and second cervical segments are special because this is what holds the head. The lower back of the head is called the Occiput. The first cervical vertebra, upon which the head is perched is sometimes called Atlas, after the Greek mythological figure who held up earth. The second cervical vertebra is sometimes called the Axis, upon which Atlas pivots. The interface between the occiput and the atlas is therefore called the atlanto-occiput junction. The interface between the first and second vertebra is called the atlanto-axis junction. The C3 cord contains the phrenic nucleus. The cervical cord innervates the deltoids (C4), biceps (C4-5), wrist extensors (C6), triceps (C7), wrist extensors (C8), and hand muscles (C8-T1).

The Thoracic Cord. The thoracic vertebral segments are defined by those that have a rib. These vertebral segments are also very special because they form the back wall of the pulmonary cavity and the ribs. The spinal roots form the intercostal (between the ribs) nerves that run on the bottom side of the ribs and these nerves control the intercostal muscles and associated dermatomes.

The Lumbosacral Cord. The lumbosacral vertebra form the remainder of the segments below the vertebrae of the thorax. The lumbosacral spinal cord, however, starts at about T9 and continues only to L2. It contains most of the segments that innervate the hip and legs, as well as the buttocks and anal regions.

The Cauda Equina. In human, the spinal cord ends at L2 vertebral level. The tip of the spinal cord is called the conus. Below the conus, there is a spray of spinal roots that is frequently called the cauda equina or horse's tail. Injuries to T12 and L1 vertebra damage the lumbar cord. Injuries to L2 frequently damage the conus. Injuries below L2 usually involve the cauda equina and represent injuries to spinal roots rather than the spinal cord proper.

In summary, spinal vertebral and spinal cord segmental levels are not necessarily the same. In the upper spinal cord, the first two cervical cord segments roughly match the first two cervical vertebral levels. However, the C3 through C8 segments of the spinal cords are situated between C3 through C7 bony vertebral levels. Likewise, in the thoracic spinal cord, the first two thoracic cord segments roughly match first two thoracic vertebral levels. However, T3 through T12 cord segments are situated between T3 to T8. The lumbar cord segments are situated at the T9 through T11 levels while the sacral segments are situated from T12 to L1. The tip of the spinal cord or conus is situated at L2 vertebral level. Below L2, there is only spinal roots, called the cauda equina.

A dermatome is a patch of skin that is innervated by a given spinal cord level. Figure 2 is taken from the ASIA classification manual, obtainable from the ASIA web site. Each dermatome has a specific point recommended for testing and shown in the figure. After injury, the dermatomes can expand or contract, depending on plasticity of the spinal cord.

C2 to C4. The C2 dermatome covers the occiput and the top part of the neck. C3 covers the lower part of the neck to the clavicle (the horizontal bone that goes to the shoulder. C4 covers the area just below the clavicle.

C5 to T1. These dermatomes are all situated in the arms. C5 covers the lateral arm at and above the elbow. C6 covers the forearm and the radial (thumb) side of the hand. C7 is the middle finger, C8 is the lateral aspects of the hand, and T1 covers the medial side of the forearm.

T2 to T12. The thoracic covers the axillary and chest region. T3 to T12 covers the chest and back to the hip girdle. The nipples are situated in the middle of T4. T10 is situated at the umbilicus. T12 ends just above the hip girdle.

L1 to L5. The cutaneous dermatome representating the hip girdle and groin area is innervated by L1 spinal cord. L2 and 3 cover the front part of the thighs. L4 and L5 cover medial and lateral aspects of the lower leg.

S1 to S5. S1 covers the heel and the middle back of the leg. S2 covers the back of the thighs. S3 cover the medial side of the buttocks and S4-5 covers the perineal region. S5 is of course the lowest dermatome and represents the skin immediately at and adjacent to the anus.

Ten muscle groups represent the motor innervation by the cervical and lumbosacral spinal cord. The ASIA system does not include the abdominal muscles (i.e. T10-11) because the thoracic levels are much easier to determine from sensory levels. It also excludes certain muscles (e.g. hamstrings) because the segmental levels that innervate them are already represented by other muscles.

Arm and hand muscles. C5 represents the elbow flexors (biceps), C6 the wrist extensors, C7 the elbow extensors (triceps), C8 the finger flexors, and T1 the little finger abductor (outward movement of the pinky finger).

Leg and foot muscles. The leg muscles represent the lumbar segments, i.e. L2 are the hip flexors (psoas), L3 the knee extensors (quadriceps), L4 the ankle dorsiflexors (anterior tibialis), L5 the long toe extensors (hallucis longus), S1 the ankle plantar flexors (gastrocnemius).

The anal sphincter is innervated by the S4-5 cord and represents the end of the spinal cord. The anal sphincter is a critical part of the spinal cord injury examination. If the person has any voluntary anal contraction, regardless of any other finding, that person is by definition a motor incomplete injury.

It is important to note that the muscle groups specified in the ASIA classifications represent a gross over simplication of the situation. Almost every muscle received innervation from two or more segments.

In summary, the spinal cord segment serve specific motor and sensory regions of the body. The sensory regions are called dermatomes with each segment of the spinal cord innervating a particularly area of skin. The distribution of these dermatomes are relatively straightforward except on the limbs. In the arms, the cervical dermatomes C5 to T1 are arrayed from proximal radial (C5) to distal (C6-8) and proximal medial (T1). In the legs, the L1 to L5 dermatomes cover the front of the leg from proximal to distal while the sacral dermatomes cover the back of the leg.

Differences between neurological and rehabilitation definitions of spinal cord injury levels. Doctors use two different definitions for spinal cord injury levels. Given the same neurological examination and findings, neurologists and physiatrists may not assign the same spinal cord injury level. In general, neurologists define the level of injury as the first spinal segmental level that shows abnormal neurological loss. Thus, for example, if a person has loss of biceps, the motor level of the injury is often said to be C4. In contrast, physiatrists or rehabilitation doctors tend to define level of injury as the lowest spinal segmental level that is normal. Thus, if a patient has normal C3 sensations and absent C4 sensation, a physiatrist would say the sensory level is C3 whereas a neurologist or neurosurgeon would call it a C4 injury level. Most orthopedic surgeons tend to refer to the bony level of injury as the level of injury.

EXAMPLE. The most common cervical spinal injuries involve C4 or C5. Take, for example, a person who has had a burst fracture of the C5 vertebral body. A burst fracture usually indicates severe trauma to vertebral body that typically injures the C6 spinal cord situated at the C5 vertebrae and also the C4 spinal roots that exits the spinal column between the C4 and C5 vertebra. Such an injury should cause a loss of sensations in C4 dermatome and weak deltoids (C4) due to injury to the C4 roots. Due to edema (swelling of the spinal cord), the biceps (C5) may be initially weak but should recover. The wrist extensors (C6), however, should remain weak and sensation at and below C6 should be severely compromised. A neurosurgeon or neurologist examining the above patient usually would conclude that there is a burst fracture at C5 from the x-rays, an initial sensory level at C4 (the first abnormal sensory dermatome) and the partial loss of deltoids and biceps would imply a motor level at C4 (the highest abnormal muscle level). Over time, as the patient recovers the C4 roots and the C5 spinal cord, both the sensory level and motor level should end up at C6. Such recovery is often attributed to "root" recovery. On the other hand, a physiatrist would conclude that the patient initially has a C3 sensory level, a C4 motor level, and a C5 vertebral injury level. If the patient recovers the C4 root and the C5 cord, the physiatrist would conclude that both the sensory and motor levels are C5.

Discrepant lower thoracic vertebral and cord levels. The spinal vertebral and cord segmental levels become increasingly discrepant further down the spinal column. For example, a T8 vertebral injury will result in a T12 spinal cord or neurological level. A T11 vertebral injury, in fact, will result in a L5 lumbar spinal cord level. Most patients and even many doctors do not understand how discrepant the vertebral and spinal cord levels can get in the lower spinal cord.

EXAMPLE. The most common thoracic spinal cord injury involves T11 and T12. A patient with a T11 vertebral injury may have or recover sensations in the L1 through L4 dermatomes which include the front of the leg down to the mid-shin level. In addition, such a patient should recover hip extensors, knee extensors, and even ankle dorsiflexion. However, the sacral functions, including bowel and bladder and many of the flexor functions of the leg may be absent or weak. As in the case of cervical and thoracic spinal cord injury, it is important to assess both sensory and motor function.

Conus and Cauda Equina Injuries. Injuries to the spinal column at L2 or lower will damage the tip of the spinal cord, called the conus, or the spray of spinal roots that are descending to the appropriate spinal vertebral levels to exit the spinal canal or the caudal equina. Please note that the spinal roots for L2 through S5 all descend in the cauda equina and injury to these roots would disrupt sensory and motor fibers from these segments. Strictly speaking, the spinal roots are part of the peripheral nervous system as opposed to the spinal cord. Peripheral nerves are supposed to be able to regenerate to some extent. However, the spinal roots are different from peripheral nerves in two respects. First, the neurons from which sensory axons emanate are situated in the dorsal root ganglia (DRG) which are located just outside the spinal column. One branch of the DRG goes into the spinal cord (called the central branch) and the other is the peripheral branch.

Thus, a spinal root injury is damaging the central branch of the sensory nerve whereas peripheral nerve injury usually damages the peripheral branch. The sensory axon must grow back into the spinal cord in order to restore function and they generally will not do so because of axonal growth inhibitors in the spinal cord and particular at the so-called PNS-CNS junction at the dorsal root entry zone. Second, the cauda equina contains the ventral roots of the spinal cord, through which the motor axons of the spinal cord pass to innervate muscles. If the injury to the ventral root is close to the motoneurons that sent the axons, the injury may damage the motoneuron itself. Both of these factors significantly reduce the likelihood of neurological recovery in a cauda equina injury compared to a peripheral nerve injury.

Most clinicians commonly describe injuries as "complete" or "incomplete".

Traditionally, "complete" spinal cord injury means having no voluntary motor or conscious sensory function below the injury site. However, this definition is often difficult to apply. The following three example illustrate the weaknesses and ambiguity of the traditional definition. The ASIA committee considered these questions when it formulated the classification system for spinal cord injury in 1992.

Most clinicians would regard a person as complete if the person has any level below which no function is present. The ASIA Committee decided to take this criterion to its logical limit, i.e. if the person has any spinal level below which there is no neurological function, that person would be classified as a "complete" injury. This translates into a simple definition of "complete" spinal cord injury: a person is a "complete" if they do not have motor and sensory function in the anal and perineal region representing the lowest sacral cord (S4-S5).

The decision to make the absence and presence of function at S4-5 the definition for "complete" injury not only resolved the problem of the zone of partial preservation but lateral preservation of function but it also resolved the issue of recovery of function. As it turns out, very few patients who have loss of S4/5 function recovered such function spontaneously. As shown in figure 3 below, while this simplifies the criterion for assessing whether an injury is "complete", the ASIA classification committee decided that both motor and sensory levels should be expressed on each side separately, as well as the zone of partial preservation.

In the end, the whole issue of "complete" versus "incomplete" injury may be a moot issue. The absence of motor and sensory function below the injury site does not necessarily mean that there are no axons that cross the injury site. Many clinicians equate a "complete" spinal cord injury with the lack of axons crossing the injury site. However, much animal and clinical data suggest that an animal or person with no function below the injury site can recover some function when the spinal cord is reperfused (in the case of an arteriovenous malformation causing ischemia to the cord), decompressed (in the case of a spinal cord that is chronically compressed), or treated with a drug such as 4-aminopyridine. The labeling of a person as being "complete" or "incomplete", in my opinion, should not be used to deny a person hope or therapy.

Clinicians have long used a clinical scale to grade severity of neurological loss. First devised at Stokes Manville before World War II and popularized by Frankel in the 1970's, the original scoring approach segregated patients into five categories, i.e. no function (A), sensory only (B), some sensory and motor preservation (C), useful motor function (D), and normal (E).

The ASIA Impairment Scale is follows the Frankel scale but differs from the older scale in several important respects. First, instead of no function below the injury level, ASIA A is defined as a person with no motor or sensory function preserved in the sacral segments S4-S5. This definition is clear and unambiguous. ASIA B is essentially identical to Frankel B but adds the requirement of preserved sacral S4-S5 function. It should be noted that ASIA A and B classification depend entirely on a single observation, i.e. the preservation of motor and sensory function of S4-5.

The ASIA scale also added quantitive criteria for C and D. The original Frankel scale asked clinicians to evaluate the usefulness of lower limb function. This not only introduced a subjective element to the scale but ignored arm and hand function in patients with cervical spinal cord injury. To get around this problem, ASIA stipulated that a patient would be an ASIA C if more than half of the muscles evaluated had a grade of less than 3/5. If not, the person was assigned to ASIA D.

ASIA E is of interest because it implies that somebody can have spinal cord injury without having any neurological deficits at least detectable on a neurological examination of this type. Also, the ASIA motor and sensory scoring may not be sensitive to subtle weakness, presence of spasticity, pain, and certain forms of dyesthesia that could be a result of spinal cord injury. Note that such a person would be categorized as an ASIA E.

These changes in the ASIA scale significantly improved the reliability and consistency of the classification. Although it was more logical, the new definition of "complete" injury does not necessarily mean that it better reflects injury severity. For example, is there any situation where a person could be an ASIA B and better off the ASIA C or even ASIA D?

The new ASIA A categorization turns out to be more predictive of prognosis than the previous definition where the presence of function several segments below the injury site but the absence of function below a given level could be interpreted as an "incomplete" spinal cord injury.

The ASIA committee also classified incomplete spinal cord injuries into five types. A central cord syndrome is associated with greater loss of upper limb function compared to the lower limbs. The Brown-Sequard syndrome results from a hemisection lesion of the spinal cord. Anterior cord syndrome occurs when the injury affects the anterior spinal tracts, including the vestibulospnal tract. Conus medullaris and cauda equina syndromes occur with damage to the conus or spinal roots of the cord.

Much confusion surrounds the terminology associated with spinal cord injury levels, severity, and classification. The American Spinal Injury Association tried to sort some of these issues and standardize the language that is used to describe spinal cord injury. The ASIA Spinal Cord Injury Classification approach has now been adopted by almost every major organization associated with spinal cord injury. This has resulted in more consistent terminology being used to /describe the findings in spinal cord injury around the world.

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Spinal Cord Injury Levels & Classification

Spinal Cord Injury Information – Paralyzed Veterans of America

Every year, more than 10,000 people in the U.S. sustain a spinal cord injury (SCI). An SCI changes a persons life in an instant, creating new challenges for everyday life. Paralyzed Veterans of America membership offers resources and benefits to meet the needs of veterans who have sustained these injuries.

Explore our resources below about spinal cord injury, andtalk to us if you need help understanding and selecting treatment options.

When a person sustains an SCI, the communication between the brain and other parts of the body is disrupted, and messages no longer flow past the damaged area. The extent of the communication breakdown is dependent on both the severity and location of the injury. The human spinal cord is a bundle of nerve cells and fibers approximately 17 inches long that extends from the brain to the lower back. The spinal cord carries messages from the brain to all parts of the body and receives incoming messages from the body as well.

The nerves that lie only within the spinal cord itself are called upper motor neurons (UMNs). These run only between the brain and the spinal nerves. The spinal nerves branch out from the spinal cord into the tissues of the body. Spinal nerves are also called lower motor neurons (LMNs). In movement, the brain sends messages through the spinal cord (UMNs) to the spinal nerves (LMNs). The LMNs then carry these messages to the muscles to coordinate complicated movements such as walking. In this way, the brain can influence movement.

Most spinal injuries damage both UMNs and LMNs. A complete injury cuts or squeezes all the UMNs running down the spinal cord. In a UMN injury, control by the brain no longer exists because messages from the brain cant get through the point of injury. The LMNs act by themselves, causing reflexes without limit. One example is spasticity. Spasticity is the uncontrolled movement of the arms or legs. LMN injuries are a different story. This kind of injury is found, for the most part, at the lower tip of the spinal cord, or the cauda equina.

Spasticity is not found in LMN injuries as it is in UMN injuries, because muscles governed by these LMNs tend to shrink or atrophy. Stated simply, a UMN injury is one where the UMN pathway is broken, and the LMNs below the injury are intact and spasticity is noted. An LMN injury, usually at the cauda equina, abolishes nerve contact with muscles controlled below the injury and no spasticity develops.

There are many causes of these injuries, which can be traumatic or non-traumatic. Traumatic injuries include injuries sustained in military service, auto accidents, falls, sports injuries,or violence. Non-traumatic injuries may be caused by arthritis, cancer, infections, or disk degeneration of the spine.

Spinal cord injuries can occur at any level of the spinal cord, and the level of the injury will dictate which bodily functions are altered or lost. Damage to the spinal cord can cause changes in movement, feeling, bladder control, or other bodily functions. How many changes there are depends on where the spinal cord was injured and how severely the spinal cord was injured.

Immediately after a spinal cord injury, the spinal cord stops doing its job for a period of time called spinal shock. The return of reflexes below the level of injury marks the end of spinal shock. At this time, a doctor can determine if the injury is complete or incomplete. If the injury is incomplete, some feelings and movement may come back.

Rehabilitation begins immediately. The individual will be instructed in strengthening exercises, new styles of movement, and the use of special equipment. If additional recovery of feeling or movement does not occur, a rehabilitation team will help the individual to develop new goals.

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Spinal Cord Injury Information - Paralyzed Veterans of America

What is a Spinal Cord Injury? – Apparelyzed

Contents Spinal Cord Injury Overview

A spinal cord injury (SCI) is caused by damage or trauma to the spinal cord that results in a loss or impaired function causing reduced mobility or sensation.

Common causes of damage to the spinal cord are:

The spinal cord does not have to be severed in order for a loss of function to occur. In most people with SCI the spinal cord is intact, but the cellular damage resulting from compression or inflammation results in the loss of function. An SCI is very different from back injuries such as ruptured disks, spinal stenosis or pinched nerves. The later involves musculoskeletal and peripheral nerve changes where as a spinal cord injury involves damage to the central nervous system.

It is possible for a person to "break their back or neck" yet not sustain a spinal cord injury as long as only the bones (the vertebrae) around the spinal cord are damaged, but the spinal cord is not affected. In such cases the person may not experience paralysis after the affected vertebrae are stabilised. Fractured vertebrae and dislocated vertebrae can be stabilised using surgical management such as traction, vertebral fusion, fixation using titanium plates or rods and for less severe fractures of the vertebra bed rest.

The spinal cord is the major bundle of tightly compacted nerves contained within the vertebral column that carry nerve impulses to and from the brain throughout the body. The brain and the spinal cord constitute the central nervous system. Motor and sensory nerves outside the central nervous system constitute the peripheral nervous system, and another system of nerves that control involuntary functions such as blood pressure and temperature regulation are the sympathetic and parasympathetic nervous systems.

The spinal cord is about 18 inches in length and extends from the base of the brain vertically downwards through the middle of the spinal column to around the waist. The pathways that are situated within the spinal cord are called upper motor neurons (UMN's). Their function is to carry messages back and forth from the brain along spinal tracts within the spinal cord responsible for specific functions. The spinal nerves that branch out from the spinal cord to parts of the body are peripheral nerves called lower motor neurons (LMN's). These spinal nerves exit and enter between each vertebra and communicate with specific areas of the body. The sensory portions of the LMN carry messages about sensation from the skin and muscles such as pain, temperature, joint position and information from organs to the spinal cord and upwards via ascending spinal tracts to the brain. The motor portions of the LMN receive messages from the brain via descending tracts in the spinal cord to initiate actions such as muscle movement, gland functions and certain internal organ commands.

The spinal cord is surrounded by a hollow column of bones called vertebrae. These bones constitute the spinal column (back bones and neck bones). Generally the higher in the spinal column the spinal cord injury occurs, the more physical impairment a person will experience resulting in an increased level of paralysis. The vertebra are named according to their location. The seven vertebrae in the neck are called the cervical vertebrae. The top vertebra is called C1 or atlas vertebra and connects the top of the spinal column to the skull. The bottom cervical vertebra is called C7. Cervical SCI's usually result in loss of function in the arms and legs resulting in tetraplegia which is also referred to as quadriplegia. The next twelve vertebra are called the thoracic vertebra, T1-T12. The first thoracic vertebra T1 is the vertebra where the top rib attaches. There are 5 lumbar vertebrae, one fused sacral vertebra and one fused coccygeal vertebra.

So to recap, the five sections of the vertebral column are:

An injury to the spinal cord segments contained within the cervical spinal vertebrae C1-C7 usually result in paralysis of all four limbs to some degree resulting in tetraplegia (quadriplegia). Injuries in the thoracic region usually affect the chest and the legs and result in paraplegia. The vertebra in the lower back between the thoracic vertebra where the ribs attach and the pelvis are the lumbar vertebra. The sacral vertebra run from the pelvis to the end of the spinal column. Injuries to the five lumbar vertebra (L1 thru L5) and similarly to the five sacral vertebra (S1 thru S5) generally result in varying loss of function in the hips, legs, bladder, bowel and sexual function.

The spinal cord ends between L1-L2 where a mass of spinal nerves continue downwards inside the lumbar (L2-L5) and sacral (S1-S2) vertebrae. This mass of spinal nerves is referred to as the cauda equina and damage to these nerve roots is referred to as cauda equina syndrome.

The effects of SCI depend on the type of injury and the level of the injury. SCI can be divided into two types of injury: complete and incomplete. A complete injury results in no function below the level of neurological injury: no sensation and no voluntary movement. Both sides of the body are equally affected. An incomplete injury results in some preserved function below the level of neurological 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 function on one side of the body than the other.

Types of incomplete spinal cord injury are:

With the recent advances in medical intervention and treatment of acute SCI, incomplete injuries are becoming more common. The most frequent spinal cord injury neurological classifications at time of discharge (2014) from a spinal injury centre is incomplete tetraplegia (31.6%), followed by incomplete paraplegia (18.6%), complete paraplegia (24.6%) and complete tetraplegia (19.3%). It is estimated that less than 1% of individuals diagnosed with a spinal cord injury experienced a complete neurological recovery at the time of hospital discharge. Over the last 20 years, the incidence of individuals with incomplete tetraplegia has increased whilst complete paraplegia and complete tetraplegia have decreased.

The level of injury is very helpful in predicting what parts of the body might be affected by paralysis resulting in loss of function. Remember that in incomplete injuries there can be a wide variation in the prognoses.

Cervical (neck) injuries usually result in Quadriplegia/Tetraplegia. Injuries to the spinal cord segments above the C4 level (C1,C2, C3) may result in the need of breathing aids such as mechanical ventilators or diaphragm pacemakers. Diaphragm pacemaker devices may be required to stimulate the phrenic nerve to initiate a persons breathing due to weak innervation of the diaphragm. C5 injuries often result in shoulder (deltoid) and biceps control, but no control of the wrist or hand. C6 injuries generally yield wrist control (wrist extensors), but no finger hand function. Individuals with C7-T1 injuries can straighten their arms (triceps) but still may have dexterity problems with the hand and fingers.

It is interesting to note that in the cervical area of the spine the nerve roots exit the spinal column above the vertebra, except for C7 where a pair of nerve roots also exit both above and below the vertebra. This is why there are seven cervical vertebrae but eight pairs of cervical nerve roots, C1-C8. From T1 downwards all spinal nerves then exit the spinal column below the vertebrae.

Injuries at the thoracic level and below result in paraplegia, with the hands not affected. At T1 to T8 whilst there is good control of the hands, trunk control may vary as the result of lack of abdominal muscle control. Lower thoracic injuries (T9 to T12) allow good truck control and good abdominal muscle control. Sitting balance is very good. Lumbar and sacral injuries yield decreasing control of the hip flexors and legs.

To reference the spinal segments discussed above, the 5 spinal segments are:

Sources

The above information has been written with reference from the following sources: https://www.nscisc.uab.edu/ Sekhon, Lali H.S.; Fehlings, Michael G. (2001). "Epidemiology, Demographics, and Pathophysiology of Acute Spinal Cord Injury". Spine 26 (24 Suppl): S212. doi:10.1097/00007632-200112151-00002. PMID11805601. Alexander Vaccaro; Michael Fehlings (2010). Spine and Spinal Cord Trauma: Evidence-Based Management. Thieme Publishers. ISBN9781604062229. Retrieved 2012-05-06.

Updated: May 2014

Showing the difference between spinal cord injury levels and the difference between tetraplegia (quadriplegia) and paraplegia. Note that there are seven cervical vertebrae, but eight pairs of cervical nerve roots due to how nerve roots exit the cervical vertebrae.

Any medical treatments or therapies discussed on this website should be reviewed by a medical professional before being acted upon.

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What is a Spinal Cord Injury? - Apparelyzed

Spinal cord injury Symptoms – Mayo Clinic

Your ability to control your limbs after spinal cord injury depends on two factors: the place of the injury along your spinal cord and the severity of injury to the spinal cord.

The lowest part of your spinal cord that functions normally after injury is referred to as the neurological level of your injury. The severity of the injury is often called "the completeness" and is classified as either of the following:

Additionally, paralysis from a spinal cord injury may be referred to as:

Your health care team will perform a series of tests to determine the neurological level and completeness of your injury.

Spinal cord injuries of any kind may result in one or more of the following signs and symptoms:

Emergency signs and symptoms of spinal cord injury after an accident may include:

Anyone who experiences significant trauma to his or her head or neck needs immediate medical evaluation for the possibility of a spinal injury. In fact, it's safest to assume that trauma victims have a spinal injury until proven otherwise because:

.

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Spinal cord injury Symptoms - Mayo Clinic

Spinal Cord Injury | Johns Hopkins Medicine Health Library

What is an acute spinal cord injury?

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The spinal cord is a bundle of nerves that carries messages between the brain and the rest of the body.

Acute spinal cord injury (SCI) is due to a traumatic injury that can either result in a bruise (also called a contusion), a partial tear, or a complete tear (called a transection) in the spinal cord. SCI is more common in men and young adults.

There are about12,000 new cases of SCI each year. The number of people in the U.S. in 2008 living with a spinal cord injury was approximately 259,000.

SCI results in a decreased or absence of movement, sensation, and body organ function below the level of the injury. The most common sites of injury are the cervical and thoracic areas. SCI is a common cause of permanent disability and death in children and adults.

The spine consists of 33 vertebrae, including the following:

* By adulthood, thefive sacral vertebrae fuse to form one bone, and the fourcoccygeal vertebrae fuse to form one bone.

These vertebrae function to stabilize the spine and protect the spinal cord. In general, the higher in the spinal column the injury occurs, the more dysfunction a person will have.

Injury to the vertebrae does not always mean the spinal cord has been damaged. Likewise, damage to the spinal cord itself can occur without fractures or dislocations of the vertebrae.

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Spinal Cord Injury | Johns Hopkins Medicine Health Library

Living With a Spinal Cord Injury-Topic Overview

What is a spinal cord injury?

A spinal cord injury is damage to the spinal cord . The spinal cord is a soft bundle of nerves that extends from the base of the brain to the lower back. It runs through the spinal canal, a tunnel formed by holes in the bones of the spine . The bony spine helps protect the spinal cord.

The spinal cord carries messages between the brain and the rest of the body. These messages allow you to move and to feel touch, among other things. A spinal cord injury stops the flow of messages below the site of the injury. The closer the injury is to the brain, the more of the body is affected.

A spinal cord injury may be complete or incomplete. A person with a complete injury doesn't have any feeling or movement below the level of the injury. In an incomplete injury, the person still has some feeling or movement in the affected area.

A spinal cord injury usually happens because of a sudden severe blow to the spine. Often this is the result of a car accident, fall, gunshot, or sporting accident. Sometimes the spinal cord is damaged by infection or spinal stenosis, or by a birth defect, such as spina bifida.

At the hospital, treatment starts right away to prevent more damage to the spine and spinal cord. Steps are taken to get your blood pressure stable and help you breathe. You may get a steroid medicine to reduce swelling of the spinal cord. A number of tests are done. These include X-ray of the spine, CT scan, MRI, and ultrasound of the kidneys. These tests are repeated over time to check how you are doing.

A few days after the injury, you will be tested to see how you respond to pinpricks and light touch all over your body. The doctor will ask you to move different parts of your body and test the strength of your muscles. These tests help the doctor know how severe the injury is and how likely it is that you could get back some feeling and movement. Most recovery occurs in the first 6 months.

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Living With a Spinal Cord Injury-Topic Overview

AANS – Spinal Cord Injury

Updated March 2015

According to the National Spinal Cord Injury Association, as many as 450,000 people in the U.S. are living with a spinal cord injury (SCI). Other organizations conservatively estimate this figure to be about 250,000.

Every year, an estimated 11,000 SCIs occur in the U.S. Most of these are caused by trauma to the vertebral column, thereby affecting the spinal cord's ability to send and receive messages from the brain to the body's systems that control sensory, motor and autonomic function below the level of injury.

According to the Centers for Diseases Control and Prevention (CDC), SCI costs the nation an estimated $9.7 billion each year. Pressure sores alone, a common secondary condition among people with SCI, cost an estimated $1.2 billion.

Incidence

The Spinal Column/Cord

The spinal cord is about 18 inches long, extending from the base of the brain to near the waist. Many of the bundles of nerve fibers that make up the spinal cord itself contain upper motor neurons (UMNs). Spinal nerves that branch off the spinal cord at regular intervals in the neck and back contain lower motor neurons (LMNs).

The spine itself is divided into four sections, not including the tailbone:

Cervical vertebrae (C1-7) located in the neck;

Thoracic vertebrae (T1-12), in the upper back (attached to the ribcage);

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AANS - Spinal Cord Injury

Spinal Cord Injury Information Pages

This site is a free and informative resource for those living with a spinal cord injury or other disabling injuries or diseases of the spine. It is meant to be a "best of the web" site for SCI health and caregiver information. Visit regularly for updated resources, news and more. If you know of something that should be added, such as a good resource site, news, clinical trials, pictures, etc., please contact me.

This site was originally created as my own personal resource. As it grew I decided to share it with others like me (C5/6 Quadriplegic per a diving accident in 1999). Please note that only quality websites and related information are listed here. So, there is no need to bookmark a bunch of sites as the best resources are right here for you.

Be sure to check out the spinal cord injury news blog. It's updated on a regular basis featuring current SCI news. If you know of any encouraging news, a new SCI resource, a new daily living aid or just something noteworthy drop me a line and I'll try to post it.

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Spinal Cord Injury Information Pages

Spinal Cord Injury: Read About the Levels – MedicineNet

Spinal Cord Injury Facts The most common cause of spinal cord injury is trauma. Spinal cord injury is most common in young, white men. Spinal cord injury can be either complete or incomplete. In complete injuries there is no function below the level of injury. In incomplete injuries there is some function remaining below the level of injury. Early immobilization and treatment are the most important factors in achieving recovery from spinal cord injury. Aggressive rehabilitation and assistive devices allow even people with severe spinal cord injuries to interact in society and remain productive. What is the spinal cord injury?

The spinal cord is a collection of nerves that travels from the bottom of the brain down your back. There are 31 pairs of nerves that leave the spinal cord and go to your arms, legs, chest and abdomen. These nerves allow your brain to give commands to your muscles and cause movements of your arms and legs. The nerves that control your arms exit from the upper portion of the spinal cord, while the nerves to your legs exit from the lower portion of the spinal cord. The nerves also control the function of your organs including your heart, lungs, bowels, and bladder. For example, signals from the spinal cord control how fast your heart beats and your rate of breathing.

Other nerves travel from your arms and legs back to the spinal cord. These nerves bring back information from your body to your brain including the senses of touch, pain, temperature, and position. The spinal cord runs through the spinal canal. This canal is surrounded by the bones in your neck and back called vertebrae which make up your back bone. The vertebrae are divided into 7 neck (cervical) vertebrae, 12 chest (thoracic) vertebrae and 5 lower back (lumbar) vertebrae. The vertebrae help protect the spinal cord from injury.

The spinal cord is very sensitive to injury. Unlike other parts of your body, the spinal cord does not have the ability to repair itself if it is damaged. A spinal cord injury occurs when there is damage to the spinal cord either from trauma, loss of its normal blood supply, or compression from tumor or infection. There are approximately 12,000 new cases of spinal cord injury each year in the United States. They are most common in white males. Specifically, 80% of spinal cord injuries occur in males, and 65% occur in whites. Most injuries occur in patients under 30 years of age.

Spinal cord injuries are described as either complete or incomplete. In a complete spinal cord injury there is complete loss of sensation and muscle function in the body below the level of the injury. In an incomplete spinal cord injury there is some remaining function below the level of the injury. In most cases both sides of the body are affected equally.

An injury to the upper portion of the spinal cord in the neck can cause quadriplegia-paralysis of both arms and both legs. If the injury to the spinal cord occurs lower in the back it can cause paraplegia-paralysis of both legs only.

Medically Reviewed by a Doctor on 1/28/2014

Spinal Cord Injury - Causes Question: What was the cause of your spinal cord injury?

Spinal Cord Injury - Symptoms Question: What were the symptoms associated with your spinal cord injury?

Spinal Cord Injury - Treatment Question: What was the treatment for your spinal cord injury?

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Spinal Cord Injury: Read About the Levels - MedicineNet

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