Frequently Asked Questions & Answers
Spinal Cord Injuries & Traumatic Brain Injuries
Spinal cord injuries are those that result in damage to the spinal cord, a bundle of nerves that are located in the spinal column. There are two broad main categories: incomplete and complete.
Incomplete spinal injuries entail that the spinal cord has been partially severed or damaged. These injuries are increasingly common, accounting for more than 60% of spinal cord injuries due to increased medical knowledge and enhanced treatment. Some of the most common incomplete spinal injuries include:
Complete spinal injuries entail that the spine has been completely severed at the injury site, effectively eliminating function of the nerves located below. These injuries result in loss of function due to a complete severance of the spinal cord. However, it may be possible to regain some abilities with the help of therapy and other medical treatment.
While spinal cord injuries can result from damage to any portion of the spinal cord or nerves at its base, these injuries typically are divided into three main areas:
The cervical spinal cord consists of a total of eight vertebrae, ranging from the top to bottom as C1-C8. Cervical spine damage, such as a C6 spinal cord injury, may potentially impact everything below the top of the ribcage, therefore resulting in quadriplegia.
The thoracic spinal cord is situated in the middle of the spinal cord and contains 12 vertebrae, numbered T1-T12. This range of the spinal cord, in conjunction with spinal nerves, control the main trunk of the body and aids in coordinating movement in the lower body. Learn more about T1-T8 and T9-T12 spinal cord injuries.
The lumbar spinal cord is the lower region of the spinal cord, where it naturally begins to curve. This area of the spine consists of five vertebrae, numbered L1-L5. This region of the spinal column coordinates sensations in the lower body, including bladder and sexual functions.
The sacral spine, an area of vertebrae and nerves that exists between the bottom of the lumbar spine and the coccyx (tailbone), can undermine sensation in lower regions of the body. This region of the spine does not contain any spinal cord tissue. So while it is possible to injure the vertebrae or nerves, damage cannot be directly inflicted to your spinal cord at this location.
The coccygeal region consists of bones that may be fused together and a single vertebral nerve that is located at the base of the spinal cord.
The spinal cord, essentially, is the signal communication superhighway between the brain and the rest of the body. It is a bundle of nerve cells and fibers that is protected by the spinal column, or a series of vertebrae (bones) that run vertically along the center of the back from the hips to your skull. The spinal cord and spinal column are two separate structures.
From a high-level overview, human spinal cord anatomy consists of the cervical spinal cord, the thoracic spinal cord, the lumbar spinal cord, sacral spinal nerves, and single the coccygeal spinal nerve. It is important to understand that the spinal cord and spinal column have separate naming segmentations that do not always correspond.
There are two types of oxygen deprivation: Cerebral hypoxia, which occurs when oxygen supply to the brain is reduced but not completely eliminated, and cerebral anoxia, which is a complete lack of oxygen to the brain. Read more about the basics of brain oxygen deprivation.
Because the brain relies on oxygen, even just a minute of deprivation can cause temporary or permanent damage. Lack of oxygen symptoms can include changes in mood or personality, memory difficulties or dementia-like symptoms, chronic pain or the inability to feel pain, difficulties with impulse control, and changes in motor skills.
Cerebral hypoxia occurs when oxygen supply to the brain is reduced, often as the result of decreased blood flow, but is not completely eliminated. This differs from cerebral anoxia, which is a complete lack of oxygen to the brain.
Because the brain relies on oxygen, even just a minute of deprivation can cause lasting or permanent damage. Hypoxia of the brain, which can result in short-term and long-term brain damage, can be identified in four distinct categories that range in severity: Diffuse cerebral hypoxia, focal cerebral ischemia, global cerebral ischemia, and cerebral infarction.
Learn more about hypoxia of the brain, its symptoms, short- and long-term effects, and available treatment options.
The paralysis definition we will use includes the partial or full loss of movement, often in response to an injury or illness that most commonly affects the spine. Strokes can be caused by a number of factors, most commonly a stroke (29%), followed by spinal cord injury (23%), multiple sclerosis (17%), cerebral palsy (7%), and other injuries and ailments.There are four main categories of paralysis:
In the case of spinal cord injuries, tetraplegia and paraplegia are the two most common forms of paralysis.
Cervical spinal cord injuries are among the most devastating, affecting the largest areas of the body and resulting in limited or lack of movement or feeling below the injury sites. These injuries can impact the high cervical nerves (C1-C4) or low cervical nerves (C5-C8).
Unfortunately, there is no way to fully reverse the damages to the cervical spine. However, there are options for treatment to help patients. Early recovery focuses on stabilizing the cervical spine, regulating respiratory functions and blood clot prevention efforts. Long-term rehabilitation includes spinal surgery, steroid injections, physical therapy, and experimental stem cell injections. Lastly, mental health is an important component of physical health. Speaking with a mental health professional who specializes in patients with paralysis often is highly beneficial to a patient’s recovery.
Massages, in general, can be highly beneficial to the physical and mental health of spinal cord injury (SCI) survivors. However, in addition to studies that show the positive benefits of massage, there also are studies that show the potential risk posed by massage for individuals with certain conditions. Among the differences between a general massage for relaxation and a deep tissue massage is the amount of force or pressure applied to the body.
According to LiveStrong, deep tissue massage can result in increased pain and contusions (bruising), blood clots, and nerve damage. SCI survivors often already face issues with nerve damage and are at increased risk of blood clots, so anyone with an SCI should have a candid discussion with their doctor before getting a deep tissue massage.
While there currently is no all-inclusive “cure” for paralysis that results from spinal cord injuries (SCI), there is research taking place around the world to try to find ways to reverse spinal cord damage enough to essentially “cure” it.
Treatments to facilitate spinal cord injury recovery vary depending on the type, location and severity of injury. Some types of treatment are encompassed in four main categories: neuroprotection, regeneration, cell replacement, and CNS circuit retraining. One experimental treatment that shows promise is epidural electric stimulation, which applies electrical stimulation to the lumbosacral spinal cord (lower spinal cord) to restore autonomic and motor functions below the injury site. Early clinical trials have shown promising results, with one resulting in a previously paralyzed patient being able to voluntarily move his or her legs for the first time in years. Learn more about ongoing epidural electrical stimulation research.
Activity based therapy centers have also been extremely beneficial in providing paralysis recovery.
The use of stem cells in medical research for the treatment of spinal cord injuries, though highly debated, shows promising results as a potential future cure for paralysis. This key research aims to use stems cells to help repair damaged or degenerating spinal nerve cells and motor axons to aid in the regeneration of spinal cord function. Stem cells are gathered from two main sources: embryonic stem cells and somatic stem cells gathered from throughout the body.
However, while the use of this experimental transplantation of cells in animal research has demonstrated repair of spinal cord material by replacing dead nerve cells and generating new ones to stimulate regrowth, this still requires further exploration and is still in the testing stages.
Much like a concussion, a brain contusion (bruise) is a form of traumatic brain injury (TBI) that often results from a fall or blow to the head. A contusion is a localized injury that ranges from relatively minor to life threatening.
Much like a skin bruise, it involves bleeding under the skin (subdural hematomas) and can result in a number of symptoms, including changes in personality or intelligence, memory challenges, localized numbness, and difficulty speaking or moving. Subdural hematomas can have deadly consequences and require immediate medical attention.
The human brain uses about 20% of the body’s oxygen supply. Hypoxic brain injuries occur when the brain receives less oxygen than it requires without completely depriving it. This differs from cerebral anoxia, which entails complete oxygen deprivation of the brain.
As a general rule of thumb, brain damage that results from loss of oxygen begins at the one-minute mark and can cause immediate or long-term brain damage. Hypoxic brain injury recovery depends on the length of time that the brain goes without oxygen. Brain cells begin dying after the first minute of oxygen loss. Neuron sustain extensive damage after three minutes of oxygen deprivation, increasing the chances of lasting brain damage. Death becomes imminent at the five minute mark after oxygen deprivation — even when an oxygen supply is restored.
An unusual but effective preventative treatment for brain damage includes therapeutic hypothermia, or what is referred to as “brain cooling.” This process involves reducing the patient’s body temperature to a subnormal level to chill the brain and slow metabolic processes. This reduces the amount of oxygen needed by the brain and aids in slowing the processes that result in brain damage.
A contusion and a concussion are both considered forms of serious traumatic brain injuries (TBI). However, the two injuries are fundamentally different: A contusion is a localized injury and bleed in the brain, whereas a concussion is a wide-reaching brain trauma. While both can result from impacts to the head, falls, accidents or other causes, their symptoms and treatments also differ. Contusions can be treated with antibiotics and surgery to reduce brain swelling and to control any damage, whereas concussions must be monitored closely and the symptoms may begin to subside on their own over time.
Gray matter and white matter both exist in the brain and spinal cord. Gray matter, named for its pinkish-gray hue, contains axon terminals, neural cell bodies, and all nerve synapses. This form of brain tissue is prevalent in the cerebellum, cerebrum and brainstem, also forming a butterfly-shaped portion of the central spinal cord.
White matter, on the other hand, is comprised of axon bundles that are coated with myelin, a mix of proteins and lipids, that protects the axons and aids in conducting nerve signals between the brain and the rest of the body.
Injuries to the lumbar spine, which encompasses a lower area of the spinal column below the cervical and thoracic regions and above the sacral spine (L1-L5), are severe but not necessarily life-threatening. It is important to note that not all spinal injuries result in paralysis. Damage to this section of the spine may result in weakness or numbness in the hips and groin and can affect the lower abdominal muscles and thigh flexion.
Whether an injury is incomplete or complete helps to determine the severity of the injury and its resulting symptoms. Something that sets the lumbar section of the spine apart from the thoracic or cervical spine is that the spinal cord does not extend its entire length; after L2, nerve roots exist each of the remaining lumbar levels.
Injuries that occur between C1-C8 of the cervical spine can result in tetraplegia (commonly referred to as quadriplegia), or an injury that affects all of a person’s limbs to a certain extent. For example, a C3 or C6 spinal cord injury can result in a loss of function of both legs and arms, depending on the severity of the spinal cord damage.
Paraplegia, however, is the result of an injury in the spinals section below, or what are referred to as the thoracic or lumbar regions of the spine (T1-L5). With this injury, the legs and sometimes part of the torso are affected, meaning that the patient is still able to use full function of his or her hands.
The circumstances surrounding spinal cord injuries (SCI) vary from person to person. Additionally, depending on whether the SCI is incomplete or complete also will play a crucial role in a person’s prognosis and whether they may again walk. Unfortunately, there is no cure for a completely severed spinal cord and therefore is no guarantees about an outcome.
The greatest chance for recovery involves undergoing immediate treatment and rehabilitation, as well as time, commitment and having a positive attitude. This may require surgery to remove any obstructive elements or to realign the spinal column, using supportive braces or other equipment, and occupational or physical therapy. Some people have responded well to acupuncture and chiropractic methods, although there is no scientific proof that these methods will affect paralysis symptoms.
Yes, there are a number of government, non-profit and private organizations that provide grants and other financial assistance to those who have survived spinal cord injuries. Some of the organizations include the Travis Roy Foundation, The Christopher and Dana Reeve Foundation, Spinal Cord Opportunities for Rehabilitation Endowment (SCORE).
Hemiplegia is a form of paralysis that affects one side of the body, often one arm and leg, although the paralysis sometimes can be experienced in the torso as well. Most commonly associated with cerebral palsy, this weakness or lack of sensation that leads to paralysis indicates an issue with one side of the brain, which is unable to produce, send or interpret signals as the result of disease or a traumatic injury, such as a traumatic brain injury (TBI).
In the early stages, patients often report experiencing the sensation of pins and needles before the situation progresses to muscle weakness and full paralysis.
Spinal shock is the temporary reduction or loss of reflexes resulting from a spinal cord injury (SCI). The more severe the injury and shock to the autonomic nervous system, the more severe the resulting dysfunction will be. As a result, the spine experiences either hyporeflexia or areflexia, a reduction or loss of reflexes. Learn more about the stages of spinal shock, as well as treatment options and prognosis.
Monoplegia is the paralysis of one area of the body, such as an arm, and most often is associated with cerebral palsy. Most people who monoplegia experience a slow deterioration in functioning, beginning with limpness or weakness in the affected area and ultimately leading to a partial or full paralysis of the limb.
Yes, it is still possible for men to have sex and to get their partners pregnant after surviving a spinal cord injury (SCI). However, engaging in sexual relations after sustaining a SCI will be different experience than what people have done before suffering their injuries. Loss of sensitivity, muscle movement and sexual reflexes often result from sustaining an SCI. However, the impact the injury has on a person’s fertility and ability to achieve arousal and orgasm will vary depending on the location and severity of his or her injury.
Sexual function after spinal cord injury are among the primary obstacles to fertility for both men and women. These issues can include a lack of desire and sexual sensations that result in decreased self-esteem. For men, SCIs can result in a loss of an ability to get or hold an erection and to ejaculate. This means that they may not be able to get their partner pregnant if they have issues sustaining an erection. However, there are therapy and alternative options, including penis pumps or electro stimulation to facilitate an erection or ejaculation.
For women, lubricants can help them to safely have sex and by help sperm travel more efficiently. There also are other alternatives to getting pregnant, including intrauterine insemination, in-vitro fertilization, hormonal treatments and medications, or even surgery to clear blocked fallopian tubes or to remove uterine scar tissue or fibroids.
Although it is relatively rare to have an extra bone, such as a sixth lumbar vertebrae (known as a transitional vertebra), it is not actually that extraordinary. It is estimated that about 10% of adults have some form of spinal abnormality, which can include an extra vertebra.
While having an extra bone typically does not serve any function, it also typically results in no symptoms for most people. However, if the bone should fuse with another bone, it can cause back pain or lead to bulging or herniated discs. For individuals with spinal cord injuries, it is particularly important to let your doctor know if you have an extra vertebrae to ensure there is no miscounting during assessments and treatments.
The occipital lobe, the smallest brain lobe, is located beneath the occipital bone at the back of the skull, sitting under the parietal lobe and above the temporal lobe. This region of the brain is home to the brain’s visual cortex, which enables you to see and process visual stimuli, measure distance, determine color properties, and transmit information to other areas of the brain that assign meaning to and remember what you see.
However, researchers now believe that the lobe’s functions may extend beyond those responsibilities by receiving information from other brain lobes, although the extent of this functional collaborates remain unknown.
Sacral sparing is a spinal cord injury phenomenon in which some or all function remains intact below the injury site at the sacral spine level. The sacrum is a triangle-shaped 5-segment bone located at the lower spine between the lumbar region and the tailbone.
Incomplete spinal cord injuries to the sacral spine are often referred to as sacral sparkings. When a sparing occurs, it means that the spinal cord is partially compressed but not entirely severed, leaving some of the motor functions intact.
The topic about whether the spinal cord can be considered an organ continues to be a subject of much debate within the medical community. While the spinal cord plays a vital role in the body, some argue that the spinal cord is strictly a bundle of nerves that the brain uses to communicate information to the rest of the body. The fact that many of the body’s organs can still run without a functioning spinal cord helps to support this argument.
However, many other medical professionals are beginning to support the ideology that the spinal cord is, in fact, an organ because it is consists of common tissue and acts as a single function unit, receiving and sending signals from and to the brain and the rest of the body.
There are many functions of the spinal cord, the greatest of which is serving as the signal relay channel from the brain to the rest of the central nervous system and back. The nerves in the spinal cord relay these messages to and from the brain.
Some of the other major functions of the spinal cord include controlling sensory functions and motor functions, such as walking and controlling motor and conditioned reflexes (such as automatically retracting your hand from a hot stove burner or automatically reacting to a certain stimulus).
Although injuries to the lumbar spine, including L4 and L5, are severe, they alone are not typically life-threatening, however other injuries or complications caused by the traumatic event certainly can be. The lumbar spine, which is located below the cervical and thoracic sections, consist of five vertebrae that control areas that include the hips and groin, and sometimes also the lower abdominal muscles and thigh flexion as well. As with other spinal cord injuries, the completeness of the injury — whether the spinal cord is partially severed (incomplete) or completely severed (complete) — will determine the true severity of the injury and its resulting symptoms.
The spinal cord is a bundle of nerves that run vertically through a cavity in the spinal column called the vertebral foramen, which exists between the intervertebral disk and the spinous process along the back of the spine. The spinal cord features a protective myelin sheath that helps to insulate the individual nerves.
The spinal column, the cord’s main protection, consists of a series of 33 protective bones called vertebrae that are divided into five main sections: the cervical spine (C1-C7 in the upper spine), thoracic spine (T1-T12 in the next level down), lumbar spine (L1-L5 in the level below that), and the sacrum (5 fused vertebrae), and the coccygeal section (the lowest level, which contains 4 vertebrae).
The most severe types of spinal cord injuries (SCI) are those that affect the cervical spine because they often can result in quadriplegia, or paralysis of the body below the injury site. As a result, the SCI survivor has little to no mobility, which can lead to a number of increased health risks. Respiratory impairment that results from high cervical spine injuries is characterized by low lung volumes and weakness in respiratory muscles and decreased ability to cough.
Depending on the severity of the injury and location of its damage in the spinal cord, respiratory functions can be impacted to the point that a person’s ability to breathe, cough, or swallow on their own is impeded, and they may be required to use a ventilator. Additionally, SCI survivors are more prone to developing respiratory infections, which are the leading cause of death for individuals with spinal injuries.
Life after sustaining a spinal cord injury (SCI) is different for everyone. No two people sustain the exact same injury, so the severity of the injury and location of damage to the spinal cord will play a role in determining your initial condition. Some SCI survivors can experience a limited loss of sensation or mobility, whereas others with more severe injuries can experience complete paralysis. Some additional changes may include limitations or loss of independence and changes to or loss of sexual and excretory function control.
Each of these changes can change the day-to-day functions of life for you and your family. It can result in needing to reside at a specialized care facility, moving from a one-story to a two-story house, having to change jobs or not be able to work, hiring a home care worker, and needing to attend many treatment and therapy appointments.
What plays a critical role in your life after an SCI is keeping a positive attitude and mental mindset. Read or watch videos from some SCI survivors in the SpinalCord.com online community to hear about their experiences, learn some coping strategies, and to find support.
After sustaining a spinal cord injury (SCI), your recovery is dependent on you receiving comprehensive, ongoing treatment — and the earlier your treatment begins, the greater your chance for recovery. The cost associated with quality treatment for a traumatic SCI can be astronomical, reaching upwards of $1 million or more in the first year, according to the Dana and Christopher Reeve Foundation. And every year afterward, the costs can reach hundreds of thousands of dollars per year, depending on the severity of your injury.
An injury that affects the C1 vertebrae is often referred to as an upper cervical spinal injury. If the cervical spine injury is a fracture that affects the anterior and posterior arches of the C1 vertebra, it is commonly referred to as an Atlas fracture (because the C1 vertebra is known as the Atlas) or a Jefferson fracture, which is named after the neurosurgeon who named this type of injury. However, it is important to note that a Jefferson fracture does not always result in a spinal cord injury; SCI typically occurs when the transverse ligament also has been ruptured.
There are four main forms of paralysis.
In the case of spinal cord injuries, paraplegia and tetraplegia are the two most common forms of paralysis.
Injuries to the cervical spine, including C3 and C4, are the most severe of all spinal cord injuries. The greater the level of damage to this spinal region, the more functional loss that results in the central nervous system. Survivors are likely to experience limited mobility in the flexion and extension (the movement of the chin toward the chest, and the backward movement of the head, respectively) of the neck, as well as breathing difficulties or need for a ventilator, quadriplegia, and difficulty or loss of bladder or bowel function.
Unfortunately, there currently is no treatment to completely reverse the damage from spinal cord injuries ac C3-C5. However, some individuals have had experienced great success in their recoveries, including Dana, who recovered full function of the muscles in her hands and arms.
Injuries to the C1 and C2 vertebrae, known respectively as Atlas and Axis, are the most severe of all spinal cord injuries, lead to paralysis and often are fatal. The upper cervical spine, including the occiput, C1 and C2, is a functionally distinct unit compared to the lower cervical spine and is primarily responsible for rotational movement.
Due to loss of function of the central nervous system below the injury site, many survivors of C1-C2 spinal cord injuries many need assistance breathing with a ventilator and may experience a reduced or complete loss of speaking abilities. These types of spinal cord injuries are classified as incomplete or complete, depending on the severity of the damage to the spine.
A compression of C3 and C4 means that the vertebrae or nerves in the midsection of the cervical spine, near the base of the neck, are compressed. Injuries that impact the nerves and tissue in this upper spinal region are the most severe because they cause the most damage to the body’s central nervous system. Compression of spinal cord nerves can result in temporary quadriplegia, a form of paralysis, until swelling subsides or a spinal decompression procedure is performed.
Blood circulation dysfunctions is one of the most common challenges that people face after sustaining a spinal cord injury (SCI). “Cardiovascular disturbances are the leading causes of morbidity and mortality in both acute and chronic stages of SCI,” according to a study on vascular functions. Vascular dysfunctions also can increase the risk for deep-vein thrombosis, or blood clots in deep veins. Massage helps to improve blood circulation in the body. A study at the University of Alberta found that improved blood flow or inhaling more oxygen helped to increase cord oxygenation and improved motor functions in rat test subjects that experienced compromised spinal blood flow due to SCI.
A person’s mental and physical health also are connected — this is particularly true for people with chronic illness and those that have sustained catastrophic injuries. A study on the effects of massage on patients with spinal cord injuries shows that the patients who underwent massage treatments experienced increased development of muscle strength and improved wrist range of motion.
Injuries to the cervical spine, particularly C1 and C2, often are considered the most devastating of spinal cord injuries, either killing or leaving individuals fully paralyzed. Because of the close proximity to vertebral arteries, the disruption at C1 and C2 also can inflict neurological damage by depriving the brain of vital blood and the oxygen it carries.
The chance of C2 fracture recovery is dependent on several factors, mainly the individual circumstances of the injury. Immediate treatment is critical for the recovery of patients who sustain C1 and C2 injuries. Securely stabilizing the head helps to prevent further damage from being inflicted and encourages healing. Learn more about some of the fundamentals of these injuries and the latest treatments.
The types of spinal cord injuries (SCI) with the best spinal cord injury prognoses are those that have not resulted in paralysis. However, this most critical factors to a patient’s recovery include the patient receiving immediate and effective medical treatment, and the location and severity of the injury. The sooner that treatment begins, the faster the muscles below the injury site can begin to regain strength, and therefore improve the prognosis.
Spinal cord injuries are traumatic for patients and their families. They cause disruptive changes to every aspect of your life and there is a lot of new information to navigate and understand. Our experts have collected everything in one place to help you learn more about your injury, locate doctors and treatment centers, find financial support, and get assistance navigating your next move.
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