Spinal injury

What is a spinal injury?

A spinal injury is damage to your spinal cord, the bundle of nerves that carries signals between your brain and the rest of your body. Depending on where the damage is and how severe it is, it can cause temporary or permanent changes to movement, feeling and other body functions below the site of injury.

What are the symptoms of a spinal injury?

Symptoms depend on which part of the spinal cord is affected and how severe the damage is. An injury higher up, in your neck, tends to affect more of the body than one lower down. You may notice:

• numbness, tingling, or a loss of feeling in your hands and feet
• weakness or paralysis, which is a loss of movement
• pain or pressure in your head, neck or back
• an unnatural or uncomfortable position of your spine or head
• loss of bladder or bowel control
• difficulty walking
• difficulty breathing
• changes in sexual function

An injury to the upper spinal cord can cause paralysis affecting all four limbs, known as tetraplegia. An injury lower down may only affect your legs and lower body, known as paraplegia.

What causes a spinal injury, and who is at risk?

A spinal injury usually happens after a hard blow that fractures or dislocates one of the bones (vertebrae) that protect your spinal cord. Most injuries do not cut through the spinal cord itself. Instead, pieces of bone tear into the cord or press down on it, damaging the nerves that carry signals.

Common causes include:

• motor vehicle crashes, the most common cause
• falls
• violence, such as gunshot or stab wounds
• sports injuries, particularly diving
• workplace or industrial accidents
• certain diseases and conditions, such as tumours, infections, or a loss of blood flow to the spinal cord

You may be at higher risk if you are aged 16 to 30, or over 65 and prone to falls, drink alcohol, or do not wear protective equipment such as a seatbelt or sports gear.

Are there different types of spinal injury?

Yes. Doctors describe a spinal injury as either complete or incomplete, and by where along the spine it happens.

• complete injury - the spinal cord cannot send any signals past the site of injury, so all feeling and movement is lost below it
• incomplete injury - the spinal cord can still send some signals, so some feeling, movement or function remains below the injury

The location also matters. Injuries in the neck (cervical spine) tend to affect the arms, hands and breathing as well as the legs. Injuries further down, in the mid back (thoracic), lower back (lumbar) or tailbone area (sacral), are more likely to affect the legs and lower body only.

How is a spinal injury diagnosed?

After an injury, a doctor will check for movement, feeling, breathing and responsiveness at and below the site of a suspected spinal injury. They may also arrange:

• an MRI scan, which shows damage to the spinal cord, discs, ligaments and blood vessels
• a CT scan, which is faster and shows broken bones or narrowing of the spinal canal
• X-rays, which can quickly show misaligned or broken bones

How is a spinal injury treated?

A suspected spinal injury following an accident is always a medical emergency, so treatment usually begins before you reach hospital.

Non-surgical treatment

• keeping the spine still using a rigid collar, backboard or brace, to prevent further damage
• medicines such as steroids, to reduce swelling and inflammation around the spinal cord
• traction, which holds you in place to limit movement

Once your condition is stable, treatment moves on to rehabilitation, combining physical therapy, occupational therapy and emotional support. This helps you regain strength, adapt to any changes, and become as independent as possible. Depending on your injury, this may include braces, a wheelchair, or devices that stimulate your nerves and muscles.

Surgical treatment

Surgery may be used to:

• remove fractured bone, disc material or other material pressing on your spinal cord
• relieve pressure within the spinal column (decompression surgery)
• realign and stabilise the spine

Some studies suggest that having surgery sooner after injury is linked to a better recovery of function, though this depends on the individual case.

When should I see a doctor?

A spinal injury is a medical emergency. Call 999 (or 112) straight away if you suspect one, for example after a road traffic accident, a serious fall, a sports injury, or a dive into shallow or unclear water.

While you wait for help:

• do not move the person unless they are in immediate danger, such as from fire
• keep their head and neck as still as possible, in the position you found them
• do not try to straighten or bend their neck
• do not remove a helmet if they are wearing one
• check their breathing, and if needed, give chest compressions only, without tilting the head back

If you have a long-term condition that you think might be damaging your spinal cord, such as unexplained weakness or numbness that is getting worse, see a doctor as soon as possible rather than waiting.