Spinal Cord Injury

• Spinal Cord Injury - is caused by trauma or damage to the spinal cord

• Spinal Cord injury - Caused by trauma or damage to the spinal cord. Result in either a temporary or permanent alteration in the function of the spinal cord
• People at greatest risk for Spinal Cord Injury

  • Young adult men between ages 16 and 30 years
  • Eighty-one percent are male
• Most common causes of Spinal Cord Injury

  • motor vehicle collisions (42%)
  • falls (27%)
  • violence (15%)
  • sports injuries (7%)
  • other miscelaneous causes (8%)
• Primary Injuries


  • Tough layers of dura is rarely torn or transected by direct trauma
  • Can be due to cord compression by bone displacement, interruption of blood supply to the cord, or traction resulting from pulling on the cord
  • Penetrating trauma, eg, gunshot and stab wounds result in tearing and transection
  • Refers to the inital mechanical disruption of axons as a result of stretch or laceration
• Secondary Injury


  • Refers to the ongoing, progressive damage that occurs after the primary injury
  • Apoptosis (cell death) occurs may continue for weeks or months after the initial injury
  • Hemorrhagic areas in the center of the spinal cord appear within 1 hour
  • By 4 hours infarction in the gray matter
  • By 24 hours or loss, permanent damage may occur because of the development of edema
  • Edema secondary to the inflammatory response is particularly harmful because of lack of space for tissue expansion
  • Resulting hypoxia reduces the oxygen levels below the metabolic needs of the spinal cord
  • Lactate metabolites and an increase in vasoactive substances, including norepinephrine, serotonin, and dopamine
  • Vasoactive substances cause vasospasms and hypoxia necrosis
  • Edema extends above and below the injury-increasing the ischemic damage
• The extent of the injury and prognosis for recovery are most accurately determined at least 72 hours or more
• Neurologic damage

  • Results from primary injury (actual physical disruption of axons)
  • Results from secondary injury (ischemia, hypoxia, hemorrhage, and edema)
• Causes of traumatic injury

  • Motor vehicle crashes
  • Falls
  • Acts of violence
  • Sports injuries
• Causes of non-traumatic injury

  • cancer
  • Infection
  • Intervertebral disc disease
  • Vertebral injury
  • Spinal cord vascular disease
  • Osteoporosis/arthritis
• Conus Medullaris Syndrome


  Result from damage to conus (lowest portion of the spinal cord)
• Cauda Equina Syndrome


  Result from damage to cauda equina (lumbar and sacral nerve roots)
• Motor level


  Defined by the lowest key muscle function that has a grade of at least 3 (on supine testing), providing the key muscle functions represented by segments above that level are judged to be intact
• Muscle function scoring scale

  • 0 = total paralysis
  • 1 = palpable or visible contraction
  • 2 = active movement, full range of motion (ROM) with gravity eliminated
  • 3 = active movement, full ROM against gravity
  • 4 = active movement, full ROM against gravity and moderate resistance in a muscle specific position
  • 5(normal) = active movement, full ROM against gravity and full resistance in a muscle specific position expected from an otherwise unimpaired person
  • 5* = (normal) active movement, full ROM against gravity and sufficient resistance to be considered normal if identified inhibiting factors (i.e., pain, disuse) were not present
  • NT = not testable (i.e., due to immobilization, severe pain such that the patient cannot be graded, amputation of limb, or contracture of >50% of the range of motion)