Spinal cord injury

What is meant by a spinal cord injury?

Spinal cord paralysis occurs as a result of a spinal cord injury, which can have various causes. When the motor pathways that transmit movement signals from the brain to the muscles are affected, paralysis occurs.

Immediately following an acute spinal cord injury, a condition known as "spinal shock" occurs. During this phase, the muscles affected by the spinal cord injury exhibit flaccid paralysis, and reflexes cannot be triggered. After 6 to 8 weeks, the actual spinal cord injury develops along with spastic paralysis. In this stage, muscle tone is increased without being controllable, often leading to painful muscle spasms.

What types of spinal cord injuries are there? 

There are different classifications for categorizing spinal cord injuries. Relevant classifications include:

Classification by type of paralysis

• Flaccid paralysis
• Spastic paralysis

Classification by affected muscle groups

• Paraplegia (paralysis of both legs)
• Tetraplegia (paralysis of both legs and both arms)

Classification by neurological impairment

The ASIA Impairment Scale (AIS) from the American Spine Injury Association defines 5 levels of impairment for spinal cord injuries:

• A: no sensory or motor function in the area innervated by the lowest spinal nerves (S4 and S5) (anal area)
• B: sensory function, but no motor function in the affected area
• C: sensory function, motor function partially preserved in the affected area, but not strong enough for daily use
• D: sensory function, motor function partially preserved in the affected area, strong enough for daily activities
• E: sensory and motor functions have returned to normal after a temporary disturbance

How does a spinal cord injury occur?

There are various ways in which a spinal cord injury occurs, and symptoms can appear either abruptly or gradually, depending on the cause. Possible causes are, for example:

• Injury, e.g., from a traffic accident (in such cases, the full extent of the damage may only become apparent with a delay due to tissue swelling)
• Tumor disease
• Infarction
• Haemorrhage
• Spinal canal stenosis (narrowing oft he spinal canal)
• Cerebrospinal fluid drainage disorder
• Infection (e.g. poliomyelitis, Coxsackie virus, chickenpox)
• Multiple sclerosis
• Congenital malformation
• Iatrogenic (medically induced), for example as a complication following an operation

If the entire cross-section of the spinal cord is affected by the damage, this is known as a complete spinal cord injury. This always involves paraplegia, along with other conditions. In the case of an incomplete spinal cord injury, only parts of the spinal cord cross-section are damaged. Here, paralysis only occurs if the motor pathways are affected.

The closer to the brain the spinal cord is injured, the larger parts of the body are affected by paralysis and/or sensory deficits.

How is a spinal cord injury diagnosed?

In the case of an acute spinal cord injury, the patient can suffer circulatory shock, either due to spinal cord damage or due to other causes, such as heavy blood loss in a serious accident. Stabilizing or securing the vital parameters (blood pressure, heart rate, oxygen saturation) is therefore the top priority.

To diagnose a spinal cord injury, a clinical neurological examination is carried out to test the strength of individual muscles as well as the sensory function. Further tests, such as X-rays or CT scans in the case of a spinal injury or suspected tumor, angiographies if an infarction is suspected, or blood tests for potential infections, are conducted depending on the most likely cause.

Which therapy and treatment options are available?

The treatment of spinal cord injury depends primarily on the cause. Surgery is often required, for example to treat an unstable vertebral fracture, to remove a tumor or to widen the spinal canal in the case of a spinal stenosis. With vascular complications like a heart attack or a hemorrhage, minimally invasive intervention via a catheter inserted through an artery might be an option. Medication treatment is also possible for certain causes, such as the use of immunosuppressants for multiple sclerosis.

All patients with spinal cord injury require treatment for possible complications like incontinence or respiratory paralysis, as well as pain management and rehabilitation that begins as early as possible to minimize any restrictions to their quality of life.

Rehabilitation for spinal cord injuries

There are various treatments available for the rehabilitation of people with spinal cord injury. These include, for example

• Physiotherapy
• Psychotherapy and patient education
• Music therapy
• Art therapy
• Occupational therapy
• Acupuncture
• Physical therapy

The federal working group for rehabilitation of the association of German pension insurance providers defines the following phases of rehabilitation for patients with spinal cord paralysis:

• Phase A: Acute treatment phase, usually in the intensive care unit.
• Phase B: Early rehabilitative therapies take place, but intensive medical care is still required.
• Phase C: Patients still need medical and nursing care but can actively participate in therapies.
• Phase D: Further rehabilitation after early rehabilitation is completed; patients are mobile with or without aids and no longer require extensive nursing care.
• Phase E: Occupational and social (re-) integration.
• Phase F: If permanent treatments are necessary, this is referred to as Phase F.

The speed at which the phases of rehabilitation are completed varies greatly from case to case. It is also possible for individuals to skip phases or to never fully complete a phase throughout their lifetime. On average, the duration of initial inpatient rehabilitation is 150 days for paraplegia and 200 days for tetraplegia.

Which doctors & clinics specialize in spinal cord injuries? 

While paralysis is primarily a neurological condition, the treatment and rehabilitation of people with spinal cord injuries generally requires additional expertise from other fields including orthopaedics and trauma surgery, psychiatry and psychotherapy, and physical and rehabilitative medicine. Many other professional groups, such as specially trained nursing staff, physiotherapists and occupational therapists, are also involved in providing the best possible care for patients.

To enable such interdisciplinary collaborations, there are centers for paraplegiology that specialize specifically in spinal cord injuries.

Anyone in need of a doctor would expect the best possible medical care for themselves. Therefore, patients are looking for the most suitable clinic for their needs. Since this is not an objective decision and a respectable doctor would refrain from claiming to be the best, patients must trust the experience of a doctor.

We can help you find an appropriate expert for your condition. All the doctors and clinics listed have undergone extensive review and have been verified by us for their outstanding expertise in the field of spinal cord injuries. They are looking forward to and are ready to address your questions and treatment requests.