In the emergency room, a doctor may be able to rule out a spinal cord injury by careful inspection and examination, testing for sensory function and movement, and by asking some questions about the accident.
But if the injured person complains of neck pain, isn't fully awake, or has obvious signs of weakness or neurological injury, emergency diagnostic tests may be needed.
These tests may include:
- X-rays. Medical personnel typically order these tests on people who are suspected of having a spinal cord injury after trauma. X-rays can reveal vertebral (spinal column) problems, tumors, fractures or degenerative changes in the spine.
- Computerized tomography (CT) scan. A CT scan may provide a better look at abnormalities seen on an X-ray. This scan uses computers to form a series of cross-sectional images that can define bone, disk and other problems.
- Magnetic resonance imaging (MRI). MRI uses a strong magnetic field and radio waves to produce computer-generated images. This test is very helpful for looking at the spinal cord and identifying herniated disks, blood clots or other masses that may be compressing the spinal cord.
A few days after injury, when some of the swelling may have subsided, your doctor will conduct a more comprehensive neurological exam to determine the level and completeness of your injury. This involves testing your muscle strength and your ability to sense light touch and pinprick sensations.
Unfortunately, there's no way to reverse damage to the spinal cord. But researchers are continually working on new treatments, including prostheses and medications that may promote nerve cell regeneration or improve the function of the nerves that remain after a spinal cord injury.
In the meantime, spinal cord injury treatment focuses on preventing further injury and empowering people with a spinal cord injury to return to an active and productive life.
Urgent medical attention is critical to minimize the effects of any head or neck trauma. Therefore, treatment for a spinal cord injury often begins at the scene of the accident.
Emergency personnel typically immobilize the spine as gently and quickly as possible using a rigid neck collar and a rigid carrying board, which they'll use to transport you to the hospital.
Early (acute) stages of treatment
In the emergency room, doctors focus on:
- Maintaining your ability to breathe
- Preventing shock
- Immobilizing your neck to prevent further spinal cord damage
- Avoiding possible complications, such as stool or urine retention, respiratory or cardiovascular difficulty, and formation of deep vein blood clots in the extremities
If you do have a spinal cord injury, you'll usually be admitted to the intensive care unit for treatment. You may even be transferred to a regional spine injury center that has a team of neurosurgeons, orthopedic surgeons, spinal cord medicine specialists, psychologists, nurses, therapists and social workers with expertise in spinal cord injury.
- Medications. Intravenous (IV) methylprednisolone (A-Methapred, Solu-Medrol) has been used as a treatment option for an acute spinal cord injury. But recent research has shown that the potential side effects, such as blood clots and pneumonia, from using this medication outweigh the benefits. Because of this, methylprednisolone is no longer recommended for routine use after a spinal cord injury.
- Immobilization. You may need traction to stabilize your spine, to bring the spine into proper alignment or both. In some cases, a rigid neck collar may work. A special bed also may help immobilize your body.
- Surgery. Often surgery is necessary to remove fragments of bones, foreign objects, herniated disks or fractured vertebrae that appear to be compressing the spine. Surgery may also be needed to stabilize the spine to prevent future pain or deformity.
- Experimental treatments. Scientists are trying to figure out ways to stop cell death, control inflammation and promote nerve regeneration. For example, doctors may lower the body temperature significantly — a condition known as hypothermia — for 24 to 48 hours to help prevent damaging inflammation. Ask your doctor about the availability of such treatments.
After the initial injury or the condition stabilizes, doctors turn their attention to preventing secondary problems that may arise, such as deconditioning, muscle contractures, pressure ulcers, bowel and bladder issues, respiratory infections, and blood clots.
The length of your hospitalization depends on your condition and the medical issues you're facing. Once you're well enough to participate in therapies and treatment, you may transfer to a rehabilitation facility.
Rehabilitation team members will begin to work with you while you're in the early stages of recovery. Your team may include a physical therapist, an occupational therapist, a rehabilitation nurse, a rehabilitation psychologist, a social worker, a dietitian, a recreation therapist, and a doctor who specializes in physical medicine (physiatrist) or spinal cord injuries.
During the initial stages of rehabilitation, therapists usually emphasize maintenance and strengthening of existing muscle function, redeveloping fine motor skills and learning adaptive techniques to accomplish day-to-day tasks.
You'll be educated on the effects of a spinal cord injury and how to prevent complications, and you'll be given advice on rebuilding your life and increasing your quality of life and independence.
You'll be taught many new skills, and you'll use equipment and technologies that can help you live on your own as much as possible. You'll be encouraged to resume your favorite hobbies, participate in social and fitness activities, and return to school or the workplace.
Medications may be used to manage some of the effects of spinal cord injury. These include medications to control pain and muscle spasticity, as well as medications that can improve bladder control, bowel control and sexual functioning.
Inventive medical devices can help people with a spinal cord injury become more independent and more mobile. Some devices may also restore function. These include:
- Modern wheelchairs. Improved, lighter weight wheelchairs are making people with spinal cord injuries more mobile and more comfortable. For some, an electric wheelchair may be needed. Some wheelchairs can even climb stairs, travel over rough terrain and elevate a seated passenger to eye level to reach high places without help.
- Computer adaptations. For someone who has limited hand function, computers can be very powerful tools, but they're difficult to operate. Computer adaptations range from simple to complex, such as key guards or voice recognition.
- Electronic aids to daily living. Essentially any device that uses electricity can be controlled with an electronic aid to daily living. Devices can be turned on or off by switch or voice-controlled and computer-based remotes.
- Electrical stimulation devices. These sophisticated devices use electrical stimulation to produce actions. They're often called functional electrical stimulation systems, and they use electrical stimulators to control arm and leg muscles to allow people with spinal cord injuries to stand, walk, reach and grip.
- Robotic gait training. This emerging technology is used for retraining walking ability after a spinal cord injury.
Prognosis and recovery
Your doctor may not be able to give you a prognosis right away. Recovery, if it occurs, typically starts a week to six months after an injury. The fastest rate of recovery is often seen in the first six months, but some people experience small improvements for up to one to two years.
Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.
Coping and support
An accident that results in paralysis is a life-changing event. Suddenly having a disability can be frightening and confusing, and adapting is no easy task. You may wonder how your spinal cord injury will affect your everyday activities, job, relationships and long-term happiness.
Recovery from such an event takes time, but many people who are paralyzed progress to lead productive and fulfilling lives. It's essential to stay motivated and get the support you need.
If you're newly injured, you and your family will likely experience a period of mourning and grief. Although the grieving process is different for everyone, it's common to experience denial or disbelief, followed by sadness, anger, bargaining and, finally, acceptance.
The grieving process is a common, healthy part of your recovery. It's natural — and important — to grieve the loss of the way you were. But it's also necessary to set new goals and find a way to move forward with your life.
You'll probably have concerns about how your injury will affect your lifestyle, your financial situation and your relationships. Grieving and emotional stress are normal and common.
However, if your grief and sadness are affecting your care, causing you to isolate yourself from others, or prompting you to abuse alcohol or other drugs, you may want to consider talking to a social worker, psychologist or psychiatrist. Or you might find a support group of people with spinal cord injuries helpful.
Talking with others who understand what you're going through can be encouraging, and members of the group may have good advice on adapting areas of your home or work space to better accommodate your current needs. Ask your doctor or rehabilitation specialist if there are any support groups in your area.
One of the best ways to regain control of your life is to educate yourself about your injury and your options for reclaiming an independent life. A range of driving equipment and vehicle modifications is available today.
The same is true of home modification products. Ramps, wider doors, special sinks, grab bars and easy-to-turn doorknobs make it possible for you to live more autonomously.
Because the costs of a spinal cord injury can be overwhelming, you may want to find out if you're eligible for economic assistance or support services from the state or federal government or from charitable organizations. Your rehabilitation team can help you identify resources in your area.
Talking about your disability
Your friends and family may respond to your disability in different ways. Some may be uncomfortable and unsure if they're saying or doing the right thing.
Being educated about your spinal cord injury and willing to educate others is helpful. Children are naturally curious and sometimes adjust rather quickly if their questions are answered in a clear, straightforward way. Adults also can benefit from learning the facts.
Explain the effects of your injury and what your family and friends can do to help. At the same time, don't hesitate to tell friends and loved ones when they're helping too much. Although it may be uncomfortable at first, talking about your injury often strengthens your relationships with family and friends.
Dealing with intimacy, sexuality and sexual activity
Your spinal cord injury may affect your body's response to sexual stimuli. However, you're a sexual being with sexual desires. A fulfilling emotional and physical relationship is possible but requires communication, experimentation and patience.
A professional counselor can help you and your partner communicate your needs and feelings. Your doctor can provide the medical information you need regarding sexual health. You can have a satisfying future complete with intimacy and sexual pleasure.
By nature, a spinal cord injury has a sudden impact on your life and the lives of those closest to you. When you first hear your diagnosis, you may start making a mental list of all of the things you can't do anymore. However, as you learn more about your injury and your treatment options, you may be surprised by all you can do.
Thanks to new technologies, treatments and devices, people with spinal cord injuries play basketball and participate in track meets. They paint and take photographs. They get married, have and raise children, and have rewarding jobs.
Today, advances in stem cell research and nerve cell regeneration give hope for a greater recovery for people with spinal cord injuries. At the same time, new treatments are being investigated for people with long-standing spinal cord injuries.
No one knows when new treatments will be available, but you can remain hopeful about the future of spinal cord research while living your life to the fullest today.
Preparing for your appointment
Traumatic spinal cord injuries are emergencies, and the person who's injured may not be able to participate in his or her care in the beginning.
A number of specialists will be involved in stabilizing the condition, including a doctor who specializes in nervous system disorders (neurologist) and a surgeon who specializes in spinal cord injuries and other nervous system problems (neurosurgeon), among others.
A doctor who specializes in spinal cord injuries will lead your rehabilitation team, which will include a variety of specialists.
If you have a possible spinal cord injury or you accompany someone who's had a spinal cord injury and can't provide the necessary information, here are some things you can do to facilitate care.
What you can do
- Be prepared to provide information about the circumstances of the event that caused the injury, including any that may seem unrelated.
- Ask another family member or friend to join you when you're speaking with the doctors, if possible. Sometimes it can be difficult to remember all the information provided. Someone who accompanies you may remember the details and help you communicate them to the person with the injury at the appropriate time.
- Write down questions to ask the doctors.
For a spinal cord injury, some basic questions to ask the doctor include:
- What's the prognosis?
- What will happen in the short term? What will happen over the long term? What treatments are available, and which do you recommend?
- What types of side effects can be expected from treatment?
- Could surgery help?
- What type of rehabilitation might help?
- Are there any alternatives to the primary approach that you're suggesting?
- What research is being done to help this condition?
- Do you have brochures or other printed material? Are there websites you recommend?
Don't hesitate to ask any other questions you have.
What to expect from the doctor
Your doctor is likely to ask questions, including:
- What were the circumstances that led to your injury?
- When did it occur?
- What do you do for work and leisure?
- With whom do you live?
- Tell me about your housing situation (home, apartment, number of stairs)?
- Do you or anyone in your family have a history of blood clots?
- Do you have any other medical conditions?
Dec. 19, 2017