The spinal cord is the collection of nerves through which the brain transfers signals to the rest of the body. The spinal column protects the cord.

Encased by the protective spinal column and covered in a protective liquid called CSF (Cerebral Spinal Fluid) is the spinal cord. This consists of nerve fibres which are an important part of the human Central Nervous System.

The spinal cord connects the brain stem to the body in order for the brain to control the body and monitor the information sent back to it from the body.

Individually known as vertebra and collectively known as vertebrae, there are 33 bones that make up the spinal column.

Vertebrae are connected by muscles and ligaments. They are separated by a disc of cartilage to ensure they do not damage each other while moving.

Nerves go through holes in the vertebrae to connect the majority of the body between the brain and the pelvic area. This allow signals to be sent by the brain to all areas of the body.

The column also provides a frame for the torso and upper body that supports the body and facilitates mobility.

The spinal column’s 4 main purposes are as follows:

• To provide primary protection for the spinal cord
• To provide secondary protection for many internal organs
• To provide balance and an even distribution of weight to facilitate movement
• To provide support for the weight of the body and for an upright posture

The spinal column can be divided into 5 regions: cervical, thoracic, lumbar, sacrum and coccyx.

Cervical

Within the cervical region, at the top of the spinal column, there are 7 vertebrae that provide the neck and head with their wide range of movement.

Thoracic

Here there are 12 vertebrae which cannot move very much, although this region connects to the ribcage for structural strength purposes.

Lumbar

This region’s 5 vertebrae carry the majority of the weight of the body, so it is very strong but only has slightly more mobility than the thoracic region.

Sacrum

5 fused vertebrae make up the sacrum, which connects the spine to the hips behind the pelvis.

Coccyx

This is the very bottom of the spine, consisting of 4 fused vertebrae that act as a securing point for tendons and ligaments in the area of the body around the pelvis.

This type of injury is not common but is the most severe of spinal injuries.
The injury consists of damage to the full width of the spinal cord, resulting in a full loss of sensation, movement and function below the site of the injury.

The general rule is that the higher the area of injury to the spinal cord, the worse the extent and severity of the paralysis.

These injuries are sub-categorised as either complete tetraplegia or complete paraplegia.

Complete Tetraplegia

This is the most severe of all spinal injuries that do not result in death, as there is a loss of sensation, movement and function in the whole body below the point of injury which is situated in the vertebrae in the neck.

Complete Paraplegia

Where there is complete damage in the thoracic, lumbar or sacral regions of the spinal cord, the arms are not affected but there results a loss of sensation, movement and function below the chest.

This is more common but less severe than complete spinal cord injuries.

This type of injury does not sever the full width of the spinal cord but may seriously damage it, resulting in limited sensation, movement and function.

Incomplete spinal cord injuries are sub-categorised based on the location of the injury within the spinal column:

• Anterior Cord Syndrome: the front of the spinal cord
• Central Cord Syndrome: the centre of the spinal cord
• Posterior Cord Syndrome: the back of the spinal cord
• Brown-Sequard Syndrome: one side of the spinal cord
• Cauda Equina Syndrome: the nerves in the lower region of the column

The resulting effects of incomplete spinal cord injures are not as severe as complete spinal cord injuries. Nevertheless, they should not be dismissed as minor due the fact that they can have a life-altering impact.

Complete Tetraplegia

Primary effects may or may not include:

• Complete paralysis of the body and limbs or complete paralysis of the body and legs, but with some arm function and the ability to move the head and neck
• Loss of bowel control
• Loss of bladder functions
• Impaired ability to breathe without the aid of medical equipment
• Loss of ability to cough in order to get rid of waste in the windpipe

Secondary effects may or may not include:

• Kidney stones
• Osteoporosis
• Pressure sores
• Respiratory infection
• Deep vein thrombosis

Complete Paraplegia

Primary effects may or may not include:

• Complete loss of feeling in the legs and below the chest
• Loss of bowel functions
• Loss of bladder functions
• Reduced stability when sitting due to compromised abdominal muscles
• Loss of reproductive functions

Secondary effects may or may not include:

• Chronic pain
• Osteoporosis
• Pressure sores
• Pneumonia
• Deep vein thrombosis

Effects may or may not include:

• Feeling of vibration
• Preserved sense of self spatial awareness
• Loss of feeling of pain
• Loss of feeling of temperature
• Loss of general strength below the point of damage

Central Cord Syndrome

Effects may or may not include:

• All arm function is lost
• All hand function is lost
• Loss of bowel control
• Loss of bladder functions
• Reduced function in the legs which may have the potential for some improvement

Posterior Cord Syndrome

Effects may or may not include:

• Preserved muscle power
• Preserved feeling of pain
• Preserved feeling of temperature
• Lack of control of arms and legs
• Lack of coordination

Brown-Sequard Syndrome

Effects may or may not include:

• All effects take place below the point of damage in an asymmetrical pattern
• Complete loss of movement on one side of the body
• Preserved ability of movement on the other side of the body
• Feelings of pain and preserved feeling of temperature on the movement impaired side of the body
• Loss of feelings of pain and temperature on the side of the ability without movement impairments

Cauda Equina Syndrome

Effects may or may not include:

• Severe lower back pain
• Partial loss of movement and feeling
• Complete loss of movement and feeling
• Loss of bowel control
• Loss of bladder function

Acute Stage

As soon as the nature of the injury is ascertained, this stage of treatment and rehabilitation can begin. It often involves realigning the spine if it is out of shape and providing eating and breathing help if necessary. This is usually done in the intensive care unit of a hospital.

As An In-patient

The in-patient stage of treatment and rehabilitation either takes place at hospital or an in-patient centre. It aims to improve strength, mobility and functionality by teaching an injured person new ways to carry out tasks in their new circumstances and exercises in order to maximise their independence.

As An Out-patient

Out-patients live at home and have rehabilitation sessions at home or at centres. These sessions are constructed according to the needs of the injured person and they tend to change over time to become more effective, taking into account any progress made or any arising difficulties faced by the injured person. The general aim of the out-patient stage is to further maximise their ability to live independently.

Physiotherapy

Physical therapy is tailored to an individual depending on their existing strength post-injury and the nature of the effects of their injury with the aim to make key muscle groups stronger and increase their endurance abilities. This type of therapy can be very hard and frustrating for an injured person as it can be painful and fatiguing, especially early on in the process, so it is vital that family and friends get on board to encourage and even participate in the completion of physiotherapy in order to improve an injured person’s overall physical condition long term.

Psychotherapy

One type of psychotherapy, called Cognitive Behavioural Therapy (CBT) is extremely effective. It generally targets those with or at risk of depression as a result of their injuries. It aims to discover how an individual’s thought processes affect their actions and the way their actions affect their thought processes. By targeting thought processes and actions that reinforce them, negativity in their thinking can be reduced while positive thoughts are encouraged. This can help to reduce stress levels and allow a person to look ahead to the future by wielding a positive outlook.

Rational Emotive Therapy (RET) has become more used of late. This is a type of psychotherapy that tackles the irrational demands people place upon their life by having too much expectation about many aspects of it in order to negate the stress and anxiety that results from being disappointed by these unrealistic expectations.

Occupational Therapy

Tasks that were previously considered simple by the injured person, such as bathing, are likely to be difficult for many of those suffering from serious spinal cord injuries. This types of therapy aims to maximise a person’s independence by helping a person to adapt to their new level of capability in order to perform the tasks they need to on a daily basis.