Spinal cord injuries

Key points about spinal injuries

  • A spinal injury happens when damage or trauma to your spinal cord leads to the loss of movement, function or sensation below the site of the injury.
  • The spinal cord runs through the centre of your spine.  Damage to it can affect a number of body functions.
  • The amount of function lost tends to relate to the level in your spinal cord where the damage takes place.
  • Severance (complete cutting) of the spinal cord does permanent damage. 
  • Many people with spinal cord injury can do most things that the rest of the community can and live fulfilling lives with all levels of spinal injury.
  • Leading a healthy lifestyle can help to avoid or minimise health issues that can arise from long-term immobility.
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The spinal cord contains the nerves that carry messages between your brain and the rest of the body. The cord passes through your neck and back. Damage to your spinal cord can occur when its blood and oxygen supply is disrupted and/or pressure is applied to it. 

Frequent causes of damage are traumatic accidents such as motor vehicle incidents, falls, violence and sports activities. There are also many diseases that can cause spinal cord injury such as transverse myelitis, multiple sclerosis, cervical myelopathy, infections, tumours, disturbance to the blood supply and motor neurone disease.

Video: ASK DR. B - Episode #1 - Magazines

Watch this video from New Zealand Spinal Trust explaining about spinal injury. This video may take a few moments to load.

 (New Zealand Spinal Trust, NZ, 2019)

For more videos the same series, visit Ask Dr. B(external link), New Zealand Spinal Trust

The symptoms experienced are different for everyone and depend on the level at which the spinal cord is damaged. They can include: 

  • loss of feeling or numbness
  • loss of mobility (motor function)
  • loss of bowel or bladder control
  • loss of temperature control
  • severe pain in your neck, head or back
  • paralysis or difficulty with balance or walking
  • stinging sensations
  • oddly positioned or twisted neck or back
  • difficulty breathing at higher levels near your neck. 

A physical examination is often the first test that is performed. The doctor may assess your muscle tone, strength, reflexes and your ability to sense touch and pin-prick. Other common tests doctors may use to assist diagnosis include:

Spinal injuries can be diagnosed as:

Complete – When your spinal cord is completely damaged and there is total loss of feeling and the ability to control movement below the injury.

Incomplete – When there is some movement and/or sensation below the injury. Types of incomplete spinal cord injury include conditions such as brown sequard syndrome, central cord syndrome, posterior cord syndrome and anterior cord syndrome.

When a spinal injury causes paralysis, paraplegia refers to the loss of function in 2 limbs, usually your legs. Quadriplegia and tetrapleglegia refer to functional loss of your arms and legs and usually includes your trunk (main body area). 

Treatment for spinal cord injuries has 3 key phases. 

1. Minimising further injury to your spinal cord

  • If you suspect a spinal injury and need to perform first aid, do not move the injured person as permanent complications can result. Call 111 for emergency medical assistance.
  • Keep the person's head, neck and back aligned and prevent unnecessary movement.
  • Provide as much first aid as possible without moving the person's head or neck.
  • If the person is wearing a helmet, don't remove it.
  • In hospital, further steps will be taken to stabilise the spine. This can include traction or braces.
  • Sometimes surgery is needed and any other injuries need to be treated.

2. Rehabilitation

  • This involves a combination of physical therapies and occupational therapy tailored to each person's needs.
  • This phase also usually includes counselling for both the person and their loved ones to help the adjustment and recovery process.

3. Preventing and managing long-term complications

Health issues that may arise for people with spinal cord injuries include:

Talk to your doctor about the best way to prevent and manage these conditions.

If you get a spinal injury, it is likely you and your whānau/family will experience a period of grief. Grief is a healthy and important part of recovery. It can be helpful to talk about your disability and educate yourself about spinal injuries and technologies that can assist you. 

Other self-care includes:

  • learning about how to avoid pressure injuries
  • learning about how to avoid urinary tract injuries
  • setting goals for your future.

If I have a spinal injury, how can I prevent pressure injuries?

One of the health risks associated with having a spinal injury is getting pressure injuries or sores. Knowing the signs of a pressure sore or injury and what to do about them are important steps towards preventing them. Here are some tips from a health consumer with a C4–C5 spinal injury.

Have a good self-care routine

Taking good care of yourself, including getting enough sleep and healthy food sets your body up well to fight off any infections.

Know the signs to watch out for

Self-awareness of what is happening in your body that might indicate a pressure injury or infection means you can catch it early. A high temperature, urine smell changes, bowel accidents and increased spasms are all signs to look out for.

Reposition regularly

Regularly moving position in bed is key to avoiding pressure injuries. Your nurse or health specialist can indicate how often is needed through the night. 

Have the right equipment

Because most people with C4–C5 spinal injuries don’t feel them occurring, you need to have up-to-date mattresses and wheelchair cushions as a form of protection against them incurring.

Be informed

If you get a pressure injury, ask what happened prior to it occurring. For example, was the support worker trained properly? Was adequate care taken, eg, care plans read and adhered to? This can help you to make sure you get the correct treatment in the future.

Spinal injuries can happen to anyone, but you may be at greater risk if you are male, a young adult, drink alcohol, engage in risky behaviour or have an existing condition like osteoporosis. To reduce your risk:

  • drive safely, and never drink and drive
  • check water depth before diving
  • wear the recommended safety gear when playing sports
  • avoid leading with your head in sports, eg, don't slide head-first in rugby. 

NZ Spinal Trust(external link) Information, resources and support for people living with spinal cord injuries and their families
Kaleidoscope(external link) Vocational rehabilitation programme
Back on track(external link) Spinal injury rehabilitation handbook
Parafed Auckland(external link) Sporting and recreational opportunities
Spinal Support(external link) A non-profit organisation assisting the rehabilitation of spinal patients
Information for carers(external link) Carers NZ
It's accessible(external link) Opportunities to learn more skills
Helping you recover from an injury(external link) ACC,NZ

Video: Bulletproof – Gareth

A daring university stunt that went horribly wrong left Gareth Lynch with a permanent spinal injury. This video follows the self-confessed adrenalin junkie as he regains independence. This video may take a few moments to load.


(Attitude Live, NZ)

Video: Janine Shepherd: A broken body isn't a broken person

This video may take a few moments to load.


(TED talks, 2012)

Video: Life Changes After a Spinal Cord Injury (Bulletproof: Ashley)

In January 2019, 30-year-old Ashley Treseder dived off a pier at Shoal Bay in NSW, broke his neck, and became a C4 tetraplegic. After six months of rehabilitation, Ash is starting from scratch in his new home with the support of family and friends. This video may take a few moments to load.


(Attitude NZ, 2019)

Video: Bulletproof: Anita

A life-changing quad bike accident at 18 left Anita Kendrick paraplegic. But with determination and a few adaptations, she’s managed to get back to her job as a shepherd on a King Country farm. This video may take a few moments to load.


(Attitude Live, NZ)

Video: Overcoming a Spinal Cord Injury: Claire's Story

A spinal injury at 17 didn't stop Claire Freeman achieving her dreams of completing a design degree, Masters and now PhD in the powerchair. Despite ticking things off her bucket-list, she was severely depressed. In a bizarre twist of fate, it was a mishap in a routine operation, which forced her to pause and address her issues… nearly two-decades after her car accident. This video may take a few moments to load.


(Attitude NZ, 2017)

Video: Bulletproof: Sophie takes life on

In 2016, a horse riding accident left Sophia Malthus tetraplegic. But determined to turn her situation into a positive, she’s saying ‘yes’ to all opportunities as she figures out what her future holds. This video may take a few moments to load.


(Attitude Live, NZ)

To view more videos of the same series, visit Attitude Live: Bulletproof(external link) (Attitude Live, NZ)

Video: I am tetraplegic 

Video – the story of Patrick Bronte, who lost all feeling below his neck after hitting a shallow ledge when diving into a local river. This video may take a few moments to load.

(external link) 
(TVNZ, NZ, 2019)

Auckland Spinal Rehabilitation Unit(external link) Healthpoint, NZ
Spinal cord injury information(external link) SCI Info Pages
Staying healthy after a spinal cord injury(external link) University of Washington, US
Spinal cord resource centre(external link) United Spinal Association, US
Resources(external link) Spinal Cord Injury, Australia
Helping prevent pressure injuries(external link) ACC, NZ

Resources

NZ spinal cord impairment action plan [DOCX, 1.2 MB] Ministry of Health and ACC, NZ, 2014
Spine conditioning program(external link) American Academy of Orthopaedic Surgeons, 2012
Guide for trauma patients and whānau brochure, National Trauma Network, NZ, 2020. Available in the following languages: English(external link), te reo Māori(external link)

References

  1. Kirshblum,SC. Stephen P. Burns, SP. et al. International standards for neurological classification of spinal cord injury (revised 2011)(external link) J Spinal Cord Med. Nov 2011; 34(6): 535–546.
  2. Spinal cord injury – paraplegia(external link) Better Health Channel, Australia

Clinical resources

Continuing professional development

Video: Mr Dean Mistry - Orthopaedic Spine Surgeon - 2019 Goodfellow Symposium

Dean Mistry talks about the approach to a patient with spinal problems in the Goodfellow Symposium 2019. This video may take a few moments to load.

(Mobile Health NZ, 2019)

Brochures

spine

NZ spinal cord impairment action plan

Ministry of Health and ACC, NZ, 2014

spine conditioning program aaos

Spine conditioning program

American Academy of Orthopaedic Surgeons, 2012

guide for trauma patients and whanau eng

Guide for trauma patients and whānau brochure
National Trauma Network, NZ, 2020
English, te reo Māori

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Dr Jeremy Steinberg, FRNZCGP

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