Other Spinal Cord Injuries

Apart from paraplegia and quadriplegia, spinal cord injuries (SCI) can invoke a number of related health issues and injuries.  Some of the more common conditions include:

• Bladder and Bowel Dysfunction
• Bony Dysfunction
• Cardiovascular Disease
• Deep Vein Thrombosis (DVT)
• Heterotopic Ossification (HO) & Cysts
• Hyperthermia & Hypothermia
• Neuropathic / Spinal Cord Pain
• Osteoporosis and Fractures
• Respiratory Dysfunction, Pneumonia, Atelectasis (collapsed lung), Aspiration, Restrictive Lung Disease
• Postural (Orthostatic) Hypotension
• Spasticity
• Syringomyelia
• Vascular Dysfunction

Incomplete Spinal Cord Injuries

Anterior Cord Syndrome: damage towards the front of the spinal cord can leave a person with a lack of or impaired ability to sense pain, temperature, and touch sensations below their level of injury.  However, in some instances pressure and joint sensation may be preserved, and it is possible for some people with this injury to later recover some level of movement.

Central Cord Syndrome: when the damage is in the center of the spinal cord, this typically results in loss of function to the arms, although some leg movement may be preserved.  There may also be some control over the bowel and bladder.  It is possible for some recovery from this type of injury, usually starting in the legs, and gradually progressing upwards.

Posterior Cord Syndrome: damage towards the back of the spinal cord may leave the person with good muscle power, pain, and temperature sensation.  However, he or she may experience difficulty in coordinating limb movement.

Brown-Séquard syndrome: when damage is towards one side of the spinal cord, this causes impairment or loss of movement to the injured side, although pain and temperature sensation may be preserved.  The opposite side of injury will have normal movement, but pain and temperature sensation will be impaired or lost.

Dysreflexia (Hyperreflexia)

While most conditions focus on the loss of motor function and sensation, a spinal cord injury can also impact the autonomic nervous system, which controls involuntary activities, such as heartbeat and blood pressure, pupil dilation, respiration, and secretion of hormones by glands.  The autonomic system is further divided into the sympathetic and parasympathetic nervous systems, which moderate our "fight or flight" stress responses.  The sympathetic system responds to external stimulus from the environment and acts to speed up the heart rate and perform other functions in preparation to react to stress or an emergency, such as contracting blood vessels, reducing digestive secretions, and dilating the pupils.  The parasympathetic system, on the other hand, inhibits or opposes the sympathetic system by slowing the heart, dilating blood vessels, constricting the pupils, stimulating secretions, and otherwise bringing the body back to homeostasis after the emergency has passed. 

The sympathetic nerves lie along the thoracic region, and can be disconnected by any injury above the T6 level.  The parasympathetic system, on the other hand, is carried by the vagus nerve and operates from the brain stem and very high in the cord as well as in the sacral region in the lower part of the spinal cord.   These systems continue to operate after (or even during) spinal shock, although they no longer work in tandem to mediate each other's functions.

Even minor stimuli can initiate the sympathetic nervous system, whose effects are quickly mediated by the parasympathetic system when it is determined that the danger is minor or only imagined.  When these systems get disconnected from the brain, they continue to operate independent of one another.  Autonomic Dysreflexia, also known as AD or hyperreflexia, occurs when the sympathetic nervous system kicks in and does not stop.  The result is an abrupt onset of excessively high blood pressure.  This dangerous condition is a medical emergency which can lead to seizures, stroke, or death.

Any irritating stimulus below the spinal injury level can induce hyperreflexia.  Basically, any stimulus which would cause pain or discomfort if normal sensation were present can cause hyperreflexia.  Common causes include an overfull bladder or impacted bowel, pressure sore (bedsore), broken skin, ingrown toenail, or even a bone fracture.  Signs suggestive of dysreflexia include a pounding headache caused by elevation in blood pressure, sweating or blotchy skin above the level of injury, hypertension, or a flushed face.

People with SCI should be aware of the symptoms indicating onset of hyperreflexia and take immediate steps to identify the cause.  If the person is catheterized, the catheter system should be checked for any malfunctions.  Otherwise, bladder voidance should probably be begun.  Likewise, bowel stimulation may need to be initiated or ceased, as the case may be.  Next, the patient should check for sores or skin breakdowns, or fractures if possible.  Finally, there are several medications, including nitroglycerine and clonidine, which may alleviate dysreflexia if the cause can not be identified and remedied in a reasonable amount of time.

On the positive side, the symptoms of dysreflexia operate to let the patient know that there is probably some biological function or problem which needs attending to, which could otherwise lead to a serious medical problem if neglected.  Some tips to avoid or prevent dysreflexia include common sense steps which are already recommended to prevent other medical conditions, such as frequent pressure relief, routine skin assessments, regular maintenance of catheter kits, following a regular bowel and bladder program, maintaining a well-balanced diet with adequate fluids, and taking medications appropriately.

It is hoped that this information will help you in understanding and preventing the risks and complications that persons with spinal cord injuries are susceptible to.  If you feel that you need to speak with a lawyer regarding your legal rights and any damages you or a loved one has suffered due to a spinal cord injury, please contact The Cartwright Law Firm today for a free initial consultation with one of our attorneys.