Spinal cord trauma is damage to the spinal cord. It may result from direct injury to the cord itself or indirectly from damage to surrounding bones, soft tissues, and blood vessels.

Spinal cord trauma can be caused by any number of injuries to the spine. They can result from motor vehicle accidents, falls, sports injuries (particularly diving into shallow water), industrial accidents, gunshot wounds, assault, and others.

A minor injury can cause spinal cord trauma if the spine is weakened (such as from rheumatoid arthritis or osteoporosis) or if the spinal canal protecting the spinal cord has become too narrow (spinal stenosis) due to the normal aging process.

Direct injury, such as cuts, can occur to the spinal cord, particularly if the bones or the disks have been damaged. Fragments of bone (from fractured vertebrae, for example) or fragments of metal (such as from a traffic accident) can cut or damage the spinal cord.

Direct damage can also occur if the spinal cord is pulled, pressed sideways, or compressed. This may occur if the head, neck, or back are twisted abnormally during an accident or injury.

Bleeding, fluid accumulation, and swelling can occur inside the spinal cord or outside the spinal cord (but within the spinal canal). The accumulation of blood or fluid can compress the spinal cord and damage it.

Most spinal cord trauma occurs to young, healthy individuals. Males between ages 15 and 35 are most commonly affected. The death rate tends to be higher in young children with spinal injuries.

Risk factors include participating in risky physical activities, not wearing protective gear during work or play, or diving into shallow water.

Older people with weakened spines (from osteoporosis) may be more likely to have a spinal cord injury. Patients who have other medical problems that make them prone to falling from weakness or clumsiness (from stroke, for example) may also be more susceptible.

Symptoms vary somewhat depending on the location of the injury. Spinal cord injury results in varying degrees of weakness and sensory loss at and below the injury. The pattern depends on whether the entire cord is injured (complete) or only partially (incomplete).

The spinal cord doesn't go below the 1st lumbar vertebra, so injuries at and below this level do not cause spinal cord injury. However, they may cause "cauda equina syndrome" -- injury to the nerve roots in this area.

CERVICAL (NEAR THE NECK) INJURIES

When spinal cord injuries occur near the neck, varying degrees of symptoms can affect both the arms and the legs:

• Weakness, paralysis
• Breathing difficulties (from paralysis of the breathing muscles)
• Spasticity (increased muscle tone)
• Sensory changes
• Numbness
• Pain
• Loss of normal bowel and bladder control (such as constipation, incontinence, bladder spasms)

THORACIC (CHEST-LEVEL) INJURIES

When spinal injuries occur at chest level, varying degrees of symptoms can affect the legs:

• Weakness, paralysis
• Breathing difficulties (from paralysis of the breathing muscles)
• Spasticity (increased muscle tone)
• Sensory changes
• Numbness
• Pain
• Loss of normal bowel and bladder control (such as constipation, incontinence, bladder spasms)

Injuries to the cervical or high thoracic cord may also result in blood pressure problems, abnormal sweating, and trouble maintaining regular body temperature.

Spinal cord injury is a medical emergency requiring immediate attention.

The health care provider will perform a physical exam, including a neurological exam. This will help identify the exact location of the injury, if it is not already known. Some of the person's reflexes may be abnormal or absent. Once swelling goes down, some reflexes may slowly recover.

The following tests may be ordered:

• Spine x-rays may show fracture or damage to the bones of the spine.
• A CT scan or MRI of the spine may show the location and extent of the damage and reveal problems such as blood clots (hematomas).
• Myelogram (an x-ray of the spine after injection of dye) may be necessary in rare cases.
• Somatosensory evoked potential (SSEP) testing or magnetic stimulation may show if nerve signals can pass through the spinal cord.