Spinal Cord Injury
The physical and emotional
consequences from a spinal cord injury (SCI) can be devastating.
Loss of spinal cord function can affect activities that are
autonomous (e.g. breathing) as well as thought-driven actions such
According to the National Spinal Cord Injury Association (NSCIA),
the most common spinal cord injury results from a motor vehicle
accident (42%) and violence (24%), falling (22%), or sports (8%) are
the other main causes.
Occasionally SCIs are caused by diseases such as
polio. Spinal cord injuries are usually described using the
following terms :
A slight degree of paralysis affecting the
Complete paralysis of both lower extremities
and usually the lower trunk. The upper extremities are not involved.
Partial paralysis of all four limbs (arms,
Quadriplegia (or Tetraplegia) :
Complete paralysis of all
Other terms used to describe neural dysfunction
Partial or complete loss of motor function
Abnormal sensation such as burning or
The spinal cord does not have to be severed for
function to be lost. Most people with spinal cord dysfunction
present with the cord intact. Cord injuries usually fall into one of
the following categories :
- Contusions, or bruising of the spinal cord
- Compression injuries that place pressure on the cord
- Lacerations or tearing (e.g., from a bullet)
- Central Cord Syndrome
- Complete severing (rare)
When injury occurs and for a time period following, the spinal
cord swells. Loss of function occurs below the level of the injury
and may be permanent or temporary. Much depends on the severity of
||Neck, arms, hands
||C1 thru C7
||Torso, parts of the arms
||T1 thru T12
||T12 thru L5
||Groin, toes, parts of the leg
||S1 thru S5
Symptoms may include loss of motor function, sensation or
proprioception. The nerves responsible for these functions transmit
their messages through the muscles, tendons, joints and other
Destruction of sensory nerve fibers may lead to loss of sensation
such as touch, pressure, and temperature. Reflexes may become
exaggerated, bladder and bowel control may be lost, even the ability
to breath normally may be compromised.
When spinal cord injury is suspected (e.g., spinal fracture)
immediate medical attention is required. Spinal cord injury (SCI) is
usually first diagnosed when the patient presents with a loss of
function below the level of injury.
The initial evaluation includes x-rays, a CT scan, and possibly a
MRI. Fractures are demonstrated on plain radiographs. CT scanning
and MRI studies are used to evaluate the soft tissues in the spinal
column. In addition, a myelogram may be performed to identify and
evaluate spinal cord lesions caused by trauma or disease.
The neurologic evaluation includes assessment of the patient's
symptoms, which might include loss of motor or sensory function.
Other neurologic symptoms may include pain, numbness, paresthesias
(e.g., tingling), muscle spasm, weakness, and bowel/bladder changes.
What Are Spinal
Spinal tumors rarely occur and are either benign or malignant. Some
tumors are known to metastasize (spread) via arteries, veins, the
lymphatic system, and directly. Malignant tumors of the breast,
prostate, lung, and kidney can spread into the spine. Spinal tumors
can be dangerous when they cause spinal canal compression, which may
lead to neurologic dysfunction (e.g. paralysis).
Many patients will present with back pain as the primary symptom.
The pain can occur at rest, be worse at night, and may or may not be
related to activity. Other symptoms may include sciatica, numbness,
paraparesis (slight paralysis), spinal deformity (e.g. scoliosis,
kyphosis), and fever.
Benign Spinal Tumors
Osteochondroma is a slow growing tumor of the cartilage
usually affecting adolescents. It is uncommon and is usually found
in the posterior (rear) spine.
Osteoid Osteoma is a small bone tumor (less than 2 cm). It
usually affects adolescents causing night pain and may result in
Osteoblastoma affects children and adolescents. These tumors
can be large, aggressive, and painful sometimes causing spinal
deformity and paralysis.
Aneurysmal Bone Cysts (ABCs) typically cause pain and
swelling usually affecting children and adolescents. These tumors
can be large and quite vascular.
Giant Cell Tumor is known to affect children, adolescents
and young adults. These tumors can be found at the cervical,
thoracic, or lumbar segments of the spine, but are more common in
Hemangioma occurs most often in the thoracic spine. These
tumors affect adults and are known to be progressive vascular masses
that can cause vertebral collapse and paraparesis (slight
Eosinophilic Granuloma is usually seen in the vertebral
bodies of children and adolescents. When this tumor is systemic it
is termed Histiocytosis X. Rarely do these tumors lead to vertebral
collapse and paraparesis. On occasion, they may heal spontaneously.
Malignant Spinal Tumors
Plasmacytoma presents in middle aged and older adults. These
tumors are common in the pedicle and vertebral body and may cause
Ewing's Sarcoma is an aggressive tumor affecting adolescents
and young adults. In some cases, it may metastasize.
Lymphoma may present in one or more vertebral bodies in
middle aged or older adults. Sometimes the lymphatic system is
Chondrosarcoma is a tumor affecting spinal cartilage in
middle-aged adults. It grows slowly but can be dangerous. Usually
aggressive medical intervention is required.
Osteosarcoma is bone cancer found in adolescents and
middle-aged adults. These tumors may metastasize requiring
aggressive medical therapy.
Chordoma is usually seen in adults frequently (50%)
involving the sacrum, although it can affect other parts of the
spine. These tumors often require aggressive medical therapy.
Spine pain does not always indicate tumor presence. However, early
medical intervention is always warranted if spine pain does not
resolve or if neurologic deficit is experienced.
The term sciatica is commonly used to describe pain traveling in
the distribution of the sciatic nerve. Sciatica is a symptom caused
by a disorder occurring in the lumbar spine. The sciatic nerve is
the largest nerve in the human body, about the diameter of a finger.
Inflammation of the Sciatic Nerve
- Sciatica is a condition
which causes pain down the back of one or both thighs. Inflammation
of the sciatic nerve (which is the largest nerve in the body-about
the diameter of your little finger) can be either constant or
intermittent. Success in solving this problem is directly correlated
to the diagnosis. Sciatica can be caused by a pinched nerve as it
exits the low back spine or it can be caused by prostatic cancer.
Odds are usually that the cause is some structural imbalance, but
there are so many potential causes, some serious and some benign, it
is better to at least know that there may be a grave cause to the
This doesn't mean that you shouldn't immediately incorporate a
strategy to eliminate any structural imbalances. In most cases, this
will resolve the problem. If the problem doesn't respond to these
basic efforts, then professional assistance may be needed.
Trigger points can accumulate in the piriformis muscle forcing a
contraction and strangulation of the sciatic nerve. The tennis ball
exercise should be incorporated to help to relax the piriformis
muscle. Stretching may be beneficial, but that is more of a "try
and see" exercise.
If there are no improvements with this approach, refer to Low Back
Pain to better understand the relationship between the sciatic nerve
and the low back spine. Seeking help from a chiropractor or
orthopedist may be indicated if the sciatica solution can't be found
nerve fibers begin at the 4th and 5th lumbar vertebra (L4, L5) and
the first few segments of the sacrum. The nerve passes through the
sciatic foramen just below the Piriformis muscle (rotates the thigh
laterally), to the back of the extension of the hip and to the lower
part of the Gluteus Maximus (muscle in the buttock, thigh
extension). The sciatic nerve then runs vertically downward into the
back of the thigh, behind the knee branching into the hamstring
muscles (calf) and further downward to the feet.
|Sciatic Nerve (yellow)
Usually sciatica affects one side of the body. The pain may be
dull, sharp, burning, or accompanied by intermittent shocks of
shooting pain beginning in the buttock traveling downward into the
back or side of the thigh and/or leg. Sciatica then extends below
the knee and may be felt in the feet. Sometimes symptoms include
tingling and numbness. Sitting and trying to stand up may be painful
and difficult. Coughing and sneezing can intensify the pain.
The Cause : Nerve Compression
Compression of the sciatic nerve can cause any of the above-cited
symptoms. Rarely is nerve damage permanent and paralysis is seldom a
danger as the spinal cord ends before the first lumbar vertebra.
However, increasing trunk or leg weakness, or bladder and/or bowel
incontinence is an indication of Cauda Equina Syndrome, a serious
disorder requiring emergency treatment.
Lumbar spine disorders known to cause sciatic nerve compression
include the following :
Spinal Tumors and Infections
- Herniated discs are the most common cause of sciatica in the
- Degenerative Disc Disease, a natural biological process
associated with aging, is known to cause disc weakness that can
be a precursor to a disc herniation.
- Lumbar Spinal Stenosis is a narrowing of one or more neural
passageways due to disc degeneration and/or facet arthritis. The
sciatic nerve may become impinged as a result of these changes.
- Isthmic Spondylolisthesis results from a stress fracture
often at the 5th lumbar vertebra (L5). The fracture combined
with disc space collapse may allow the vertebra to slip forward
on the first sacral segment (S1). The slippage may cause the L5
nerve root to become pinched as it leaves the spine.
are other disorders that
may compress the sciatic nerve, but this is rare.
There are other conditions, which may occur, and may mimic true
sciatica but these are difficult to diagnose.
Diagnosis of Sciatica
The physician's examination includes the patient's medical history,
a review of current medications, a physical and neurologic
examination and, if warranted, x-rays, CT scan and/or MRI. A proper
diagnosis requires an analysis of the patient's pain. The patient is
often provided a Pain Diagram to illustrate pain distribution and
sensation (eg, tingling and burning).
The physician's questions may include :
- "How did the pain develop?"
- "On a scale from 1 to 10, with 10 being the worst pain
imaginable, rate your pain."
- "Is the pain worsened by walking uphill or downhill?"
- "How does the pain affect activities of daily living?"
- "What type of treatment has been tried and what was
The patient's range of motion is observed. Reflexes and muscle
strength are tested. The physician may use one or more movement
tests to determine the source or cause of the pain.
Sciatica : Treatment and Recovery
Treatment - Non-Surgical Treatment
Sciatica often responds well to non-operative forms of treatment
and rarely requires surgical intervention. Time, non-steroidal
anti-inflammatory (NSAIDs) medication, short-term use of a narcotic
for acute pain, lumbar injections, and physical therapy are
Although short-term bed rest is recommended during the acute phase,
some activity is good. In this scenario "activity" is
defined as being up for periods of time that will not cause severe
pain. Prescribed exercise may include light stretching, walking, and
aerobic type exercise.
Surgery is not for all patients. However, in some situations,
surgery may be indicated. Patients who have followed a non-surgical
course of treatment for four to six weeks without relief certainly
require a re-evaluation by their physician. If a MRI scan reveals a
herniated disc or spinal stenosis, surgery may provide relief of the
leg pain. The type of surgical procedure is dependent in part on the
patient's condition and diagnosis
Whether treatment for sciatica is non-operative or surgical, it is
always wise to follow the instructions provided by the doctor and/or
Work toward relieving unnecessary mechanical stress to the spine.
For example, when standing, alternate resting one foot on a stool.
When driving, place a small pillow or rolled towel behind the back
to maintain natural spinal curvature. At bedtime, sleep on the back
with a pillow under the knees or between the knees if sleeping on
Strive to eat healthy, work toward your ideal body weight, and
avoid smoking. These lifestyle changes all benefit the spine's