Spinal Cord Injuries

As an Emergency Medical Technician (EMT), when someone has a spinal injury,
additional movement may cause further damage to the spine. EMT's must always
immobilize the patient's head and torso in the position found. The purpose of an EMT is
to prevent further harm to the patient until more professional medical help can be
obtained. If in doubt about whether a person has received a spinal injury, always assume
he or she has. A spinal cord injury (SCI) is very serious because it can mean the loss of
sensation and function in the parts of the body below the site of the injury.
SCI's are caused in many different ways. Some of the most common ways a
person may obtain a SCI are- motor vehicle accidents, bullet or stab wound, diving
accidents, electric shock, awkward positioning of the body, falls, sports injuries (such as
football or diving), industrial accidents, assault and gunshot wounds. Polio, Spina Bifida
and Friedreich's Ataxia are some of the frequent diseases that cause SCI. SCI may also be
know in other names such as spinal cord compression (SCC) and spinal cord trauma
(SCT). According to an article in , SCI's occur in approximately 12,000 to 15,000 people
per year in the U.S. About 10,000 of these people are permanently paralyzed, and many
of the rest die as a result of their injuries. Most spinal cord trauma occurs to young,
healthy individuals. Males between the ages of 15 and 35 are most commonly affected.
The spinal cord is about 18 inches long and extends from the base of the brain,
down the middle of the back, to about the waist. It is composed of 33 bones called
vertebrae, 31 pairs of nerves, 40 muscles and numerous connecting tendons and ligaments
running from the base of the skull to the tailbone. Between the vertebrae are fibrous,
elastic cartilage called discs. These absorb shock and keep your spine flexible and cushion
the hard vertebrae as it moves.
The nerves that lie within the spinal cord are upper motor neurons (UMN's) and their
function is to carry the messages back and forth from the brain to the spinal nerves along
the spinal tract. The spinal nerves that branch out from the spinal cord to the other parts
of the body are called lower motor neurons (LMN's). These spinal nerves exit and enter
at each vertebral level and communicate with specific areas of the body. The sensory
portions of the LMN carry messages about sensation from the skin and other body parts
and organs to the brain. The motor portions of the LMN send messages from the brain to
the various body parts to begin actions such as muscle movement.
The brain and the spinal cord both make up the Central Nervous System. Motor
and sensory nerves outside the central nervous system make up the Peripheral Nervous
System and another diffuse system of nerves that control involuntary functions such as
blood pressure and temperature regulation are the Sympathetic and Parasympathetic
Nervous Systems.
Rings of bone called vertebra surround the spinal cord, and these bones make up
the spinal column or backbones. Most often, the higher in the spinal column the injury
occurs, the more dysfunction a person will experience. The vertebras are named
according to their location. The 8 vertebra in the neck are called the Cervical Vertebra.
The top vertebra is called C-1; the next is C-2, and etc. Cervical SCI's usually cause loss
of function in the arms and legs, resulting in quadriplegia. The 12 vertebra in the chest are
called the Thoracic Vertebra. The first is called the T-1 and it's where the top rib
attaches. Injuries to this region usually affect the chest and the legs and result in
paraplegia. The vertebra in the lower back between the thoracic and the pelvis, are called
the Lumbar Vertebra. The sacral vertebras run from the pelvis to the end of the spinal
column. Injuries to the 5 Lumbar vertebra and similarly to the 5 sacral vertebra generally
result in some loss of functioning in the hips and legs.
The effects of SCI depend on the type of injury and the level of the injury. SCI
can be divided into two types of injury- complete and incomplete. A complete injury
means that there is no function below the level of the injury, no sensation and no voluntary
movement. Both sides of the body are equally affected. An incomplete injury means that
there is some functioning below the primary level of injury. A person with an incomplete
injury may be able to