National Spinal Cord Injury Association Resource Center
about Spinal Cord Injury
1. What is Spinal Cord
Spinal Cord Injury (SCI) is damage to the spinal cord
that results in a loss of function such as mobility or
feeling. Frequent causes of damage are trauma (car
accident, gunshot, falls, etc.) or disease (polio, spina
bifida, Friedreich's Ataxia, etc.). The spinal cord does
not have to be severed in order for a loss of functioning
to occur. In fact, in most people with SCI, the spinal
cord is intact, but the damage to it results in loss of
functioning. SCI is very different from back injuries
such as ruptured disks, spinal stenosis or pinched
A person can "break their back or neck" yet
not sustain a spinal cord injury if only the bones around
the spinal cord (the vertebrae) are damaged, but the
spinal cord is not affected. In these situations, the
individual may not experience paralysis after the bones
2. What is the spinal
cord and the vertebra?
The spinal cord is the major bundle of nerves that carry
nerve impulses to and from the brain to the rest of the
body. The brain and the spinal cord constitute the
Central Nervous System. Motor and sensory nerves outside
the central nervous system constitute 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.
The spinal cord is surrounded by rings of bone called
vertebra. These bones constitute the spinal column (back
bones). In general, the higher in the spinal column the
injury occurs, the more dysfunction a person will
experience. The vertebra are named according to their
location. The eight vertebra in the neck are called the
Cervical Vertebra. The top vertebra is called C-1, the
next is C-2, etc. Cervical SCIs usually cause loss of
function in the arms and legs, resulting in quadriplegia.
The twelve vertebra in the chest are called the Thoracic
Vertebra. The first thoracic vertebra, T-1, is the
vertebra where the top rib attaches. Injuries in the
thoracic region usually affect the chest and the legs and
result in paraplegia.
The vertebra in the lower back - between the thoracic
vertebra, where the ribs attach, and the pelvis (hip
bone), are the Lumbar Vertebra. The sacral vertebra run
from the pelvis to the end of the spinal column. Injuries
to the five Lumbar vertebra (L-1 thru L-5) and similarly
to the five Sacral Vertebra (S-1 thru S-5) generally
result in some loss of functioning in the hips and legs.
3. What are the effects
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
the injury. A person with an incomplete injury may be
able to move one limb more than another, may be able to
feel parts of the body that cannot be moved, or may have
more functioning on one side of the body than the other.
With the advances in acute treatment of SCI, incomplete
injuries are becoming more common.
The level of injury is very helpful in predicting what
parts of the body might be affected by paralysis and loss
of function. Remember that in incomplete injuries there
will be some variation in these prognoses. Cervical
(neck) injuries usually result in quadriplegia. Injuries
above the C-4 level may require a ventilator for the
person to breathe. C-5 injuries often result in shoulder
and biceps control, but no control at the wrist or hand.
C-6 injuries generally yield wrist control, but no hand
function. Individuals with C-7 and T-1 injuries can
straighten their arms but still may have dexterity
problems with the hand and fingers.
Injuries at the thoracic level and below result in
paraplegia, with the hands not affected. At T-1 to T-8
there is most often control of the hands, but poor trunk
control as the result of lack of abdominal muscle
control. Lower T-injuries (T-9 to T-12) allow good truck
control and good abdominal muscle control. Sitting
balance is very good. Lumbar and Sacral injuries yield
decreasing control of the hip flexors and legs.
Besides a loss of sensation or motor functioning,
individuals with SCI also experience other changes. For
example, they may experience dysfunction of the bowel and
bladder. Sexual functioning is frequently affected: men
with SCI may have their fertility affected, while women's
fertility is generally not affected. Very high injuries
(C-1, C-2) can result in a loss of many involuntary
functions including the ability to breathe, necessitating
breathing aids such as mechanical ventilators or
diaphragmatic pacemakers. Other effects of SCI may
include low blood pressure, inability to regulate blood
pressure effectively, reduced control of body
temperature, inability to sweat below the level of
injury, and chronic pain.
4. How many people have
SCI? Who are they?
Approximately 450,000 people live with SCI in the US.
There are about 8,000 new SCIs every year; the majority
of them (82%) involve males between the ages of 16-30.
These injuries result from motor vehicle accidents (42%),
violence (24%), or falls (22%). Quadriplegia is slightly
more common than paraplegia.
5. Is there a cure for
Currently there is no cure for SCI. There are many
researchers attacking this problem, and there have been
many advances in the lab. Many of the most exciting
advances have resulted in a decrease in damage at the
time of the injury. Steroid drugs such as
methylprednisolone reduce swelling, which is a common
cause of secondary damage at the time of injury. The
experimental drug Sygen®appears to reduce loss of
function, although the mechanism is not completely
6. Do people with SCI
ever get better?
When a SCI occurs, there is usually swelling of
the spinal cord. This may cause changes in virtually
every system in the body. After days or weeks, the
swelling begins to go down and people may regain some
functioning. With many injuries, especially incomplete
injuries, the individual may recover some functioning as
late as 18 months after the injury. In very rare cases,
people with SCI will regain some functioning years after
the injury. However, only a very small fraction of
individuals sustaining SCIs recover all functioning.
7. Does everyone who
sustains SCI use a wheelchair?
No. Wheelchairs are a tool for mobility. High
C-level injuries usually require that the individual use
a power wheelchair. Low C-level injuries and below
usually allow the person to use a manual chair.
Advantages of manual chairs are that they cost less,
weigh less, disassemble into smaller pieces and are more
agile. However, for the person who needs a powerchair,
the independence afforded by them is worth the
limitations. Some people are able to use braces and
crutches for ambulation. These methods of mobility do not
mean that the person will never use a wheelchair. Many
people who use braces still find wheelchairs more useful
for longer distances. However, the therapeutic and
activity levels allowed by standing or walking briefly
may make braces a reasonable alternative for some people.
Of course, people who use wheelchairs aren't always in
them. They drive, swim, fly planes, ski, and do many
activities out of their chair. If you hang around people
who use wheelchairs long enough, you may see them sitting
in the grass pulling weeds, sitting on your couch, or
playing on the floor with children or pets. And of
course, people who use wheelchairs don't sleep in them,
they sleep in a bed. No one is "wheelchair
8. Do people with SCI
Yes. Before World War II, most people who sustained SCI
died within weeks of their injury due to urinary
dysfunction, respiratory infection or bedsores. With the
advent of modern antibiotics, modern materials such as
plastics and latex, and better procedures for dealing
with the everyday issues of living with SCI, many people
approach the lifespan of non-disabled individuals.
Interestingly, other than level of injury, the type of
rehab facility used is the greatest indicator of
long-term survival. This illustrates the importance of
and the difference made by going to a facility that
specializes in SCI. People who use vents are at some
increased danger of dying from pneumonia or respiratory
infection, but modern technology is improving in that
area as well. Pressure sores are another common cause of
hospitalization, and if not treated - death.
9. Do people with SCI
People with SCI have the same desires as other people.
That includes a desire to work and be productive. The
Americans with Disabilities Act (ADA) promotes the
inclusion of people with SCI to mainstreamin day-to-day
society. Of course, people with disabilities may need
some changes to make their workplace more accessible, but
surveys indicate that the cost of making accommodations
to the workplace in 70% of cases is $500 or less.
10. Can people with SCI
have sex, children?
SCI frequently affects sexual functioning. However, there
are many therapies that allow people with SCI to have an
active and satisfying sex life. Fertility is also
frequently affected in men with SCI. Methods similar to
those used for non-disabled men with fertility problems
have allowed many men with SCI to father their own
children. Of course, adoption is another option. The
fertility of women with SCI may be affected in the first
months after injury. However, most women regain the
ability to become pregnant after SCI. Many women with SCI
are able to carry babies to full term. However, it is
important that she consult a physician experienced in
11. What do I say when
I meet a person with SCI?
A person with a SCI is no different from a
non-disabled individual except in a few ways. People with
SCI have the same hopes, interests and desires as other
people. People with SCI are interested in sports - or not
(just like non-disabled people). Although disabled
individuals do some things differently than non-disabled
individuals, the result is the same. It's important to
remember that although SCI changes a person, they are
still people, so treat them that way.
The most important thing to remember is:
Life does not end with spinal cord
This Factsheet is offered as an
information service and is not intended to cover all
treatments or research in the field, nor is it an
endorsement of the methods mentioned herein. The National
Spinal Cord Injury Resource Center (NSCIRC) provides
information and referral on many subjects related to
spinal cord injury. Contact the resource center at
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