Spinal cord disorders can cause permanent severe problems, such as paralysis or impaired bladder and bowel control (urinary incontinence Urinary Incontinence in Adults Urinary incontinence is involuntary loss of urine. Incontinence can occur in both men and women at any age, but it is more common among women and older people, affecting about 30% of older women... read more and fecal incontinence Fecal Incontinence Fecal incontinence is the loss of control over bowel movements. Fecal incontinence can occur briefly during bouts of diarrhea or when hard stool becomes lodged in the rectum ( fecal impaction)... read more ). Sometimes these problems can be avoided or minimized if evaluation and treatment are done quickly.
Causes of spinal cord disorders include injuries, infections, a blocked blood supply, and compression by a fractured bone or a tumor.
Typically, muscles are weak or paralyzed, sensation is abnormal or lost, and controlling bladder and bowel function may be difficult.
Doctors base the diagnosis on symptoms and results of a physical examination and imaging tests, such as magnetic resonance imaging.
The condition causing the spinal cord disorder is corrected if possible.
Often, rehabilitation is needed to recover as much function as possible.
Anatomy of the Spinal Cord
The spinal cord Spinal Cord The spinal cord is a long, fragile tubelike structure that begins at the end of the brain stem and continues down almost to the bottom of the spine. The spinal cord consists of bundles of nerve... read more is the main pathway of communication between the brain and the rest of the body. It is a long, thick, fragile structure that extends downward from the base of the brain. The cord is protected by the back bones (vertebrae) of the spine (spinal column). The vertebrae are separated and cushioned by disks made of cartilage.
The spine is divided into four sections, and each section is referred to by a letter.
Cervical (C): Neck
Thoracic (T): Chest
Lumbar (L): Lower back
Sacral (S): Pelvis and tailbone
Within each section of the spine, the vertebrae are numbered beginning at the top. These labels (letter plus a number) are used to indicate locations (levels) in the spinal cord. Doctors can sometimes determine where the spinal cord is damaged—the level—based on the symptoms a person has. For examples, if a person's legs, trunk, and hands are paralyzed but the person can move shoulders and elbows normally, the cervical spinal cord between levels 7 and 8 (C7 to C8) is damaged.
Where Is the Spinal Cord Damaged?
Along the length of the spinal cord, 31 pairs of spinal nerves emerge through spaces between the vertebrae. Each spinal nerve runs from a specific vertebra in the spinal cord to a specific area of the body. Based on this fact, the skin’s surface has been divided into areas called dermatomes. A dermatome is an area of skin whose sensory nerves all come from a single spinal nerve root. Loss of sensation in a particular dermatome enables doctors to locate where the spinal cord is damaged.
The surface of the skin is divided into specific areas, called dermatomes. A dermatome is an area of skin whose sensory nerves all come from a single spinal nerve root. Sensory nerves carry information about such things as touch, pain, temperature, and vibration from the skin to the spinal cord.
Spinal roots come in pairs—one of each pair on each side of the body. There are 31 pairs:
There are dermatomes for each of these nerve roots.
Sensory information from a specific dermatome is carried by sensory nerve fibers to the spinal nerve root of a specific vertebra. For example, sensory information from a strip of skin along the back of the thigh, is carried by sensory nerve fibers to the 2nd sacral vertebra (S2) nerve root.
A spinal nerve has two nerve roots (a motor root and a sensory root). The only exception is the first spinal nerve, which has no sensory root.
Motor root: The root in the front (the motor or anterior root) contains nerve fibers that carry impulses (signals) from the spinal cord to muscles to stimulate muscle movement (contraction).
Sensory root: The root in the back (the sensory or posterior root) contains nerve fibers that carry sensory information about touch, position, pain, and temperature from the body to the spinal cord.
Did You Know...
The spinal cord ends in the lower back (around L1 or L2), but the lower spinal nerve roots continue, forming a bundle that resembles a horse’s tail (called the cauda equina Cauda Equina Syndrome Cauda equina syndrome occurs when the bundle of nerves that extends from the bottom of the spinal cord is compressed or damaged. The most common cause of cauda equina syndrome is a herniated... read more ).
The spinal cord is highly organized. The center of the cord consists of gray matter shaped like a butterfly. Its "wings" are called horns:
The front (anterior or motor) horns contain nerve cells that carry signals from the brain or spinal cord through the motor root to muscles.
The back (posterior or sensory) horns contain nerve cells that receive signals about pain, temperature, and other sensory information through the sensory root from nerve cells outside the spinal cord.
The outer part of the spinal cord consists of white matter that contains pathways of nerve fibers (called tracts or columns). Each tract carries a specific type of nerve signal either going to the brain (ascending tracts) or from the brain (descending tracts).
To and From and Up and Down the Spinal Cord
Spinal nerves carry nerve impulses to and from the spinal cord through two nerve roots:
In the center of the spinal cord, a butterfly-shaped area of gray matter helps relay impulses to and from spinal nerves. The "wings" are called horns.
Impulses travel up (to the brain) or down (from the brain) the spinal cord through distinct pathways (tracts). Each tract carries a different type of nerve signal either going to or from the brain. The following are examples:
Causes of Spinal Cord Disorders
Spinal cord disorders may originate outside the cord or, less commonly, inside the cord.
Outside the spinal cord
These disorders include
The spinal cord may be compressed by bone (which may result from cervical spondylosis Cervical Spondylosis Cervical spondylosis is degeneration of the bones in the neck (vertebrae) and the disks between them, putting pressure on (compressing) the spinal cord in the neck. Osteoarthritis is the most... read more , spinal stenosis, or a fracture), an accumulation of blood (hematoma), a tumor, a pocket of pus (abscess), or a ruptured or herniated disk Herniated Disk A herniated disk occurs when the tough covering of a disk in the spine tears or ruptures. The soft, jelly-like interior of the disk may then bulge out (herniate) through the covering. Aging... read more .
Inside the spinal cord
These disorders include fluid-filled cavities (syrinxes Syrinx of the Spinal Cord or Brain Stem A syrinx is a fluid-filled cavity that develops in the spinal cord (called syringomyelia), in the brain stem (called syringobulbia), or in both. Syrinxes may be present at birth or develop later... read more ), blockage of the blood supply Blockage of the Blood Supply to the Spinal Cord Blockage of an artery carrying blood to the spinal cord prevents the cord from getting blood and thus oxygen. As a result, tissues can die (called infarction). Causes include severe atherosclerosis... read more , inflammation (as occurs in acute transverse myelitis Acute Transverse Myelitis Acute transverse myelitis is inflammation that affects the spinal cord across its entire width (transversely) and thus blocks transmission of nerve impulses traveling up or down the spinal cord... read more ), tumors, abscesses, bleeding (hemorrhage), vitamin B12 deficiency Copper Deficiency Copper deficiency is rare among healthy people and occurs most commonly among infants who have other health problems or inherit a genetic abnormality. (See also Overview of Minerals.) Most of... read more , copper deficiency Copper Deficiency Copper deficiency is rare among healthy people and occurs most commonly among infants who have other health problems or inherit a genetic abnormality. (See also Overview of Minerals.) Most of... read more , infection with the human immunodeficiency virus Human Immunodeficiency Virus (HIV) Infection Human immunodeficiency virus (HIV) infection is a viral infection that progressively destroys certain white blood cells and is treated with antiretroviral medications. If untreated, it can cause... read more (HIV), COVID-19 COVID-19 COVID-19 is an acute respiratory illness that can be severe and is caused by the coronavirus named SARS-CoV-2. Symptoms of COVID-19 vary significantly. Two types of tests can be used to diagnose... read more , multiple sclerosis Multiple Sclerosis (MS) In multiple sclerosis, patches of myelin (the substance that covers most nerve fibers) and underlying nerve fibers in the brain, optic nerves, and spinal cord are damaged or destroyed. The cause... read more , and syphilis Syphilis Syphilis is a sexually transmitted infection caused by the bacteria Treponema pallidum. It can occur in three stages of symptoms, separated by periods of apparent good health. Syphilis... read more .
Radiation therapy can also damage the spinal cord.
Symptoms of Spinal Cord Disorders
Because of the way the spinal cord functions and is organized, damage to the cord often produces specific patterns of symptoms based on where the damage occurred. The following may occur in various patterns:
Loss of sensation Sensory Nerves When a neurologic disorder is suspected, doctors usually evaluate all of the body systems during the physical examination, but they focus on the different parts of the nervous system. Examination... read more (such as the ability to feel a light touch, pain, temperature, or vibration or to sense where the arms and legs are)
By identifying which functions are lost, doctors can often tell which part of the spinal cord (such as the front, back, side, center, or entire cord) is damaged. By identifying the specific location of symptoms (for example, which muscles are paralyzed and which parts of the body lack sensation), doctors can determine where the spinal cord is damaged (that is, the specific level in the spinal cord).
Functions controlled by areas of the spinal cord below the damage may be completely or partially lost. Functions controlled by areas of the spinal cord above the damage are not affected.
When weakness or paralysis occurs suddenly, muscles go limp (flaccid), losing their tone. After muscles become flaccid, muscle tone increases over days to weeks, and muscles tend to contract involuntarily (called spasms, or spasticity).
When disorders (such as cervical spondylosis Cervical Spondylosis Cervical spondylosis is degeneration of the bones in the neck (vertebrae) and the disks between them, putting pressure on (compressing) the spinal cord in the neck. Osteoarthritis is the most... read more and hereditary spastic paraplegia Hereditary Spastic Paraplegia Hereditary (familial) spastic paraplegia is a group of rare hereditary disorders that cause gradual weakness with muscle spasms (spastic weakness) in the legs. People with hereditary spastic... read more ) slowly damage the spinal cord, they can cause paralysis with increased muscle tone and muscle spasms (called spastic paralysis).
Spasms can occur because signals from the brain cannot pass through the damaged area to help control some reflexes. As a result, the reflexes become more pronounced over days to weeks. Then, the muscles controlled by the reflex may tighten, feel hard, and contract uncontrollably from time to time.
Diagnosis of Spinal Cord Disorders
Magnetic resonance imaging or myelography with computed tomography
Often, doctors can recognize a spinal cord disorder based on its characteristic pattern of symptoms. Doctors always do a physical examination, which provides clues to the diagnosis and, if the spinal cord is damaged, helps doctors determine where the damage is. An imaging test is done to confirm the diagnosis and determine the cause.
Magnetic resonance imaging (MRI) is the most accurate imaging test for spinal cord disorders. MRI shows the spinal cord, as well as abnormalities in the soft tissues around the cord (such as abscesses, hematomas, tumors, and ruptured disks) and in bone (such as tumors, fractures, and cervical spondylosis).
If MRI is not available, myelography Myelography Diagnostic procedures may be needed to confirm a diagnosis suggested by the medical history and neurologic examination. Imaging tests commonly used to diagnose nervous system (neurologic) disorders... read more with computed tomography (CT) is used. For myelography with CT, CT is done after a radiopaque contrast agent (which can be seen on x-rays) is injected into the space around the spinal cord.
X-rays may be done to check for problems with the spine, such as fractures or tumors, but CT provides more information about bone and is generally preferred.
Did You Know...
Treatment of Spinal Cord Disorders
Treatment of the cause when possible
Prevention of complications
Physical and occupational therapy
If symptoms of spinal cord dysfunction (such as paralysis or loss of sensation) suddenly occur, people should immediately go to the emergency department. Sometimes doing so can prevent permanent spinal cord damage or paralysis. If possible, the cause is treated or corrected. However, such treatment is often impossible or unsuccessful.
People who are paralyzed or confined to bed because of a spinal cord disorder require skilled nursing care to prevent complications, which include the following:
Pressure sores Pressure Sores : Nurses inspect the person's skin daily, keep the skin dry and clean, and turn the person frequently. When necessary, a special bed with a surface that reduces pressure and provides support is used. It can be turned to shift pressure on the body from front to back and from side to side. Surfaces include air, foam, gel, and water overlays for mattresses. Other surfaces or mattresses require electricity to work. For example, some shift supportive pressure from one area of the person's body to another. Some have pockets of air that are alternately inflated and deflated by a pump,
Urinary problems: If a person is immobile and cannot use a toilet, a urinary catheter may be needed. To help reduce the risk of a urinary tract infection, nurses use sterile techniques when the catheter is inserted and apply antimicrobial ointments or solutions daily.
Pneumonia: To reduce the risk of pneumonia, therapists and nurses may teach the person deep breathing exercises. They may also place the person at an angle to help drain secretions that accumulate in the lungs (postural drainage), or they may suction secretions out.
Blood clots: Anticoagulants, such as heparin or low molecular weight heparin, may be given by injection. If a person cannot take anticoagulants (for example, because of a bleeding disorder or stomach ulcers), a filter, sometimes called an umbrella Inferior Vena Cava Filters: One Way to Prevent Pulmonary Embolism , is inserted into the inferior vena cava (the large vein that carries blood from the abdomen to the heart). The filter traps blood clots that have broken loose from leg veins before they reach the heart.
Extensive loss of body functions can be devastating, causing depression and loss of self-esteem. Formal counseling can be very helpful. Learning exactly what has happened and what to expect in the near and distant future helps people cope with the loss and prepare them for rehabilitation.
Rehabilitation helps people recover as much function as possible. The best care is provided by a team that includes nurses, a physical therapist Physical Therapy (PT) Physical therapy, a component of rehabilitation, involves exercising and manipulating the body with an emphasis on the back, upper arms, and legs. It can improve joint and muscle function, helping... read more , an occupational therapist Occupational Therapy (OT) Occupational therapy, a component of rehabilitation, is intended to enhance a person's ability to do basic self-care activities, useful work, and leisure activities. These activities include... read more , a social worker, a nutritionist, a psychologist, a counselor, and sometimes a doctor who specializes in rehabilitation (physiatrist), as well as the person and family members. A nurse may teach the person ways to manage bladder and bowel dysfunction, such as how to insert a catheter, when to use laxatives, or how to stimulate bowel movements using a finger.
Physical therapy involves exercises for muscle strengthening and stretching. People may learn how to use assistive devices such as braces, a walker, or a wheelchair and how to manage muscle spasms.
Occupational therapy helps people relearn how to do their daily tasks and helps them improve dexterity and coordination. They learn special techniques to help compensate for lost functions. Therapists or counselors help some people make the adjustments needed to return to work and to hobbies and activities. People are taught ways to deal with sexual dysfunction. Sex is still possible for many people, even though sensation is usually lost.
Emotional support from family members and close friends is important.
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