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Injuries of the Spinal Cord and Vertebrae


Gordon Mao

, MD, Johns Hopkins School of Medicine

Reviewed/Revised Jul 2023
Topic Resources

A spinal cord injury is damage to the bundle of cells and nerves that carry incoming and outgoing messages between the brain and the rest of the body.

The spine consists of 24 back bones (vertebrae) plus the tailbone (sacrum). The vertebrae bear most of the body's weight and thus are under a lot of pressure. Disks of cartilage between vertebrae help cushion and protect the bones. The spine forms a protective canal of bone in which the spinal cord is encased.

The spinal cord is a long, fragile tubelike structure that begins at the end of the brain stem and continues down to the lower part of the spine. The spinal cord consists of nerves that carry incoming and outgoing messages between the brain and the rest of the body. (See also 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 .)

Spinal injuries may affect the bones of the spine, the spinal cord, or the roots of the spinal nerves (short branches of the spinal nerves), which pass through the spaces between the vertebrae. The bundle of nerve roots that extend downward from the end of the spinal cord (cauda equina) may also be injured. Injuries of the spinal cord cause nerve damage or dysfunction in one the following ways:

  • Jarring by a blunt injury (such as a fall or a collision)

  • Pressure (compression) by broken bones, swelling, or an accumulation of blood (hematoma)

  • Partial or complete tears (severing)

Because the spinal cord is surrounded and protected by the spine, injuries of the spine or its connective tissue (such as disks and ligaments—see figure A 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 Herniated Disk ) can also injure the spinal cord. Such injuries include the following:

  • Fractures

  • Complete separation (dislocation) of adjacent vertebrae

  • Partial misalignment (subluxation) of adjacent vertebrae

  • Loosened ligament attachments (composed of connective tissue) between adjacent vertebrae

Ligaments may be loosened so much that the vertebrae move freely. These injuries are considered unstable. When vertebrae move, they can compress the spinal cord or its blood supply and damage spinal nerve roots. An unstable injury to the spine may not damage the spinal cord immediately. For example, the injury may cause spasms of muscles supporting the spine that prevent the vertebrae from moving much. However, after hours or days, muscle spasms may subside, enabling the vertebrae to move freely, which can damage the spinal cord.

The most common cause of spinal cord injuries is motor vehicle crashes, accounting for almost half of them. Other causes include falls, sports, work-related injuries, and violence (such as a knife or gunshot wound).

Symptoms of Spinal Injuries

If the spine is injured, people usually feel pain in the affected part of the neck or back. The area over the injury may be tender to the touch, particularly if a fracture is present. If the spinal cord is injured, the nerves at and below the site of the injury malfunction, causing loss of muscle control and loss of sensation. However, children may have spinal cord injuries in which nerves malfunction only temporarily and briefly. They may have lightning-like pains that shoot down the arms or legs.

Exactly what and how much function is lost in the arms and legs depends on the location of the spinal cord injury. For example, if the spinal cord is injured in the neck, the person may lose movement and sensation in both the arms and the legs, whereas an injury farther down the spinal cord may result in dysfunction in the legs only. A person can lose control of the ability to urinate or have a bowel movement and lose sexual function regardless of the location of the spinal cord injury.

When nerve damage occurs, loss of muscle control or sensation may be temporary or permanent, partial or total, depending on the severity of the injury. An injury that severs the spinal cord or destroys nerve pathways in the spinal cord causes permanent paralysis, but a blunt injury that jars the spinal cord may cause temporary weakness, which can last days, weeks, or months. Sometimes swelling causes symptoms that suggest an injury more severe than it is, but the symptoms usually lessen as the swelling subsides.

Partial loss of muscle control results in muscle weakness. Paralysis usually refers to complete loss. When muscles are paralyzed, they often go limp (flaccid), losing their tone. Muscle reflexes that doctors check using a reflex hammer are weak or absent. But when the spinal cord is injured, paralysis may progress weeks later to involuntary, prolonged muscle spasms (called spastic paralysis). In this case, muscle reflexes are stronger than normal.

Where Is the Spinal Cord Damaged?

Where Is the Spinal Cord Damaged?

Complications of spinal cord injury

Diagnosis of Spinal Injuries

  • Imaging

People who have symptoms of spine injury (such as significant pain in the bones of the neck or back) and children who have even brief symptoms of possible nerve damage or pains that shoot down the arms or legs need to be evaluated in an emergency department.

Injuries to the spine (affecting bones) and spinal cord are diagnosed by imaging tests.

Although MRI is best suited for assessing the spinal cord and ligaments of the spine, occasionally MRI is not possible due to implanted devices such as pacemakers. In these cases, CT myelography may be done. CT myelography is a CT scan done after doctors inject a radiopaque dye into the space around the spinal cord. CT myelography can show displaced structures that impinge on the spinal cord.

Treatment of Spinal Injuries

  • Immobilization

  • Surgery to stabilize the spine when appropriate

  • Rehabilitation

People who may have a spinal cord injury should not be moved except by emergency personnel. The initial goals are to make sure people can breathe and to prevent further damage. Thus, emergency personnel take great care to keep the neck immobile when moving a person with a possible spinal cord injury. Usually, the person is strapped to a firm board and carefully padded to prevent movement. A rigid collar may be used to keep the neck from moving. When the spine is severely damaged, the vertebrae may no longer be held in place or may be broken, making the spine unstable. Thus, even slight movement of the injured person can cause the spine to shift, putting pressure on the spinal cord. Pressure on the cord increases the risk of permanent paralysis.

Surgery is needed to remove blood and bone fragments if they have accumulated and are pressing on the spinal cord. If the spine is unstable, the person is immobilized until the bone and other tissues have had time to heal. Sometimes a surgeon implants steel rods to stabilize the spine so that it cannot move and cause additional injury. The best time for surgery is debated. Spinal surgery may be done by neurosurgeons or orthopedic surgeons.

Medications may be useful.

  • Pain relievers (analgesics): If the injury causes pain, analgesics are given. During the first hours and days, opioids are usually used. Milder analgesics, such as acetaminophen or ibuprofen, may be used later.

  • Muscle relaxants: If spastic paralysis develops, muscle relaxants, such as baclofen or tizanidine, may be used.

Experimental treatments to stimulate growth of spinal nerves are being studied. For example, a certain type of white blood cell (macrophage) can be extracted from the blood, then injected back into the injured person. The injected macrophages help speed the removal of waste products generated by the body’s reaction to the injury and secrete substances that may help the nerves regenerate. Experimental medications can be injected into the space around the spinal cord (epidurally) or taken by mouth. Using stem cells (unspecialized cells from which other, more specialized cells can be derived) is another possibility, but this treatment requires much more study. Researchers are also investigating using various surgical techniques to relieve pressure that builds up in the sac around the spinal cord after injury.

Rehabilitation Rehabilitation After a Spinal Injury Recovery from spinal cord injury depends on the location (level) and degree of damage. The higher the level of injury, the greater the physical impairment and need for rehabilitation. Injury... read more , including physical and occupational therapy, can help people recover more quickly or more completely. People usually need emotional support, and often counseling and antidepressants, because depression usually develops when injury results in disability.

Prognosis for Spinal Injuries

Recovery is more likely if paralysis is partial and if movement or sensation starts to return during the first week after the injury. If function is not regained within 6 months, loss is likely to be permanent. However, several studies have shown that some recovery is possible up to one year after injury.

More Information

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

  • United Spinal Association: This organization empowers people with spinal cord injuries to live full lives by providing information on emergency preparedness, hosting support groups for those with spinal cord injuries and their loved ones, and working to strengthen the Americans With Disabilities Act.

Drugs Mentioned In This Article

Generic Name Select Brand Names
7T Gummy ES, Acephen, Aceta, Actamin, Adult Pain Relief, Anacin Aspirin Free, Apra, Children's Acetaminophen, Children's Pain & Fever , Comtrex Sore Throat Relief, ED-APAP, ElixSure Fever/Pain, Feverall, Genapap, Genebs, Goody's Back & Body Pain, Infantaire, Infants' Acetaminophen, LIQUID PAIN RELIEF, Little Fevers, Little Remedies Infant Fever + Pain Reliever, Mapap, Mapap Arthritis Pain, Mapap Infants, Mapap Junior, M-PAP, Nortemp, Ofirmev, Pain & Fever , Pain and Fever , PAIN RELIEF , PAIN RELIEF Extra Strength, Panadol, PediaCare Children's Fever Reducer/Pain Reliever, PediaCare Children's Smooth Metls Fever Reducer/Pain Reliever, PediaCare Infant's Fever Reducer/Pain Reliever, Pediaphen, PHARBETOL, Plus PHARMA, Q-Pap, Q-Pap Extra Strength, Silapap, Triaminic Fever Reducer and Pain Reliever, Triaminic Infant Fever Reducer and Pain Reliever, Tylenol, Tylenol 8 Hour, Tylenol 8 Hour Arthritis Pain, Tylenol 8 Hour Muscle Aches & Pain, Tylenol Arthritis Pain, Tylenol Children's, Tylenol Children's Pain+Fever, Tylenol CrushableTablet, Tylenol Extra Strength, Tylenol Infants', Tylenol Infants Pain + Fever, Tylenol Junior Strength, Tylenol Pain + Fever, Tylenol Regular Strength, Tylenol Sore Throat, XS No Aspirin, XS Pain Reliever
Advil, Advil Children's, Advil Children's Fever, Advil Infants', Advil Junior Strength, Advil Migraine, Caldolor, Children's Ibuprofen, ElixSure IB, Genpril , Ibren , IBU, Midol, Midol Cramps and Body Aches, Motrin, Motrin Children's, Motrin IB, Motrin Infants', Motrin Junior Strength, Motrin Migraine Pain, PediaCare Children's Pain Reliever/Fever Reducer IB, PediaCare Infants' Pain Reliever/Fever Reducer IB, Samson-8
ED Baclofen, FLEQSUVY, Gablofen, Lioresal, Lioresal Intrathecal, LYVISPAH, OZOBAX
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