Causes of spinal cord injury
Spinal cord injury (SCI) can have many causes. The way a person's injury affects them can be different depending on the cause of SCI. SCI can generally be described as being 'traumatic' or due to a trauma, or 'non-traumatic' being due to other causes.
This page will briefly explain:
- the main causes of traumatic and non-traumatic SCI
- the way traumatic and non-traumatic SCI looks in our population
- what traumatic and non-traumatic SCI can mean for rehabilitation and long term health and well-being.
How does traumatic injury occur?
Spinal cord injuries occur in a variety of ways. In adults, damage to the spinal column is usually also involved and the cord is stretched, bruised, impacted or compacted because of an external force or movement.
Age-related wear and tear on the spinal column, can cause narrowing of the intervertebral canal called stenosis. This results in pressure on the spinal cord and the spinal nerves, causing loss of function.
In children, a spinal cord injury often occurs by an over-stretching of the spinal cord.
What are the common causes of traumatic SCI?
Most traumatic SCI in Australia is caused by:
- Motor vehicle accident involving either occupants or pedestrians
- Falls
- Sporting related accidents
- Diving into shallow water
In Australia, traumatic SCI occurs in about 15 adults for each million in the population, every year. This has not changed for many years. It is expected to increase gradually in the years ahead due to our aging population, as many older people fall, which can cause a traumatic SCI.
The following types of injuries can cause spinal cord damage.
Flexion injuries:
Occur when there is a sudden forcible forward movement of the head, similar to a whiplash injury. This results in damage to the vertebrae in the neck (cervical) region of the spinal column. The damaged vertebrae then impact on the spinal cord, causing damage around C5-C6. Spinal ligaments are often also torn. These types of injuries commonly occur in motor vehicle accidents.
Rotation injuries:
Often occur alongside a flexion injury, where there is rotation of the spinal column, often in the cervical, lower thoracic and lumbar regions. This results in an associated injury of the spinal cord. Spinal ligaments are also often torn. Rotation injuries often happen in motor vehicle accidents where the vehicle is hit from the side. They also occur with people wearing lap seat belts, and in motorbike accidents.
Compression injuries:
Occur in diving accidents, where the force is transmitted through the head; or falls from a height, where the force is transmitted through the base of the spine or lower limbs. Impact causes the vertebrae, mostly commonly in the cervical or lower thoracic and lumbar region, to fracture into pieces and protrude into the spinal canal, damaging the spinal cord. The intervertebral discs may also be displaced and protrude into the spinal canal.
Hyperextension injuries:
Happen if you fall and the neck is forcibly extended in a backward direction, stretching the spinal cord. Even if there is minimal damage to the spinal column, the opening up of the discs and stretching of the ligaments damages the spinal cord. This injury is often seen in older people, and those injured in domestic accidents and assaults. Hyperextension of the neck is the most common way children damage their spinal cords. There is often little or no damage to the spinal column, but the force of the trauma causes excessive stretching of the spinal cord.
Penetrating injuries:
Occur when an object such as a knife or bullet penetrates the spinal cord. This type of injury can occur at any level of the spinal column and is often not associated with spinal column damage.
How does non-traumatic injury occur?
Sometime the spinal cord can be damaged by disease, abscesses from an infection, bleeds, clots or tumours that directly affect the functioning of the spinal cord. These injuries are called non-traumatic injuries.
What are the common causes of non-traumatic SCI?
Non-traumatic spinal cord injury can be caused by a wide range of health problems and diseases. The most common are:
- Arthritis and degeneration of the spinal column
- Cancer
- Circulation or bleeding problems
- Infections
- Inflammation
Non-traumatic SCI occurs more often than traumatic SCI. In Australia non-traumatic SCI occurs in about 26 adults for each million in the population, every year. It is expected that this will increase significantly in the years ahead due to the aging of our population.
The following types of situations can result in direct damage to the spinal cord:
- an abscess in the spinal cord (this can damage spinal tracts and spinal nerves).
- inflammation or infection in the spinal cord
- lack of blood flow causing tissue damage (when a blood clot cuts off blood supply or an aneurysm ruptures, and large amounts of blood are lost. When the spinal cord is deprived of adequate blood)
- diseases of the nervous system, in which the spinal cord or spinal nerves are destroyed (e.g. multiple sclerosis, motor neuron disease)
- tumours creating pressure on the cord and destroying tissue
- spontaneous bleeding from the pressure of blood building up in a confined space, or from lack of blood supply to the spinal cord tissue
Spinal cord injury in Australia
What does traumatic spinal cord injury look like in Australia?
- Traumatic SCI is about 4 times more common in males than females.
- Traumatic SCI typically occurs in people aged in their 20s to 40s, but with another small peak with people in their 70s and 80s. It can, however, occur at any age.
- Traumatic SCI is more likely to result in quadriplegia (affects the arms and legs and sometime also referred to as tetraplegia) and result is an injury that causes greater damage to the functioning of the spinal cord.
- As a result, people with traumatic SCI are less likely to have significant recovery of function in the affected areas.
What does non-traumatic spinal cord injury look like in Australia?
- Non-traumatic SCI tends to affect males and females almost equally.
- Non-traumatic SCI is much more common in older age, typically in people aged in their 50s to 70s. It can, however, occur at any age.
- Non-traumatic SCI is more likely to result in paraplegia (affects only the legs) and result in an injury that leaves some functioning of the spinal cord in the affected area. As a result, people with non-traumatic SCI are more likely to have some recovery of function in the affected area.
What can SCI mean for rehabilitation, complications, and outcomes?
Immediately following a SCI there is a need for acute hospital care where all medical and surgical treatment is completed. After this initial care, all people with a new SCI should be considered for rehabilitation. Regardless of whether an injury is caused by traumatic or non-traumatic events, a person with a SCI has the ability to benefit from rehabilitation. Ideally, this should be in a dedicated, specialist spinal rehabilitation unit. Research has shown that the outcomes for people with a SCI are better if they have rehabilitation in a specialist unit rather than a general rehabilitation unit.
The potential changes to a person with traumatic or non-traumatic SCI are similar regarding their ability to move, feel, control their bladder and bowel and other possible problems.
However, people with traumatic SCI tend to be at higher risk for many of the potential complications following SCI than those with non-traumatic SCI.
People with non-traumatic SCI tend to have a better recovery for affected areas and often stay in hospital for shorter periods compared with those with a traumatic SCI.
For anyone with SCI, no matter what the cause, it is best to have periodic reviews from a specialised team of health care professionals with expertise in spinal cord medicine. This is to help achieve the best possible outcomes for health and well-being and prevent and treat SCI complications.
