Spinal Cord Injury Case Management

The spine is formed from a verterbral column of 33 individual bones called verterbrae, stacked one on top of the other. The spine provides the main support for your body, allowing you to stand upright, bend, and twist, while protecting the spinal cord from injury. The 33 vertebrae are numbered and divided into regions, from top to bottom, they are: cervical C1–C8 (neck), thoracic T1–T12 (mid back), lumbar L1–L5 (low back), sacrum S1–S5, and coccyx. Only the top 24 bones are moveable; the vertebrae of the sacrum and coccyx are fused.

The spinal cord is a long, thin, tubular structure made up of nervous tissue, which extends from the brainstem to the lower, lumbar, region of the vertebral column. The spinal cord serves as an information super-highway, relaying messages between the brain and the body. The brain sends motor messages to the limbs and body through the spinal cord allowing for movement. The limbs and body send sensory messages to the brain through the spinal cord about what we feel and touch. Sometimes the spinal cord can react without sending information to the brain. These special pathways, called spinal reflexes, are designed to immediately protect our body from harm.

How is a Spinal Cord Injury caused?

A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. An SCI can be traumatic or nontraumatic, and can be classified into three types based on cause: mechanical forces, toxic, and ischemic (from lack of blood flow). In the majority of cases the damage is a result of physical trauma such as a car accident, a fall or being hit by a large object. Forces involved can be hyperflexion (forward movement of the head); hyperextension (backward movement); lateral stress (sideways movement); rotation (twisting of the head); compression (force along the axis of the spine downward from the head or upward from the pelvis); or distraction (pulling apart of the vertebrae). Traumatic SCI can result in contusion, compression, or stretch injury.

The part of the spinal cord that is damaged corresponds to the spinal nerves at that level of the verterbral column and below. Injuries can be cervical (C1–C8), thoracic (T1–T12), lumbar (L1–L5), or sacral (S1–S5). A person’s level of injury is defined by the level of full sensation and function. Paraplegia occurs when the legs are affected by the spinal cord damage this can be in thoracic, lumbar, or sacral injuries, and tetraplegia occurs when all four limbs are affected, cervical damage. A SCI can also be defined as “complete” or “incomplete”, depending on if the functions below the injured area are lost, whether or not the spinal cord is severed. An “incomplete” spinal cord injury involves preservation of motor or sensory function below the level of injury in the spinal cord.

What are the effects of a Spinal Cord Injury?

The effects of a SCI will vary depending on where the spinal cord is injured and the extent of the injury. Some effects, such as bowel and bladder dysfunction can occur regardless of where the injury is located. Neurogenic bladder involves a compromised ability to empty the bladder and is a common symptom of spinal cord injury. This can lead to high pressures in the bladder that can damage the kidneys.

Cervical C1-C8

Spinal cord injuries at the cervical (neck) level result in full or partial tetraplegia (also called quadriplegia). Depending on the specific location and severity of trauma, limited function may be retained. Additional symptoms of cervical injuries include low heart rate, low blood pressure, problems regulating body temperature, and breathing dysfunction. If the injury is high enough in the neck to impair the muscles involved in breathing, the person may not be able to breathe without the help of an endotracheal tube and mechanical ventilator.

Thoracic T1-T12

In addition to the problems found in lower-level injuries, thoracic (chest height) SCIs can affect the muscles in the trunk. Injuries at the level of T1 to T8 result in inability to control the abdominal muscles. Trunk stability may be affected; even more so in higher level injuries. The lower the level of injury, the less extensive its effects. Injuries from T9 to T12 result in partial loss of trunk and abdominal muscle control. Thoracic spinal injuries result in paraplegia, but function of the hands, arms, and neck are not affected.

Lumbosacral L1–L5

The effects of injuries at or above the lumbar or sacral regions of the spinal cord (lower back and pelvis) include decreased control of the legs and hips, genitourinary system, and anus. People injured below level L2 may still have use of their hip flexor and knee extensor muscles. It is common to experience sexual dysfunction after injury, as well as dysfunction of the bowel and bladder, including fecal and urinary incontinence.

How can Spinal Cord Injury Case Management help?

Due to the complexity of spinal cord injury (SCI), it is important that an individual who has sustained a SCI is comprehensively supported by a team of experienced specialists. NeuroHealth’s SCI Case Managers are highly skilled experienced clinicians, registered with the Health and Care Professions Council (HCPC).

A NeuroHealth SCI Case Manager will have knowledge of specialist services in both the private and public sector, and through the case management process they will ensure that the individual who has sustained a SCI is able to access the services available to them as quickly and safely as possible. The SCI Case Manager will tailor the service they provide to the needs of the injured individual, ensuring the induvial and their close family and friends are supported to facilitate optimal health, wellbeing and quality of life. SCI Case Management is a service provided in collaboration with medical, therapeutic, vocational and domestic services.

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