Spinal Cord and Paralysis Injuries

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What Is the Spinal Cord?

The spinal cord is the long, tube-like structure that stretches from your brain stem all the way down to your lower back. Your spinal cord acts as an information highway for the brain, permitting your brain to send and receive signals from other nerves located throughout your entire body.  The brain, spinal cord and connecting nerves (collectively known as the nervous system) allow us to sense pain, pressure, temperature, and the position of our body parts. It also allows us to flex and contract our muscles and move about. It also plays a role in numerous autonomic functions such as breathing, heart rate, blood pressure, body temperature, digestion (including urination and bowel movements), metabolism, and sexual response. Because the spinal cord is responsible for so many basic functions, an injury can have devastating effects on one's quality of life. When the spinal cord is damaged, the exchange of information between the brain and other parts of the body is disrupted, which can result in pain, weakness, numbness, loss of sensation, loss of bodily functions, and in the most serious cases, paralysis.     

Spinal Cord and Spinal Column Anatomy

The spinal cord is enclosed and protected by the spinal column which is made up of 33 bones called vertebrae which interlock with one another and are cushioned by disks of cartilage. The spinal cord is further protected and cushioned within the spinal column by three layers of tissue called meninges. The spinal column is divided into five sections: the cervical, thoracic, lumbar, sacral, and coccygeal regions.  The cervical (neck) region of the spine consists of seven vertebrae numbered C1 to C7,   the thoracic (upper torso) region of the spine has 12 vertebrae (T1-T12), and the lumbar (lower back) region of the spine has five vertebrae (L1-L5). The sacral region is made up of five fused vertebrae (S1-S5) and the coccygeal region is made up of four fused vertebrae. Each specific area of the spinal cord controls a particular region of the body – therefore, the scope, severity, and symptoms of a spinal injury are highly dependent on the specific area that is damaged.    

Spinal Cord Injuries

According to 2019 data from the National Spinal Cord Injury Statistical Center, there are about 17,730 new spinal cord injury cases each year, which equates to about 54 cases per one million people in the United States. These figures do not include those who die from their spinal injury at the scene of the accident.  Furthermore, it is estimated that between 249,000 to 363,000 persons in the United States currently live with a spinal cord injury.  

A spinal cord injury occurs when some type of trauma damages the spinal column vertebrae and the fragile spinal cord within. In most spinal cord injuries, one or more vertebrae pinch the spinal cord, resulting in swelling or bruising. More severe injuries may involve torn nerves and fibers along the spinal cord. The most severe injuries involve a complete severing of the spinal cord. 

Spinal cord injuries are usually classified as either complete or incomplete. In a complete spinal cord injury, all functions below the injured area are lost, regardless of whether the spinal cord is severed. In contrast, in an incomplete spinal cord injury, the injured person retains some level of function below the affected area. 

Types of Incomplete Spinal Cord Injury

The four main types of incomplete spinal cord injury are: anterior cord syndrome, central cord syndrome, Brown-Séquard syndrome, and posterior cord syndrome. Each signifies damage to a different portion of the spinal cord (front, center, side, rear) causing different symptoms. 

Anterior syndrome occurs when the front part of the spinal cord is damaged. It is usually caused by herniated disks, fractures or dislocations of vertebrae, or when the head is suddenly forced to the chest (cervical flexion). It may also be due to a reduction in the blood supply from the anterior spinal artery or due to a tumor.  Anterior syndrome causes loss of movement and loss of pain sensation and temperature sensation below the level of injury. The injured person retains their sense of position of their arms and legs (proprioception) as well as their sense of touch or pressure. 

Central cord syndrome occurs when the middle part of the spinal cord is damaged. It typically causes impairment in the arms and hands and to a lesser extent in the legs. There is also usually a loss of sensation of pain, temperature, light touch, and pressure below the level of injury. It is usually caused by a sudden and forceful hyperextension of the back (where the head is forced backward) or flexion of the neck. The most common cause of central cord symptoms are falls and vehicle accidents, although they may also be due to a medical condition such as spinal stenosis or a tumor impinging on the spinal cord.

Brown-Séquard syndrome occurs when one side of the spinal cord is injured more than the other side. The side of the body where the spinal cord suffered greater damage experiences impairment or loss of movement (motor control) below the injured area, as well as a loss of sense of vibration, touch and proprioception (sense of body position), but retains its sense of pain and temperature. Conversely, the less injured side of the body loses its sense of pain and temperature, but retains most or some motor control and sense of touch and proprioception. Brown-Séquard syndrome is usually the result of penetrating trauma such as a gunshot or knife wound, but can also be due to a fractured vertebrae or tumor.

Posterior cord syndrome occurs when the dorsal or rear part of the spinal cord is damaged and typically causes loss of proprioception and sense of vibration below the level of injury, but does not affect motor function or other senses like pain, temperature or touch.  This type of injury is much rarer than other conditions. It may occur as the result of trauma, such as a car accident or fall, but is more often usually due to an underlying illness or medical condition.

Spinal Cord Injury Ratings

The American Spinal Injury Association (ASIA) rates the severity of spinal cord injuries on a letter scale (A-E). An “A” rating signifies no sensory or motor function below the level of injury. A “B” rating signifies some sensory but no motor function below the level of injury. A “C” rating signifies there is some muscle movement below the level of injury, but 50 percent of the muscles below the level of injury cannot move against gravity. A “D” rating signifies that more than 50 percent of the muscles below the level of injury are strong enough to move against gravity. An “E” rating indicates normal motor and sensory function. 

Location of Spinal Cord Injuries and Symptoms and Complications

Because different areas of the spinal cord control different parts of the body, the location of the spinal cord injury determines the parts of the body that are affected. Generally, injuries located higher on the spine will be more severe. 

Cervical spinal injuries (C1-C8) are generally the most serious type of spinal cord injury since that portion of the spinal cord is attached and closer to the brain. The cervical region also happens to be the most flexible part of the spine as it allows the head to rotate – it is therefore especially susceptible to injury, especially from accidents involving sudden and violent force, such as whiplash. Cervical injuries usually impact most of the body from the neck down, including the function of the legs, arms, and hands. Cervical injuries may also adversely affect bowel and bladder control, heart rate, blood pressure, body temperature regulation, speech, and breathing. Cervical spinal injuries also carry the risk of complications related to lower spinal injuries. 

Thoracic spinal injuries (T1-T12) impact areas from the chest down. They are less common than other types of back injuries since the spine in that area has the additional protection of the rib cage. Thoracic injuries may cause weakness or paralysis of the legs (paraplegia) as well as a loss of bowel and bladder control, and sexual dysfunction. They also may impact trunk and abdominal muscles, and require the use of a brace to maintain core stability.  Usually, arms and hands are not affected. One complication of thoracic injuries (especially those at T6 and above) is autonomic dysreflexia (AD) which causes uncontrolled, excessively high blood pressure, increasing the risk of heart attack or stroke. Another complication is neurogenic shock caused by low blood pressure and which can result in irreversible damage to organs and body tissue, and death.

Lumbar (L1-L5) and sacral (S1-S5) spinal injuries affect areas below the chest, including the legs and hips. Arms and hands are not affected. Serious injuries may result in a loss of leg function (paraplegia) while others may still have control of their hip flexor and knee extension muscles.  Lumbar and sacral region injuries also usually result in sexual dysfunction and loss or impairment of bladder and bowel control. 

Quadriplegia/Tetraplegia

Complete spinal cord injuries affecting the higher cervical regions (C1-C4) are usually fatal or result in quadriplegia (also called tetraplegia), meaning paralysis (loss of movement/control) of the arms, hands, trunk and legs. Quadriplegic patients may be able to move around with the assistance of power wheelchairs with specialized controls; however, they require around-the-clock assistance with all their basic daily living activities, such as eating, dressing, bathing, and getting in and out of bed. Quadriplegics may also have complete or partial loss of bowel and bladder control. Their ability to speak may also be impaired. In the most serious cases, patients may not be able to breathe on their own, and require a breathing ventilator. Long term complications of quadriplegia include muscle atrophy, pressure sores, and infections. 

Paraplegia and other types of paralysis

Thoracic, lumbar, and sacral spinal injuries (below the neck) can cause impaired motor and sensory control (paralysis) of the legs (paraplegia). Although most paraplegics will require a wheelchair in order to move about, many are able to attain a high level of function and independence, especially after extensive rehabilitation and physiotherapy.

Less common types of paralysis due to spinal cord injury are: monoplegia, affecting only one arm; hemiplegia, affecting one arm and one leg on the same side the body; and triplega, usually affecting one arm and both legs.    

Spinal Cord Concussions and Transient Quadriplegia (TQ) Affecting Sports Players  

Another type of spinal cord injury is a spinal cord concussion, also known medically as transient quadriplegia (TQ) or cervical cord neurapraxia (CCN).  TQ usually occurs after a neck hyperextension (head jerking violently forward and backward, as in a whiplash-type accident) or when the neck is compressed due to loading or pressure applied to the top of the head.  These injuries occur most commonly among athletes or players of sports that involve tackling or high-speed collisions, such as football players. Symptoms of TQ include burning and tingling pain, loss of strength, or loss of sensation in both arms and/or legs that can range from mild to complete paralysis. Unlike paraplegia or quadriplegia suffered as a result of spinal cord damage, the symptoms of transient quadriplegia are transient and usually last less than 15 minutes, but in some cases may last up to 48 hours.   Such occurrences on the sports field are terrifying – since there is no way of immediately knowing whether such paralysis is the result of TQ or more permanent spinal cord injury, all spinal cord injury precautions and treatment protocols must be followed until proper tests are performed and a diagnosis is made. The incidence of TQ is approximately seven out of every 10,000 football players. Since 1.8 million Americans play football, including 1.5 million junior and senior high school students, over 1,000 U.S. football players can be expected to experience a TQ. In order to minimize TQ injuries, sports medicine experts stress the importance of teaching players proper tackling technique, with the head kept up, and showing zero tolerance for spearing (lowering of the head to make a tackle). Furthermore, athletes should not be allowed to compete again until cleared by a qualified physician. 

Spinal Cord Injuries and Life-Expectancy

Unfortunately, according to the National Spinal Cord Injury Statistical Center, the  life expectancy of those with spinal cord injuries have not improved since the 1980s and remain significantly below life expectancies of persons without spinal injuries. Mortality rates are especially high during the first year after injury. However, 85 percent of people with spinal cord injury who survive the first 24 hours are still alive 10 years later.  The most common cause or death resulting in a lower life-expectancy is pneumonia, especially among those who require ventilators. The second leading cause of death is septicemia (blood infection), often associated with decubitus ulcers (usually from bed or pressure sores), urinary tract infections or respiratory infections. Spinal cord injury victims are also at risk of blood clots, including stroke, heart attacks, and pulmonary embolisms.  

Causes of Spinal Cord Accident Injuries

The most common causes of traumatic, accident-related spinal cord injuries in the United States are:

  • Motor vehicle accidents (e.g. car, motorcycle, rollover accidents, etc.)
  • Falls (e.g. slip and tripping accidents)
  • Violence (e.g. gunshot and knife wounds)
  • Sports and recreation injuries (e.g. football, shallow diving, etc.)
  • Medical/surgical errors
  • Work-related (e.g. construction site accidents or other hazardous work environment)

According to one analysis, the majority of traumatic spinal cord injuries are due to automobile crashes (31.5%) and falls (25.3%), followed by gunshot wounds (10.4%), motorcycle crashes (6.8%), diving incidents (4.7%), and medical/surgical complications (4.3%). Collectively these accounted for 83.1% of total spinal cord injuries since 2005. Automobile crashes were the leading cause for spinal injury for those aged 45 years or younger, whereas falls were the leading cause for those older than 45. 

The Cost of Spinal Cord Injuries

Spinal cord injuries are life changing. Paralysis and other disabilities brought on by spinal cord injuries are physically, emotionally, and financially devastating. Long-term rehabilitation costs can be overwhelming and victims often have difficulty remaining employed. Often, insurance companies are not willing to pay for the most beneficial therapies, or assist with costs of living.

The average health and living expenses of a person in the U.S. with a spinal injury depends on the severity of the injury, but can easily run into the millions over a lifetime. For example a person suffering quadriplegia from a C1-C4 level injury can expect to have over $1 million in medical costs and living expenses in just the first year after the injury. They can also expect to spend nearly $200,000 every year thereafter, which adds up to over $5 million dollars over a lifetime for someone who is injured at 25 years of age. A paraplegic can expect to have approximately $550,000 in medical and living expenses in the first year, and nearly $72,000 every year thereafter, which adds up to a lifetime cost of nearly $2.5 million for someone who is injured at 25 years of age. These numbers do not even include the cost of lost wages, employment benefits, and productivity which averaged $76,327 in 2018).    

Spinal cord treatments

In most cases, medical care cannot reverse the damage done to the spinal cord. However, medical care, medicine, and rehabilitation can sometimes improve the function of the nerves that remain after a spinal cord injury. Spinal cord injury treatment usually focuses on preventing further injury and empowering people to return to an active and productive life.

Treatment for a spinal cord injury often begins at the scene of the accident. Emergency personnel immobilize the spine using a rigid neck collar and a rigid carrying board and transport you to the hospital. In the emergency room, doctors help you to breathe and take measures to prevent further injury. You may undergo diagnostic tests and be admitted to an intensive care unit for treatment. You may be transferred to a regional spine injury center that has a team of neurosurgeons, orthopedic surgeons, spinal cord specialists, psychologists, nurses, therapists, and social workers with expertise in spinal cord injury.

Surgery may be necessary to stabilize the spine and remove foreign objects, fragments of bones, herniated disks, or fractured vertebrae that appear to be compressing the spine. You may be immobilized and given traction to help the spine heal. You may be given drugs that help reduce cell damage.

After the initial injury stabilizes, your medical team will help to prevent secondary problems that often arise. Once you're well enough to participate in therapies and treatment, you may be transferred to a rehabilitation facility. You may also need special medical equipment like special wheelchairs, adapted computers, and other devices to help with daily living. Technology such as electrical stimulation devices may help you to control arm and leg muscles to allow you to stand, walk, reach and grip. All of this care is costly.

How we can help

Because spinal injuries have a tremendous impact on a physical, social, emotional and economical level, it is important to contact a qualified attorney with experience in spinal injury accident claims in order to make sure you get the compensation you deserve. Spinal injury cases are extremely complex – experts, such as those specializing in sport or vehicle accidents, may be needed to establish the cause of the accident and the liability of the opposing party. Various medical experts are needed to determine the full level of damage and impaired function, as well as the likelihood of future complications. Experts are also needed to adequately calculate the cost of a lifetime of care.  We have helped our clients recover millions of dollars in damages for costs of immediate and long-term medical care, loss of income, pain and suffering, and other expenses. We've helped families recover damages for the loss of a loved one. Our Los Angeles based law firm invites you to contact us for a free, confidential, no-obligation consultation to review your case!

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