The Spine

Spinal cord injury is regarded as one of the most traumatic and debilitating forms of injury. Victims are usually young active males involved in high velocity accidents, RTA’s, Diving accidents, falls etc. However, there is a rise these days in spinal malformations like tumours, arterial malformations around the spinal cord causing spinal bleeds etc. This is all related to diseases of affluence and our lifestyle in this day and age. Similarly there is a distinct rise in diabetes, obesity, CHD and CVA’s due to the more sedentary lifestyles we live and poor diet we take due to convenience foods so readily available to us. Paralysis is linked to all the above. 

The Split 

The Human spine is split up into 4 sections. 

• Cervical.. containing 7 vertebrae (commonly referred to as category C injuries. I.e. C2 = The second vertebrae of the cervical region.)
• Thoracic containing 12 vertebrae (T injuries) Also referred to as the dorsal. (D injuries)
• Lumbar…5 vertebrae (L injuries)
• Sacral…5 vertebrae.(S injuries, which are found in the coccyx)

Paralysis usually appears directly below the level of the injury, so the higher up the spine the injury the greater the loss of control and sense. The late Christopher Reeve injured his spine at C2 level, meaning no sensation or motor function from the neck down. Although Marrianne crushed her C2 and C3 vertebra, Marrianne’s spinal cord injury is at level C4, resulting in a paralysis below the shoulders. 

In spinal injuries we split the spinal cord into two sections, upper motor neurone and lower motor neurone. Upper motor neurone injury is from t6 and above and lower is t6 and below. We believe this to be because the parasympathetic nervous system joins at t6 so above that level, people will have altered blood pressures and will be receptive to autonomic dysreflexia, amongst many other complications. 

Because the spinal cord connects with all the body’s nerves, damage to it can alter every system. In addition to affecting a person’s ability to move and feel, SCI can affect skin, breathing, bladder, bowel, sexual function and subconsciously controlled phenomena like blood pressure and sweating. 

Autonomic dysreflexia 

Autonomic dysreflexia is where the body reacts to a noxious [painful] stimuli below the level of injury, which can’t be felt due to sensory loss, but which the body sees as harmful and sends out a warning to the body that something’s not right! It could be caused by something as simple as a toe being curled up in a shoe, or due to a full bladder, a full bowel, sitting on something uncomfortable, a pressure sore or even the point of orgasm or ejaculation. The blood pressure rises dramatically, very quickly and to a very high level, causing a pounding headache and redness or blotching above the level of injury. It can be fatal or cause a CVA [Stroke] if not treated immediately. Treatments are either GTN spray or Nifedipine sub lingually [under the tongue] which immediately lower the blood pressure and gives time to relieve the problem.