Reader: Family, Professional

What is the Spinal Cord?

The spinal cord is the part of the central nervous system that carries messages back and forth between the brain and the rest of the body. These messages are carried along nerve fibers and nerve cells by means of electrical impulses. Unlike other cells in the body, nerve cells cannot be replaced if they die. Therefore, it is extremely important to preserve the nerve cells that are present at birth. That is why the brain and spinal cord are the most protected parts of the body.

Injury to the Spinal Cord

When the nerve cells within the spinal cord are damaged by injury or disease, they are unable to carry messages from one location to another. The damage may be permanent or temporary. If a nerve cell is "sick," bruised or swollen, it may eventually recover and resume its normal function. In this case the damage was only temporary. If a nerve cell dies, it will not grow back again or be replaced. Therefore, the damage will be permanent.

All of the affected nerve cells in the same person may not have the same degree of injury; that is, some cells may be temporarily damaged and others may be permanently damaged. Unfortunately, there is no test at this time that will determine whether the damage is temporary or permanent. Only time will tell!

Complete vs. Incomplete Injury

It is often assumed that a complete injury means that the spinal cord has been cut in two. This is not true! Instead, a complete injury is one in which no nerve messages are able to get past the injury at the time the examination is done. For example, no sensations can be felt below the injury because the messages cannot get to the brain and no voluntary movement is possible because the messages cannot get from the brain to the muscle. If even one nerve fiber is still able to carry messages past the injured area, the injury is incomplete. Therefore, a very careful neurological examination must be done before deciding if an injury is complete or incomplete with particular emphasis on sensation in the area around the rectum which may be the only preserved function.

Research

For the past 20 years, detailed clinical information has been collected by the National Spinal Cord Injury Database from numerous spinal cord injury (SCI) centers about the SCI patients who were treated there. Since an individual center may see only 100 or less new patients per year, by combining the results from many centers, a larger number of injuries can be compared. As much as possible, the information has been standardized so that each center performs the evaluations the same way and collects the same information.

Careful neurological examinations are done as soon as the patient arrives at the SCI Center and at regular intervals afterward - such as when the patient is transferred to rehabilitation, when discharged from rehabilitation, at one year after injury and at yearly intervals afterward as long as the patient is followed by the Center. In addition to the neurological examination, information is collected about the type of treatment given, complications that occurred, level of self-care independence, bowel and bladder management, etc.

Over 10,000 individuals have been followed so far. From an analysis of this information it is possible to determine such things as:

• What kind of recovery occurred following different degrees of severity at the time of the original examination.
• Long term result of different types of treatment (including complications and outcome).
• How long it takes to reach the maximum recovery that occurs.
• Life expectancy following different levels of injury.

Based on this type of research, doctors can make an "educated guess" about a new injury by comparing the neurological findings with previously injured individuals with the same findings. Therefore, if 99% of the similarly injured persons had no recovery or had excellent recovery, the odds are that the new injury will respond the same way. However, there is no guarantee that this will happen! The future of each new injury will only be determined by time.

How Much Recovery Can I Expect?

The following statements can be used as a guideline to predict recovery following a new injury. This is a very simplified summary. For further detail, see the reference at the end.

• The severity of the original injury determines whether or not recovery will occur. Unfortunately, there is no test available at this time to measure this severity and predictions must be based on what has happened to others in the past with similar neurological findings.
• Incomplete injuries have a better chance of further recovery than complete injuries, but even with incomplete injuries there is no guarantee that any further recovery will occur.
• Most of the recovery that will occur starts early (within the first few weeks). Therefore, each day that goes by without any return of function means that the chance for recovery is less!
• No amount of hard work will make the nerves return. If hard work was all it took, very few people would end up with permanent paralysis.
• Whether or not you have surgery and whether or not you go to therapy are not what determine how much recovery you will have. These things are done for other reasons.
• Rehabilitation will not affect the degree of recovery. The purpose of rehabilitation is to improve function in self-care activities (such as dressing, transfers and wheelchair mobility) using whatever is available to work with. Since most recovery that will occur tends to start within the first few weeks after injury and by coincidence this is usually the same time therapy is being done, there is a tendency to think the recovery is due to the therapy. It should be clearly understood that the therapy did not cause the recovery!
• Just because one nerve cell recovers does not mean that others will. Patients often get very excited when they see some small improvement in sensation or increase in strength, but only time will tell if anything else will come back.

Summary:

No physician knows how much recovery will occur in a specific individual and there is no test currently available that will enable him/her to give an accurate prediction. Only time will tell!

The best that can be done is to make an educated guess based on what has happened in the past to others with similar neurological findings at the same time since onset of the injury.

But in the meantime, rehabilitation (to learn to be as functionally independent as possible and to prevent complications) offers the best opportunity to take advantage of any return, if and when it should happen!