James A. Haley Veterans’ Hospital - Tampa, Florida

About Spinal Cord Injuries and Disorders

What is a spinal cord injury (SCI)?

The spinal cord may be damaged as a result of trauma or disease. Injury such as fracture of the vertebrae can cause tearing or pressure on the cord. Stab wounds or gunshot wounds can damage the spinal cord without breaking vertebrae. Paralysis may occur in parts of the body that are supplied by nerves leaving the cord below the level of injury. Damage to the spinal cord can affect your movement, feeling, and sensations as well as bodily function, such as control of your bowel and bladder.

The spinal cord is made of bundles of nerve fibers, like a telephone wire, which connect the brain to muscles, skin and the organs inside the body. The spinal cord carries messages from the brain to tell a muscle when, how far and how fast to move. Messages such as temperature, pain, touch, and location are carried from the body to the brain. The brain also controls the normal function of the organs inside your body such as the bowel and bladder. An injured spinal cord is like a broken telephone wire. The brain and body parts on each end are fine, but the connection does not work. Spinal cord injury (SCI) affects each person in a different way. This is because the spinal cord is not damaged in exactly the same way for each person.

Right after the injury, the spinal cord stops working completely for a period of time that may last days, weeks or months. This is called “spinal shock”. During this period, all the movements below the level of your injury are absent. The return of reflexes below the level of injury marks the end of spinal shock. Your doctor will describe your level of injury to you after spinal shock.

Spinal cord injuries (SCI) are identified as either paraplegia or tetraplegia (quadriplegia). Persons with paraplegia are not able to move the lower parts of their body. Someone with tetraplegia has lost movement in both the upper and lower parts of the body.

Your injury can be described as complete or incomplete. A complete injury is when there is no movement or feeling below your spinal cord injury level. If you have some feeling or voluntary movement below your injury, you have an incomplete injury. This is because there is only partial damage to your spinal cord.

A numbering system is used to describe the level of injury. It is named for the lowest level of the spinal cord which functions the way it did before your injury. For example, “C-5” means that your spinal cord from the 5th cervical nerve and above still functions the way it did before your injury. The nerves below that level are affected. Those nerves involve shoulder, arm, trunk, and leg muscles function. “T-10” means that your spinal cord from the 10th thoracic level near the lower back and above is intact. The affected nerves below that level involve your belly and leg muscle function.

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What is multiple sclerosis (MS)?

Multiple sclerosis (MS) is a disease that results from damage to the covering of the nerves (myelin sheath) in the brain and spinal cord. Intact myelin permits nerve impulses to travel quickly along the nerves. When the myelin is damaged, nerve impulses do not travel properly. Body movements may be slow or uncoordinated. Body feelings may be changed. The

The exact cause of MS is not known. The body’s immune system begins to attack the myelin sheath. This causes inflammation and damage to the nerve (demyelination). Symptoms are related to the area of the brain or spinal cord where there is damaged myelin. Over time the damaged myelin forms scars (sclerosis). These scars or plaques interfere with motor and sensory function when the underlying nerve fiber is injured.

Since many other diseases cause similar symptoms, the doctor must rule out other causes first. This may take a long time, especially if symptoms come and go. There may be tests such as magnetic resonance imaging (MRI), evoked potentials, and cerebrospinal fluid (CSF) studies. The doctor also looks for areas of demyelination.

Common symptoms are fatigue, weakness of arms and legs, numbness, loss of balance, vision problems, changes in bladder and bowel function, emotional changes, and swallowing problems.

MS affects each person in a different way. This is because the nerves are not damaged in exactly the same way for each person.

MS is described by how often a person has episodes of demyelination and the extent of the damage.

  • Relapsing-remitting MS is the most common type. A person has periods when symptoms are gone or almost gone, in between these periods the symptoms come back or get worse.
  • Secondary-progressive MS has relapses, but the symptoms get worse over time. Many people who have secondary-progressive MS started with relapsing-remitting MS.
  • Primary-progressive MS does not have relapses, although the symptoms slowly become worse.
  • Progressive-relapsing type has symptoms getting worse from the beginning and occasional relapses.
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What is amyotrophic lateral sclerosis (ALS)?

Amyotrophic lateral sclerosis or ALS is a disease of nerves in the brain and spinal cord that allow you to control your muscles (motor neurons). There is damage to the motor neurons which causes muscle weakness and loss of muscle (atrophy). ALS can affect any voluntary muscle group. This includes muscles that control facial expression, chewing, swallowing speaking, breathing, using arms and legs, and moving trunk. Symptoms get worse over time. The speed of this progression is different for each person. It can be slow, average, or rapid. Most people live with ALS for several years. It is unusual for the disease to quickly progress to breathing failure in less than a year.

Early symptoms are often weakness in a leg or hand, weakness of the face, or weakness of the tongue. Symptoms on one side of the body usually spread to the other side. For example, one leg may become weak and then the other leg will become weak also. As the damaged motor neurons stop sending messages to the muscles, the muscles get weaker and smaller until they no longer move.

It is not known what causes ALS. Researchers are attempting to find the cause. A small number of cases run in families due to an abnormal gene. Most cases, known as sporadic ALS, do not have a family history of ALS. Some theories for the cause of sporadic ALS address viruses, inflammation, dietary deficiencies, or environmental factors as causes. Studies conducted by the Department of Veteran Affairs and Department of Defense found an increased number of Veterans with ALS. Although the exact cause of ALS is not known, there is a link between military service and risk of ALS.


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