What Happens After A Spinal Cord Injury?

[ photo by Joyce McCown ]

What to expect in the initial days after a spinal cord injury.

I spent five years doing inpatient consults at a level I trauma center and many of those consults were for individuals who had experienced a spinal cord injury. These are often life-altering events. Given the acute, serious nature of spinal cord injuries I wanted to write about what to expect in the first week or so after the initial spinal cord injury. Spinal cord injuries are generally life-long journeys, and there are things to expect at different time points of the rehab and even post-rehab processes. For this post, though, let’s review those initial days. 

Let me start with the basics of spinal cord injuries (SCI). An SCI can occur at multiple levels. This can be quite complicated, but to keep it simple, it can occur at the neck (cervical), mid-back (thoracic), or low back (lumbar). If the injury occurs at the neck, the arms and legs will be affected. If at the thoracic or lumbar level, the legs will be affected. Understandably, there is a huge difference in the functional abilities of one who has the arms and legs affected (quadriparesis) and one with only the legs affected (paraparesis).

In addition to the level of injury, there are basically two qualifications of SCI. These are incomplete or complete. An incomplete injury is as described; the cord has been injured, however, it was not completely disrupted. There are still some signals that are able to pass along the spinal cord past the level of injury. With a complete injury, it is as it is named; there is no signal moving past the level of injury.

Mark’s spinal cord injury story.

I would like to tell you about a man in his 50s, Mark (not his real name), who was involved in an ATV accident and was found to have a complete spinal cord injury at the mid-back (thoracic) level. Mark was brought immediately to the ER and found to have vertebrae fractures at T9 and T10 (lower part of mid-back), which were unstable. He was seen in the ER by neurosurgery and taken right away to the operating room where he underwent a surgery to stabilize the fractures. These surgeries are often performed after spinal cord injury, but they generally do not fix the actual injury to the spinal cord. 

I was asked to see Mark three days after his accident. Fortunately, his other injuries were fairly minor, and he did not have any brain trauma. He was still in the neuro intensive care unit where his vitals were being closely monitored. I was consulted in order to get the initial rehab process moving forward so that when he moved to acute rehab he would be ready for what would take place while there. So, I want to add that if you do have a loved one that experiences an SCI (or any neurological injury for that matter), please ask that he or she be seen by a physiatrist (Physical Medicine & Rehabilitation doctor) while still in the hospital. This is done more often than not, but I know there are patients, unfortunately, that do not get seen in the acute care hospital.

Once someone arrives to acute inpatient rehabilitation, the clock is ticking in regards to how much time is granted by insurance to remain in rehab. If some of those processes have already been started, your loved one is just that much farther down the road and will be able to likely have more things accomplished in rehabilitation.

Important functions addressed during rehabilitation.

The things I address with someone who has had a spinal cord injury involve pain, managing the bowels and the bladder, and getting the person moving. Mark was having a lot of pain at the surgical site itself, which is normal. He was getting pain medicine through his IV, but the trauma team’s goal was to transition him to oral medication. I made recommendations on what oral medications would help to control that surgical site pain, but then I also talked to him about the pain he was experiencing in his legs.

After an SCI, people often experience what is called neuropathic pain. It is pain in the extremities below the level of injury. It can be burning and/or pins and needles and is usually nearly constant. There is medication that can help with this, so I often try to get it started as soon as the person reports that type of pain. Sometimes people will often have spasms below the level of the injury. This usually takes at least a few days to begin occurring, often not showing up until rehab, but if it is already present, I address this too. Mark was not yet having spasms, so I did not start anything for this. 

Just in the way the spinal cord is the highway for the nerves that tell the muscles of the arms and legs to move, it is also the highway for the nerves that tell the bowel and bladder to work. People with complete, and sometimes incomplete, SCI will experience difficulty having bowel movements and urinating. A catheter is inserted to allow the bladder to empty because without the signal passing from the brain down to the bladder, it is not able to empty itself.

As soon as it was possible, I recommended taking the catheter out so that Mark could begin learning the process for in- and out-catheterization. This usually occurs about every six hours. I explained to Mark that because of the SCI, there is a strong likelihood this will become his new normal, so the sooner he learns the process, the better. Also, getting the catheter out helps to decrease the likelihood of a bladder infection. 

In addition, I talked to Mark about the need for medications to help him have bowel movements. The sooner the medications for bowel movements are started and given on a daily basis and at the same time, the sooner his bowels can be trained to have a bowel movement at the same time each day. This helps to prevent/limit incontinent episodes. 

To achieve the best possible outcome, start rehab early.

The things I told Mark were quite a bit to process, especially after dealing with the knowledge of his new SCI. These are the basic things that need to be introduced early on to help promote a successful rehabilitation process. Mark had a lot of questions, and I did my best to answer them. I continued to see him every few days while he remained in the hospital.

While still in the hospital, the physical and occupational therapists began working with him daily. These are short sessions, but they also taught his wife exercises to do with him periodically through the day. Because of his injury and his motivation to regain independence, he was strongly recommended for acute inpatient rehabilitation. His insurance company gave the approval for him to go, and he was discharged from the hospital to rehab ten days after his accident. He still had a long road ahead, but he at least had some basic knowledge of his spinal cord injury and the best start possible to his rehab journey.

Do you have a specific question as to what happens after a spinal cord injury? Or about the rehab process after a spinal cord injury? Leave your question in the Comments section or contact me directly.

© 2021 Jessica Kluetz, DO