🧠 Spinal Cord Injury (SCI)
Definition, Types, Surgical & Physiotherapy Management — by Harikrishna M S
Definition
Spinal Cord Injury (SCI) is damage to the spinal cord resulting from trauma, disease, or degeneration that leads to partial or complete loss of motor, sensory, and autonomic functions below the level of the lesion.
⚙️ Types of Spinal Cord Injury
1️⃣ Based on Type of Lesion
| Type | Description | Example / Features |
|---|---|---|
| Complete SCI | Total loss of motor and sensory function below the level of injury. No sacral sparing. | Transection of cord due to fracture-dislocation. |
| Incomplete SCI | Partial preservation of motor or sensory function below lesion (especially sacral segments). | Central cord, anterior cord, Brown-Séquard, posterior cord syndromes. |
2️⃣ Based on Anatomical Level
| Level | Involved Segments | Typical Presentation |
|---|---|---|
| Cervical (C1–C8) | Neck region | Tetraplegia / Quadriplegia (both UE + LE involved) |
| Thoracic (T1–T12) | Upper trunk | Paraplegia (LE involved) |
| Lumbar (L1–L5) | Lower trunk | Paraplegia, bowel and bladder affected |
| Sacral (S1–S5) | Pelvic region | Bowel, bladder, sexual dysfunction, sensory loss in perineum |
3️⃣ Incomplete Spinal Cord Syndromes
| Syndrome | Site of Lesion | Clinical Features |
|---|---|---|
| Central Cord Syndrome | Cervical region (central grey matter) | More weakness in upper limbs than lower limbs; variable sensory loss; common in elderly after hyperextension injury. |
| Anterior Cord Syndrome | Anterior 2/3 of cord | Loss of motor function and pain/temperature below lesion; touch and proprioception preserved. |
| Posterior Cord Syndrome | Posterior column | Loss of proprioception and vibration; motor and pain/temperature preserved. |
| Brown-Séquard Syndrome | Hemisection of cord | Ipsilateral motor and proprioception loss; contralateral pain and temperature loss. |
| Cauda Equina Syndrome | Below L1 (nerve roots) | Flaccid paralysis, areflexia, saddle anesthesia, bladder/bowel dysfunction. |
⚕️ Clinical Features
1️⃣ Motor Changes
- Paralysis: Flaccid below level (spinal shock), later spastic.
- Hyperreflexia after recovery from spinal shock.
- Clonus and Babinski sign (in UMN lesion).
2️⃣ Sensory Changes
- Loss of sensation (pain, touch, temperature) below level of injury.
- Sensory level helps localize lesion.
3️⃣ Autonomic Dysfunction
- Bladder & Bowel: Retention or incontinence.
- Sexual dysfunction.
- Loss of temperature and sweating control below lesion.
4️⃣ Other Complications
- Pressure sores
- Deep vein thrombosis (DVT)
- Respiratory problems (in high cervical lesions)
- Spasticity and contractures
🏥 Surgical Management
1️⃣ Indications for Surgery
- Progressive neurological deficit
- Spinal instability or fracture-dislocation
- Compression by bone fragments, hematoma, or disc
- Penetrating injuries
- Intractable pain or deformity
2️⃣ Surgical Procedures
| Procedure | Purpose |
|---|---|
| Decompression (Laminectomy / Laminotomy) | Remove bone fragments, disc material, or hematoma compressing the spinal cord. |
| Internal Fixation / Stabilization | Screws, rods, or plates used to realign and stabilize fractured vertebrae (anterior or posterior fixation). |
| Spinal Fusion | Fusing adjacent vertebrae using bone grafts to prevent movement and ensure stability. |
| Discectomy | Removal of herniated intervertebral disc compressing spinal cord. |
| Dural Repair | Repair of torn dura or cerebrospinal fluid leakage. |
3️⃣ Post-operative Management
- Early physiotherapy (passive → active mobilization)
- Prevention of complications (pressure sores, DVT)
- Respiratory care (esp. cervical lesions)
- Use of orthoses (TLSO, cervical collar)
- Functional training & gait re-education
🧩 Summary Table
| Aspect | Complete SCI | Incomplete SCI |
|---|---|---|
| Motor & Sensory loss | Complete | Partial |
| Sacral sparing | Absent | Present |
| Prognosis | Poor | Better |
| Surgical aim | Decompression, stabilization | Same |
| Rehab potential | Limited | Higher |
📘 Physiotherapy Role (Post-Surgery)
- Prevention of secondary complications
- Strengthening of preserved muscles
- Balance and transfer training
- Wheelchair and gait training
- Functional independence and community re-entry
✅ In Short
Spinal cord injury can be complete or incomplete.
Clinical features depend on the level and type of lesion.
Surgical management includes decompression and stabilization to prevent further neurological damage and enhance rehabilitation outcomes.