What are the signs that indicate a spinal cord injury?

Signs Indicating Spinal Cord Injury

For a person with suspected spinal cord injury, the first aid provider should have the person remain as still as possible (unless safety considerations warrant movement) and activate the emergency response system. 1

Clinical Signs and Symptoms

Neurological Signs

• Paralysis or weakness in any part of the body, especially in the extremities 1
• Numbness, tingling, or loss of sensation (paresthesia) in the extremities 1
• Abnormal neurologic signs including motor or sensory deficits 1
• Loss of bowel or bladder control (dysfunction) 2

Motor Function Changes

• Inability to move limbs below the level of injury 1, 3
• Impaired balance or coordination difficulties 1
• Spasticity or flaccidity in affected limbs 3

Sensory Disturbances

• Loss of temperature sensation 3
• Loss of pain sensation 3
• Loss of touch sensation 3
• Sensory deficits involving the torso or upper extremities 1

Autonomic Dysfunction

• Difficulty breathing or respiratory compromise 4
• Low blood pressure (hypotension) - systolic blood pressure < 90 mmHg 5
• Bradycardia (abnormally slow heart rate) 5
• Inability to regulate body temperature 6

Pain and Discomfort

• Pain or tenderness in the neck or back 1
• Severe headache, especially if worsening 1

Mental Status Changes

• Altered level of consciousness 1
• Not fully alert or intoxicated (which may mask other symptoms) 1

High-Risk Factors

Mechanism of Injury

• Driver, passenger, or pedestrian in a motor vehicle, motorized cycle, or bicycle crash 1
• Fall from greater than standing height 1
• High-energy transfer mechanisms 1
• Sports injuries, particularly diving accidents 1

Age-Related Factors

• Age ≥65 years increases risk 1
• In children <8 years, upper cervical spine injuries are more common due to incomplete ossification, unfused synchondroses, ligamentous laxity, and large head-to-body ratio 1

Associated Injuries

• Other painful injuries, especially of the head and neck 1
• Craniofacial injury (triples the risk of cervical spine injury) 1
• Evidence of head or neck trauma in children 2 years of age or older 1

Special Considerations

SCIWORA (Spinal Cord Injury Without Radiographic Abnormality)

• More common in children 1
• Clinical symptoms of traumatic myelopathy with no radiographic or CT features of spinal fracture or instability 1
• Certain sports and recreational activities in children are associated with higher odds of SCIWORA 1

First Aid Management

• Keep the person as still as possible unless safety considerations warrant movement 1
• Avoid routine use of rigid cervical collars and long spine boards for spinal immobilization 1
• Routine spinal immobilization for penetrating trauma (e.g., gunshot or knife wounds) is not recommended 1
• Activate emergency medical services immediately 1

Imaging Considerations

• CT is considered the gold standard for identification of spine fractures 1
• MRI is complementary to CT, allowing for more detailed assessment of soft tissues, ligamentous integrity, intervertebral disc injury, and spinal cord injury 1
• The presence of intramedullary hemorrhage and extended segments of edema on MRI have been associated with clinically complete SCI 3

Remember that early recognition and appropriate management of spinal cord injury are crucial for preventing further damage and improving outcomes 5.