Spinal Cord Injury Diagnosis

The spinal cord is a tube-like structure consisting of nerves that carry commands from your brain to other parts of your body and sensory information from the body to the brain. Together, the brain and the spinal cord make up the central nervous system (CNS), which allows us to control our muscle movements, feel sensations, and much more – nearly everything we do is dependent on it.

Because the spinal cord plays such a crucial role in our overall wellbeing, injuries are serious and often result in permanent damage. The physical trauma and severity of symptoms can make daily life significantly challenging, which is why diagnosing and treating these injuries immediately is so important.

So how are spinal cord injuries diagnosed, and what types of spinal cord injury diagnosis tests do doctors use to determine the specific type injury?

Common Spinal Cord Injuries Causes

In most cases, an injury of the spinal cord is the direct result of a serious physical accident. According to the National Spinal Cord Injury Association (NSCIA), the most common causes of spinal cord injuries are:

• Motor vehicle accidents (42%)
• Violence (24%)
• Falling (22%)
• Sports related injury (8%)

If a spinal cord injury is suspected following any of the above traumatic events, immediate medical care is required. A spinal cord injury patient must be immobilised, diagnosed and treated promptly to give them the best possible chance at recovery.

Very rarely, an SCI can be caused by something other than a traumatic incident. These non-traumatic causes include degenerative diseases, cancer, congenital health issues, infections and inflammation.

Types of Spinal Cord Injuries

Spinal cord injuries generally diagnosed as “complete” or “incomplete”. A complete SCI involves total paralysis below the point of injury and occurs when the cord is fully severed. An incomplete SCI occurs when the cord is only partially severed or bruised, and causes partial loss of feeling below the point of injury. More than 60% of spinal cord injuries are incomplete.

Common Spinal Cord Injury Symptoms

Depending on the severity of the injury, symptoms can range anywhere from temporary loss of sensory functions to complete paralysis from the neck down.   

While symptoms vary greatly depending on the type of injury, a few of the most common symptoms of an SCI include:

• Inability to move part arms or legs (paralysis)
• Inability to control bladder or bowels
• Loss of sensation, pins and needles feeling
• Muscle weakness and spasms
• Neck or back pain
• Difficulty walking or breathing

How Are Spinal Cord Injuries Diagnosed?

Being able to effectively communicate the symptoms of a spinal cord injury to a doctor is the first step in reaching a diagnosis and developing a treatment plan. So how are spinal cord injuries diagnosed?

Physical Examination

Before any spinal cord injury diagnosis tests, a doctor will perform a physical examination. Doctors are able to determine which sections of the vertebrae (cervical, thoracic, lumbar, or sacral) are damaged by examining the patient’s muscle movement and reflexes.

If the patient is able to respond, the doctor will also ask questions about when and how the injury occurred, their past medical history, and the types of symptoms they’re currently experiencing.

Spinal Cord Injury Diagnosis Tests

To determine the nature and severity of the injury, doctors will perform one or more of the following spinal cord injury diagnosis tests:

• X-ray: An X-ray is typically the first imaging test doctors use to reach a spinal cord injury diagnosis after a traumatic event. Low levels of radiation are used to create images of the spinal column, allowing doctors to identify bone fractures and spinal misalignment. 
• CT scan: More commonly known as a “cat” scan, a CT scan is a painless and noninvasive diagnostic test similar to an X-ray that can produce cross-sectional images of the spine using radiation. During a CT scan, the patient lies flat on a table while a donut-shaped tube rotates around them. Unlike an X-ray, a CT scan gives doctors a more detailed, 360-degree view of the spine. 
• MRI: An MRI is an imaging test that provides a more detailed view of the spine than an X-ray or a CT scan. X-rays and CT scans are useful for identifying broken and fractured bones after a traumatic incident such as a car crash or a fall, but an MRI scan may also be needed if the cause of injury is damage to the spinal cord itself. 
• Myelogram: A myelogram is an invasive procedure that uses a special dye to get a more detailed X-ray of the spinal cord. In addition to showing bones like a regular X-ray, a myelogram is also able to show doctors the condition of nerves within the spinal canal. 
• SSEP: Somatosensory evoked potentials (SSEP’s) is a procedure used to test the sensory functions (the ability to send and receive information about touch, pain, and changes in temperature) of the spinal cord. The test measures how long it takes an electric current to travel along the nerve pathway – the slower the speed of the current, the more significantly pinched the nerves in the spinal cord.

The ASIA Impairment Scale

Once the necessary spinal cord injury diagnosis tests are completed, the injury is described using the ASIA impairment scale. From most to least severe, the diagnoses are as follows:

• A: Complete loss of motor and sensory function below the point of injury. 
• B: Incomplete impairment that results in loss of motor function below the point of injury, but sensory function is preserved. 
• C: Incomplete impairment that results in preserved motor function. More than half of key muscle groups have a muscle grade below 3 and cannot move against gravity. 
• D: Incomplete impairment that results in preserved motor function. More than half of key muscle groups have a muscle grade above 3 and can move against gravity. 
• E: All motor and sensory functions are normal.

Life after a Spinal Cord Injury Diagnosis

Even though the effects of an SCI are often permanent, there is hope after a spinal cord injury diagnosis. Depending on the severity of the damage, a combination of rehabilitative care and symptom reducing drugs can provide the help people need to lead independent and active lives.