Ask a Clinician Series

Ask a Clinician Series: Spinal Cord Injury

What medical issues should I worry about after a spinal cord injury? What am I most likely to get sick of or die of?

While there are many medical complications that can come up after a spinal cord injury (SCI), I can think of three important ones that can do the most harm, especially for people with tetraplegia.

Firstly, we have conditions that affect the lungs and breathing. The respiratory system consists of the nose, mouth, throat (pharynx), larynx (voice box), windpipe, lungs, and diaphragm. The diaphragm is a large flat muscle below the lungs which act like bellows – it helps expand the lungs when inhaling, and springs back to its usual position when the person exhales. With an SCI at C5 and above, the diaphragm is weak and the individual is unable to take deep breaths and fully expand the lungs. The person with SCI also cannot produce an effective cough; aside from the weak diaphragm, the chest muscles that help one take a deep breath are also weak or paralyzed. This makes the person with SCI prone to pneumonia and other diseases affecting breathing. Keeping the remaining muscles fit and healthy can help, and using the assisted cough maneuver is also essential in a person with tetraplegia. Assisting breathing through mechanical means with a ventilator or an insufflator-exsufflator can prevent pneumonia. Frequent handwashing and other hygiene habits by the patient and caregiver can also help prevent infections of the lungs and other parts of the body.

Speaking of infections in other parts of the body, urinary tract infections (UTIs) are another common medical issue that can affect the individual with an SCI. After an SCI, losing control of urination (becoming incontinent) makes it necessary for the person with SCI to make adjustments to their schedule and lifestyle. For example, they may need to use a urinary catheter to empty the bladder, take medications in order to have a socially acceptable bladder program, and regulate how much they drink and when they drink fluids. Not being able to empty the bladder completely (urinary retention) can lead to urinary tract infections, and reflux of urine from the bladder back to the kidneys can also lead to infection and kidney failure. Using proper, clean techniques and wearing gloves during catheterization can help prevent UTIs, as well as keeping hydrated by drinking enough fluids. Supplements like cranberry or bear berry tablets can also help. As one ages, the urinary system can also change and develop more complications. A yearly visit (more often, if needed) with a urologist is recommended for persons with SCI.

Finally, a third common complication – especially in people with complete SCI and have impaired sensation – is skin breakdown. The development of skin breakdown (pressure ulcers) often happens when a part of the body that has impaired or no sensation is in contact with an outside surface for extended periods of time. For example, sitting too long in a wheelchair can cause a pressure ulcer, as does lying in bed in one position for hours. Turning and repositioning the person with SCI every 2 hours while in bed is recommended. While sitting in a wheelchair, a weight shift every 20 minutes or so is necessary to prevent pressure ulcers. Some people use a timer, alarm or stopwatch to remind them to do a weight shift. Finding the correct supportive and pressure-relieving wheelchair cushion is also essential; your physiatrist, physical or occupational therapist and/or wheelchair vendor can help choose the right one for you. Maintaining adequate nutrition can also help, because this helps optimize the body’s healing functions and create enough “padding” between bone and the outermost layer of skin. In particular, proteins contain the “building blocks” that the body can use for healing and repair, while vitamin C and zinc supplements aid wound healing as well.

These are just a few of the medical complications that a person with SCI may encounter during their lifetime. However we must remember that they need not face these alone. Annual visits (or more frequent if needed) with a physiatrist can go a long way in preventing medical complications. A physiatrist – particularly one with extra training or experience in SCI medicine – can look after the needs and coordinate the care of an SCI patient in a holistic, comprehensive manner that can help optimize function and quality of life.