A lumbar spinal cord injury can cause varying degrees of paralysis in the lower body, also known as paraplegia. With an effective rehabilitation plan, people with paraplegia can maximize their functional abilities and lead fulfilling lives.
To help you understand what to expect after a lumbar spinal cord injury, this article will discuss:
- Causes of Lumbar Spinal Cord Injury
- Functions Affected by Lumbar SCI
- Complete vs. Incomplete SCI
- Potential Complications of Lumbar Spine Injury
- Recovery Methods
Causes of Lumbar Spinal Cord Injury
As with all spinal cord injuries, lumbar spinal cord injuries can be caused by traumatic or non-traumatic events. When an SCI is traumatic, an outside force such as a car collision, fall, or violence causes the vertebrae to compress the spinal cord. In contrast, when a lumbar SCI is non-traumatic, it is typically the result of a tumor/cancer, infection, autoimmune disease, herniated disc/spinal stenosis, or a vascular event such as a spinal stroke.
Regardless of the cause of spinal cord injury, damage to the lumbar spinal cord affects motor control and sensation in the lower body. Below, we’ll discuss which functions are affected at each level of the lumbar spinal cord.
Functions Affected by Lumbar Spinal Cord Injury
The lumbar region of the spinal cord consists of 5 segments (based on the five vertebrae found here). Each segment connects to, or innervates, a different area of skin for sensation and set of muscles for movement.
The spinal cord itself ends around the L1-2 vertebrae level; however, nerve roots branch off the bottom of the spinal cord and exit through their respective vertebral levels.
Here’s a general overview of the functions innervated at each level of the lumbar spinal cord, according to the international standards for neurological classification:
- The L1 spinal nerves affect movement and sensation of the pelvic/hip region (and below). Bowel/bladder functions may also be disrupted.
- The L2 spinal nerves affect the muscles that allow you to bend the hips (hip flexors) and sensation at the upper thighs (will present similarly to an L1 injury).
- The L3 spinal nerves affect the ability to straighten the knees (knee extension) and sensation at the lower thighs and knees.
- The L4 spinal nerves affect the ability to lift the foot upwards (ankle dorsiflexion) and sensation at the front and inner regions of the lower legs.
- The L5 spinal nerves affect the ability to bend and straighten the big toe and sensation at the outer areas of the lower legs down to the big, second, and middle toes.
Because messages between the brain and body cannot pass through spinal cord damage, motor functions and sensation are not only impaired directly at the level of injury, but also below the level of injury.
In the following section, we’ll discuss how the severity of a lumbar spinal cord injury can affect lower body functions and recovery outlook.
Complete vs. Incomplete Lumbar Spinal Cord Injury
Whether you have a complete or incomplete spinal cord injury has a significant impact on your recovery outlook.
Individuals with complete spinal cord injuries lose all motor control and feeling below their level of injury. This occurs because no spared neural pathways exist (because the spinal cord has been completely severed due to the injury). In other words, there are no pathways to relay messages between the brain and areas below the level of injury.
In contrast, individuals with incomplete spinal cord injuries (the spinal cord is only partly severed/damaged) will have partial control or sensation below the level of injury. This means that some neural pathways were undamaged and connections between areas below the level of injury and the brain still exist.
Spared neural pathways play an essential role in the recovery of lumbar (and all other) spinal cord injuries because damaged neurons in the spinal cord are not capable of regeneration. Only spared neural pathways can utilize the spinal cord’s ability to adapt and rewire itself (neuroplasticity) to relearn functions after a spinal cord injury.
Therefore, the more spared neural pathways you have, the better the potential for recovery.
Up next, we’ll discuss complications that can occur as a result of lumbar spinal cord injury.
Potential Complications of Lumbar Spine Injury
No two spinal cord injuries are alike and individuals can experience a wide range of secondary complications. Generally, the more severe a spinal cord injury is, the greater the risk of complications.
Common complications that can occur after a lumbar spinal cord injury include:
- Spasticity: involuntary muscle contractions that can cause stiff movements, muscle tightening and spasms
- Neurogenic bowel and bladder: loss of control over the bowel and bladder muscles that can increase the risk of leaking, constipation, and urinary retention
- Sexual dysfunction: impaired sexual functions due to the injury impeding the reflexes involved in sexual arousal. Loss of sensation and lack of lower body mobility also play a role in impaired sexual functioning
- Chronic pain: pain can be the result of overdependence on unaffected areas (i.e over-reliance on shoulders for wheelchair mobility), bowel and bladder problems, or nerve damage
- Muscle atrophy: reduced physical activity and weight-bearing can cause the leg muscles to weaken and shrink
- Pressure sores: sitting or lying in the same position for prolonged periods places too much pressure on the skin, causing inflammation and breakdown if not properly managed
In the following section, we’ll discuss how to manage complications and promote recovery after a lumbar spinal cord injury.
Lumbar Spinal Cord Injury Recovery Methods
Unless other medical complications are present, individuals with lumbar spinal cord injuries have normal functioning of their upper bodies. This allows for a great deal of independence.
By learning how to maximize functional abilities, individuals with lumbar spinal cord injuries can live normal, active lives.
Rehabilitation after lumbar SCI will consist of:
- Physical therapy will help you improve your mobility, strength, and flexibility through targeted exercises
- Occupational therapy helps you regain your independence by teaching you adaptive techniques for activities of daily living, community re-entry, and other tasks that you may like to engage in such as housework, caring for others, work/school etc.
- Psychotherapy can help you cope with the emotional and psychological outcomes of SCI
- Orthotics are wearable devices that help promote musculoskeletal alignment
- Medications may be prescribed to help manage secondary complications such as pain, constipation, and spasticity
- Surgery may be recommended to decompress the spinal cord, stabilize the spinal column, manually lengthen spastic tendons and muscles, and minimize the hyperactivity of spastic muscles
- Joining a support group can help connect you to other SCI patients that understand what you’re going through
- Creating a routine can help you be consistent with your exercises, medications, and better predict your bladder and bowel movements
Because everyone experiences spinal cord injury differently, a personalized approach to rehabilitation that targets your specific needs is essential. Consult with your doctor and therapists to determine an ideal treatment plan for you.
Lumbar SCI: Key Points
Lumbar spinal cord injuries can affect movement and sensation in the lower body. However, because lumbar SCI’s do not affect upper body functions, individuals generally learn to adapt and live independent, fulfilling lives.
We hope this article helped you understand what to expect following a lumbar spinal cord injury and how to promote recovery. Good luck!
Featured image: iStock/Jelena Danilovic