Impaired communication between the brain and body following a spinal cord injury can contribute to the development of additional secondary complications.
Being aware of the complications that may arise after SCI can help individuals take the precautions necessary to prevent them from developing, or at least minimize their progression.
This article will share 13 potential effects of spinal cord injury and how to manage them.
Potential Effects of Spinal Cord injury
Even years after SCI, secondary effects can develop. Therefore, it’s important to be aware of potential risks and implement practices to prevent them.
Below, we’ll discuss 13 conditions that individuals with spinal cord injuries generally have a greater risk of experiencing.
One of the most common effects of spinal cord injury is spasticity. Spasticity describes involuntary muscle contractions caused by disrupted communication between the brain and muscles.
This increased muscle tone can cause spasms and pain below the level of injury. If not properly managed, spasticity can progress and significantly limit range of motion.
Generally, spasticity management consists of:
- Physical and/or occupational therapy to stretch, strengthen, and stimulate the muscles.
- Orthotics to provide structural support and passively stretch spastic muscles.
- Medications such as Botox or baclofen to inhibit muscle contractions.
Consistently practicing movements affected by spasticity helps promote neurological adaptations in the central nervous system. By reinforcing demand for those functions through massed practice, the spinal cord may rewire those functions to healthy, spared neural pathways. When this occurs, the movement is no longer disrupted and is ultimately no longer affected by spasticity.
Some breakdown of bone, with subsequent reforming, is normal. Osteoporosis is a condition that occurs when your bones break down at a faster rate than they’re being rebuilt. As a result, they become less dense, weaker, and more likely to fracture.
Due to impaired motor control following a spinal cord injury, individuals may become less physically active. Without regularly weight-bearing, bone density will decrease, therefore individuals with spinal cord injury are at higher risk for osteoporosis.
Some ways to combat osteoporosis after spinal cord injury include:
- Incorporating more calcium and vitamin D into your diet. They’re essential for building and maintaining strong bones.
- Gradually add more weight-bearing exercises into your routine to build bone density.
- Ask your doctor about medications that can help slow down bone breakdown.
- Quit smoking cigarettes as it is considered a major risk factor for osteoporosis.
3. Heterotopic Ossification
Nearly 20% of spinal cord injury patients experience heterotopic ossification. Heterotopic ossification is a condition characterized by abnormal bone growth in your soft tissues below the level of injury.
Damage to the spinal cord may affect the transmission of signals to the body, resulting in irregular bone formation. Additionally, those with more severe spinal cord injuries are more likely to experience heterotopic ossification.
To manage this secondary effect of SCI, individuals may need medications, and may participate in radiation therapy, which can help prevent further cell division.
Additionally, if the bone growth prevents joint motion or other bodily functions, it will need to be surgically removed.
4. Weight Gain/ Weight Loss
Both weight gain and weight loss are common effects of spinal cord injury.
Initially, individuals may lose weight after spinal cord injury due to decreased levels of physical activity coupled with loss of muscle mass and bone density.
On the flip side, because loss of motor control will cause you to move less than you used to, you likely won’t be using as much energy. This means that you’ll likely have to eat less than before your injury to avoid gaining weight later on.
Weight management after spinal cord injury should focus on finding a balance between diet and physical activity.
5. Anxiety and Depression
Individuals with spinal cord injuries are more likely to develop mental health disorders. This is likely due to the significant lifestyle adjustments that may be required due to impaired motor control and sensation.
For example, some individuals may no longer be able to return to their jobs, which can introduce financial stressors.
Fortunately, there are resources available that can help individuals improve their mental health. Generally, this will consist of medications and psychotherapy.
6. Loss of Bladder and Bowel Control
Following a spinal cord injury, individuals may lose control over their bowel and bladder muscles.
Loss of bladder and bowel control can cause constipation, diarrhea, and stomach pain, if not properly managed.
Additionally, lack of sensation and impaired reflexes in the body following SCI can also make it challenging for individuals to know when to go the bathroom, which increases their risk of urine and waste-related accidents.
Drinking more water will help with the fluidity of your stool as well as eating foods high in fiber. However, it’s also important to understand that this may cause individuals to use the bathroom more frequently.
Catheters can be inserted into your body to manually empty the bladder. This type of ‘intermittent catheterization’ should typically be done roughly every 4-6 hours; however, every person’s bladder program may be different.
Individuals can also take medications to better manage bowel and bladder movements. Just keep in mind that you can build a tolerance to laxatives and that there is a risk of adverse side effects.
In general, initiating bladder and bowel regimens after SCI can be very complicated until a consistent program is achieved – work closely with your doctor, nurses, and therapists to help establish this.
7. Sexual Dysfunction
Depending on the severity of one’s spinal cord injury, sexual functions may or may not be affected.
Some men are still able to get erections, and women can still get pregnant after SCI. However, lack of sensation after SCI can prevent natural lubrication.
Oral medications like Viagra are the most popular treatment for erectile dysfunction. There’s also vacuum therapy, which manually pumps blood into the penis.
Ultimately, individuals are encouraged to go through a little bit of trial and error and see what works best for them.
8. Autonomic Dysreflexia
After a T6 or higher level spinal cord injury, individuals may experience autonomic dysreflexia. During autonomic dysreflexia, the autonomic nervous system overreacts to noxious stimulation below the level of injury, which results in a sudden spike in blood pressure and other involuntary functions.
Factors that can trigger autonomic dysreflexia include full bladders/bowels, extreme temperatures, tight clothes, and skin irritation.
Generally, management for autonomic dysreflexia involves being mindful of your surroundings and avoiding triggers. This can involve:
- Being aware of your bladder patterns and frequently emptying your bladder
- Avoiding tight clothes or clothes that have sharp items on them (i.e. zippers, studs, etc.)
- Making sure you do not sit on random objects (i.e remotes, phones, etc.)
- Avoiding extreme temperatures
There are 3 types of pain individuals typically experience after spinal cord injury:
- Musculoskeletal pain: pain due to overuse of bones/muscles/joints
- Visceral pain: pain from your internal organs near the abdominal area
- Neuropathic pain: pain caused by nerve damage that is felt below your level of injury
Treatments will vary depending on the type and severity of the pain. Examples include:
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Muscle relaxants
- Topical numbing creams
- Electrical stimulation
- Physical therapy
10. Pressure Sores/ Ulcers
For individuals without SCI, when you sit or lay in the same position for an extended period, you start to feel too much pressure at certain areas in your body and shift positions. Following a spinal cord injury, individuals may not feel this way due to impaired sensation. As a result, they remain in the same position for long periods. This places too much pressure on the skin, which can ultimately restrict blood flow, causing the skin to break down and form pressure sores.
The earlier pressure ulcers are identified, the easier they are to treat. Likewise, the later pressure ulcers are identified, the greater the risk of additional complications including pain and infections. If a pressure sore goes untreated and leads to infection of the bone, it can be deadly.
Effective ways to treat/ minimize the progression of pressure sores include:
- inspect your skin daily, especially at bony points such as the tailbone, sit bones, ankles, knees, hips, etc.
- make sure to reposition the body every two hours when lying in bed, and do “pressure reliefs” every 30 minutes when sitting up in your wheelchair.
- cushion areas susceptible to developing pressure sores (ankles, knees, tailbone, elbows, hips, etc.)
If you have a C5 or higher level spinal cord injury, innervation of the diaphragm may be affected, which can make breathing challenging.
Pneumonia is caused by a respiratory infection that causes the lungs to fill with secretions. Individuals with spinal cord injuries often do not have a strong enough cough to get rid of the buildup, which causes secretions to accumulate.
Individuals with pneumonia may experience shortness of breath, pale skin, fever, and excessive congestion.
Generally, treatment consists of antibiotics, but alternatives include suctioning, quad coughing, and air-pressurizing technologies. SCI patients with pneumonia should make sure to drink plenty of water to flush out their systems and thin the consistency of the secretions.
12. Sleep Apnea
Sleep apnea is a condition characterized by unstable breathing during sleep (breathing starts and stops). As a result, individuals may wake up multiple times throughout the night and fail to get a full night’s rest. Those with sleep apnea usually experience snoring and extreme tiredness during the day.
Treatment for sleep apnea generally involves the use of a continuous positive airway pressure device (CPAP) that supplies pressurized air into your airways while you sleep.
Atelectasis describes the complete or partial collapse of the lungs due to blocked airways. This is primarily attributed to low lung volume following high-level spinal cord injuries.
Additionally, atelectasis is often asymptomatic until it affects larger portions of the lungs. When this occurs, individuals may experience shortness of breath, coughing, and chest pain.
Practicing deep breathing exercises may help increase lung volume and coughing exercises may help strengthen the cough enough to effectively remove mucus from the lungs. Individuals may also benefit from using a ventilator or CPAP.
Secondary Effects of Spinal Cord Injury: Key Points
A variety of secondary effects can occur after a spinal cord injury. Generally, those with more severe SCIs have a greater risk of developing complications; however, many factors such as the level of injury and pre-existing health conditions can also influence SCI outcomes.
We hope this article helped you better understand the potential effects of SCI and how to treat them. Good luck!