A bruise to the spinal cord is a significant and serious medical condition known as a spinal cord contusion. The spinal cord is a dense, delicate bundle of nerve fibers protected by the bony vertebral column, serving as the central communication pathway between the brain and the rest of the body. Any physical trauma to this structure can disrupt the flow of nerve signals, leading to a loss of function below the level of the injury. A contusion is a form of traumatic spinal cord injury (SCI).
Understanding Spinal Cord Contusion
A spinal cord contusion occurs when a sudden, external force compresses or crushes the cord tissue without necessarily severing it entirely. This primary mechanical injury causes immediate damage to cells and fragile blood vessels within the spinal cord, leading to localized bleeding and swelling. This bleeding is technically an intramedullary hemorrhage, or bleeding inside the cord, which is distinct from a fracture of the surrounding vertebrae.
The immediate physical damage initiates a subsequent, more insidious process known as secondary injury, which can cause far more widespread functional loss than the initial impact. Within hours to days, the swelling (edema) in the confined space of the spinal canal compresses the remaining healthy tissue and restricts blood flow, leading to ischemia. This cascade also involves the release of damaging chemical substances and inflammatory cells that further destroy nerve cells.
The most frequent causes of spinal cord contusion are high-impact traumatic events, such as motor vehicle collisions and serious falls. Sports injuries and acts of violence are also common mechanisms of injury. While the bony spine may or may not be fractured, the neural tissue is damaged by the sudden application of pressure, often in the cervical (neck) region of the spine.
Assessing the Severity of Spinal Cord Injury
The consequences of a spinal cord contusion vary widely, depending on the level of the injury along the spine and the degree of functional loss. An injury higher up in the cervical spine can affect both the arms and legs, while a lower thoracic injury might only affect the legs and trunk. The resulting symptoms can include muscle weakness, a complete inability to move, loss of sensation, and changes in bowel or bladder control.
Medical professionals determine the extent of the damage using the American Spinal Injury Association (ASIA) Impairment Scale (AIS), which assesses motor and sensory function below the site of injury. This scale classifies the injury from AIS A (complete loss of function) to AIS D (motor-incomplete injury). A contusion often results in an incomplete injury (AIS B, C, or D), meaning some nerve signals are preserved across the injury site, offering a better chance for recovery than a complete transection. The functional assessment focuses on whether any sensation or movement remains in the S4-S5 sacral segments.
Immediate Emergency Diagnosis and Care
A suspected spinal cord contusion requires immediate, urgent medical attention to prevent the secondary injury process from causing further damage. At the scene of the trauma, first responders prioritize the rapid and gentle immobilization of the head and neck to keep the spine from moving. This stabilization is maintained throughout transport and in the emergency room to avoid shifting any unstable bony segments.
In the hospital, the diagnostic workup begins with imaging studies to visualize the extent of the trauma. A computed tomography (CT) scan is often performed first to quickly assess for fractures or misalignment of the vertebrae. The definitive evaluation relies on magnetic resonance imaging (MRI), which clearly shows the soft tissue damage, including the contusion, associated swelling (edema), and internal bleeding (intramedullary hemorrhage).
Acute medical management aims to stabilize the patient’s overall condition and optimize the environment for the injured cord. Maintaining adequate blood pressure is a priority, as low pressure can worsen the cord’s blood supply and increase ischemic damage. If imaging reveals pressure on the cord from a bone fragment or a large hematoma, surgeons may perform an emergency decompression procedure to relieve the compression.
Prognosis and Rehabilitation
The long-term outlook following a spinal cord contusion is strongly influenced by the initial severity, particularly whether the injury is classified as complete or incomplete. Since contusions rarely involve a complete physical transection, they frequently result in incomplete injuries, which have a substantially greater potential for neurological return. Any return of motor or sensory function is a positive sign for the eventual degree of recovery.
The vast majority of functional recovery typically happens within the first six to nine months post-injury, though improvements can continue for up to 18 months. This recovery is largely driven by intense, specialized rehabilitation programs involving physical and occupational therapy. Therapists work to maximize the function of preserved neural pathways and help the individual compensate for any permanent loss.
Rehabilitation focuses on regaining strength, improving mobility, and learning adaptive techniques for daily living. While some individuals may experience a near-full recovery, others will face permanent functional changes that require long-term use of assistive devices or ongoing care. The ongoing support from a multidisciplinary team is a permanent fixture in helping patients achieve the highest possible quality of life.