A spinal cord injury is damage to the nerves that send information between the brain and the rest of the body. While often associated with events like car accidents, a non-traumatic spinal cord injury (NTSCI) originates from internal medical conditions. These diseases can compress, inflame, or cut off blood supply to the spinal cord, disrupting signals between the brain and body. The onset of an NTSCI can be slow and progressive or appear suddenly, but the source is an underlying health issue.
Causes of Non-Traumatic Spinal Cord Injury
Degenerative conditions that develop over time are a primary cause of NTSCI. Cervical spondylotic myelopathy is a frequent diagnosis where age-related changes in the neck’s vertebrae and discs narrow the spinal canal. This narrowing, or stenosis, can be caused by bone spurs or bulging discs that press on the spinal cord. This chronic compression interferes with the cord’s function, leading to a progressive decline in neurological ability.
Vascular problems are another source of NTSCI. A spinal cord infarction, or spinal stroke, occurs when the blood supply to the spinal cord is blocked by a clot, depriving nerve tissue of oxygen and causing cell death. Conversely, a hemorrhage can happen when a blood vessel ruptures near the spinal cord. The resulting pool of blood, or hematoma, then compresses the cord tissue.
Tumors growing within the spinal column can cause cord compression. These tumors may be primary, originating in the spinal tissues, or metastatic, spreading from cancer elsewhere in the body. Whether cancerous or benign, a growing tumor occupies space within the rigid spinal canal, exerting pressure on the cord and leading to neurological symptoms.
Inflammatory and infectious diseases can also injure the spinal cord. Transverse myelitis is an inflammatory disorder, often triggered by an infection or autoimmune response, that damages the insulating sheath of nerve fibers. A spinal epidural abscess, a collection of pus from a bacterial or fungal infection, can form around the cord, leading to severe compression and rapid neurological decline.
Congenital or developmental conditions can also result in NTSCI. Syringomyelia is a disorder where a fluid-filled cyst, or syrinx, forms within the spinal cord, putting pressure on it from the inside as it expands. Conditions present at birth, like spina bifida, can also create structural problems in the spinal column that lead to cord damage over a person’s lifetime.
Recognizing the Symptoms
The symptoms of an NTSCI are diverse and depend on which part of the spinal cord is affected and the extent of the damage. The onset can be gradual, worsening over months or years with a slow-growing tumor or degenerative disease. In other situations, such as a spinal stroke, symptoms can appear suddenly, mirroring a traumatic injury.
Motor symptoms are common indicators of an NTSCI and relate to muscle control. A person might experience progressive weakness in their limbs, a feeling of heaviness, or a decline in coordination that makes activities like walking or writing difficult. In some cases, individuals develop spasticity, where muscles become stiff and contract uncontrollably.
Sensory changes also signal spinal cord damage. These can manifest as numbness, tingling, or a pins-and-needles sensation in parts of the body below the level of the injury. Some people experience burning or sharp neuropathic pain originating from the damaged nerves, while more severe cases involve a complete loss of sensation.
An NTSCI can disrupt the autonomic nervous system, which controls involuntary bodily functions. This can lead to issues with bladder and bowel control, ranging from incontinence to an inability to empty them. Other autonomic dysfunctions may include problems with blood pressure regulation, causing dizziness upon standing, and changes in sexual function.
The Diagnostic Process
Diagnosing an NTSCI begins with a neurological examination. A physician assesses motor skills by testing muscle strength, coordination, and reflexes. Sensory function is evaluated by checking the ability to feel light touch, pinpricks, and temperature. This initial exam helps map the potential location and severity of the injury along the spinal cord.
Imaging studies are a fundamental step in confirming a diagnosis. Magnetic Resonance Imaging (MRI) is the most effective tool, providing detailed pictures of the spinal cord, nerves, and surrounding soft tissues. An MRI can show sources of compression like a herniated disc or tumor, as well as inflammation within the cord. A Computed Tomography (CT) scan may be used for a more detailed view of bone-related issues.
If an infection or inflammatory condition like transverse myelitis is suspected, a lumbar puncture (spinal tap) may be performed. This procedure collects cerebrospinal fluid (CSF) from the lower back. The CSF is then analyzed for signs of inflammation, such as elevated white blood cell counts or protein levels, or for the presence of bacteria or viruses.
Blood tests help identify the root cause of the spinal cord injury. These tests can detect markers of systemic inflammation or infection that might point toward an autoimmune disorder or a widespread bacterial illness. Combining these results with the exam and imaging allows doctors to pinpoint the underlying disease.
Treatment and Management Strategies
Treating a non-traumatic spinal cord injury focuses first on the underlying cause, as the disease process is often ongoing. For instance, if a tumor is compressing the spinal cord, treatment may involve surgery to remove the mass, followed by radiation or chemotherapy. If the cause is a bacterial infection like a spinal epidural abscess, high-dose intravenous antibiotics are administered.
In cases where inflammation is the culprit, such as with transverse myelitis, corticosteroids are often used to reduce swelling and calm the immune response. For vascular issues like a spinal stroke, treatments may focus on dissolving clots or managing blood pressure to prevent further incidents.
The second part of the strategy is comprehensive rehabilitation to maximize functional recovery. Physical therapy plays a large role, with exercises designed to improve muscle strength, balance, and mobility. Occupational therapy helps individuals relearn how to perform daily activities, such as dressing and eating, and may involve recommending adaptive equipment to promote independence.
A multidisciplinary team of healthcare professionals is often involved in long-term care. Medications are prescribed to manage symptoms like neuropathic pain and muscle spasticity. Assistive devices, ranging from braces and walkers to wheelchairs, may be necessary to aid mobility.