Anyone who has experienced significant trauma to the head or neck needs immediate medical evaluation for the possibility of spinal cord injury. In fact, it's safest to assume that trauma victims have an unstable spine fracture until proved otherwise.

If you suspect a back or neck injury, don't move the injured person. Permanent paralysis and other serious complications may result.

Take these steps once you suspect someone has a spinal injury:

• Dial 911 or call for emergency medical assistance.
• Keep the person still.
• Place heavy towels on both sides of the neck to prevent it from moving, until emergency care arrives.
• Provide basic first aid, such as stopping any bleeding and making the person comfortable, without moving the head or neck.

Immobilizing the spine can prevent injury to the spine or prevent worsening of any injury that is already present. For this reason, emergency personnel receive training in handling an injured person without moving the neck and back. They use rigid collars around the injured person's neck and place the injured person on a rigid board, until a complete evaluation can take place.

In the emergency room, a doctor may be able to rule out spinal cord injury by carefully inspecting an injured person, testing for sensory function and movement, and asking some questions about the accident. But if the injured person complains of neck pain, isn't fully awake, or has obvious signs of weakness or neurologic injury, emergency diagnostic tests may be needed.

These tests may include:

• X-rays. Medical personnel typically order these tests on all trauma victims suspected of having a spinal cord injury. X-rays can reveal vertebrae problems, tumors, fractures or degenerative changes in your spine.

• Computerized tomography (CT) scan. A CT scan may provide a better look at abnormalities seen on an X-ray. This scan uses computers to form a series of cross-sectional images that can define bone, disk and other problems.

• Magnetic resonance imaging (MRI). MRI uses a strong magnetic force and radio waves to produce computer-generated images. This test is extremely helpful for looking at the spinal cord and identifying herniated disks, blood clots or other masses that may be compressing the spinal cord. But MRI can't be used on people with pacemakers or on trauma victims who need certain life-support machines or cervical traction devices.

• Myelography. Myelography allows your doctor to visualize your spinal nerves more clearly. After a special dye is injected into your spinal canal, X-rays or CT scans of your vertebrae can suggest a herniated disk or other lesions. This test is used when MRI isn't possible or when it may yield important additional information that isn't provided by other tests.

If your doctor suspects a spinal cord injury, he or she may prescribe traction to immobilize your spine, as well as high doses of the corticosteroid drug methylprednisolone (Medrol). This drug significantly improves neurologic functioning by reducing nerve damage and decreasing inflammation — if given within eight hours of injury.

Diagnosis doesn't stop there, though. About three days after the injury, your doctor will conduct a neurologic exam to determine the severity of the injury and predict the likely extent of recovery. This may involve more X-rays, MRIs or more advanced imaging techniques.

It's often impossible for your doctor to make a precise prognosis right away. Recovery typically starts between a week and six months after injury if it occurs, with the majority of recovery taking place within one year. Doctors generally regard any impairment remaining after 12 to 24 months as likely to be permanent.

However, some people experience small improvements for up to two years or longer. At one point, Christopher Reeve made national headlines when he regained the ability to move his fingers and wrists and feel sensations more than five years after he was paralyzed in a horse accident. But many not-so-famous folks with a spinal cord injury have made similar strides away from the media spotlight. And doctors are rigorously researching ways to improve late recovery.

You'll likely experience many thoughts and emotions after injury. And you'll likely have concerns about how your injury will affect your lifestyle, your financial situation and your personal relationships. Grieving and emotional stress are normal and common. However, if your grief and sadness are affecting your personal care, causing you to isolate yourself from others, or prompting you to abuse alcohol or other drugs, it's time to seek help. People with a spinal cord injury abuse alcohol at about twice the rate that the general population does. Depression also is common.

Other complications of a spinal cord injury may include:

• Urinary tract problems. A spinal cord injury that affects nerves that run to the bladder can cause urinary incontinence — the inability to control the release of urine from your bladder. Loss of bladder control increases your risk of urinary tract infections. It may also cause kidney infection and kidney or bladder stones. Drinking plenty of clear fluids and using a catheter — a thin, soft tube that you insert into your urethra and bladder to drain your urine — several times a day may help.

• Bowel management difficulties. After a spinal cord injury, voluntary control of the bowels may be lost or impaired. This can make it difficult for stool to move through your intestines, or it can result in fecal incontinence — the inability to control your bowel movements. Eating a high-fiber diet can help regulate your bowels. Medications and other products are also available to manage waste elimination.

• Pressure sores. Sitting or lying in the same position for a long period of time can cause pressure sores, which are also called decubitus ulcers or bedsores. People with a spinal cord injury are particularly susceptible to pressure sores because the injury reduces or eliminates sensations, making it difficult to know when a sore is developing. Changing positions frequently — with help, if needed — is the best way to prevent these sores.

• Deep vein thrombosis and pulmonary embolism. Sitting for long periods of time can also decrease blood flow through the veins and cause blood clots to form. These blood clots can develop in a vein deep within a muscle (deep vein thrombosis), and they can lead to a blocked pulmonary artery in the lungs (pulmonary embolism). Large clots that block blood flow can be fatal, so people with spinal cord injury may need devices or medications to try to prevent clotting.

• Lung and breathing problems. It's more difficult to breathe and cough with weakened abdominal and chest muscles, so people with cervical and thoracic spinal cord injury may develop pneumonia, asthma or other lung problems. Medications and therapy can treat these problems. In some instances, people with spinal cord injury may also need a yearly flu shot or other immunizations.

• Autonomic dysreflexia. Spinal cord injury above the middle of the chest may cause a condition called autonomic dysreflexia. This dangerous condition occurs when an irritation or pain below the level of the injury and the irritated area sends a signal that fails to reach the brain, producing a reflex action that can constrict blood vessels. The result is a rise in blood pressure and a drop in heart rate that can result in stroke or seizure. Changing positions or eliminating the cause of the irritation — which can be something as simple as a full bladder or tight clothes — can help.

• Spasticity. Some people with spinal cord injury develop muscle spasms and jumping of their arms and legs. Unfortunately, this doesn't mean that they're recovering. These exaggerated reflexes occur because some of the nerves in the lower spinal cord become more sensitive after injury and cause muscle contractions. However, because of the spinal cord injury, the brain can no longer send signals to the lower nerves to regulate the contractions. Medical treatments may be needed if spasms become severe.

• Weight control issues. After a spinal cord injury, weight loss and muscle atrophy are common. But the change in lifestyle and activities may eventually cause weight gain, which can make it difficult for you to lift yourself — or be lifted — from place to place and put you at risk of heart disease and other problems. It's a good idea to develop an exercise and diet plan with assistance from a dietitian and rehabilitation therapist.

• Sexual dysfunction. Many men with a spinal cord injury still have erections, even men with little sensation in the genital area. But the erections may not be firm enough or last long enough for sexual activity. Fertility also can be affected. Ninety percent of men with a spinal cord injury aren't able to ejaculate during intercourse. However, this doesn't mean that men with a spinal cord injury can't be sexually active or father a child. Doctors, urologists and fertility specialists who specialize in spinal cord injury can offer options for better sexual functioning and fertility. Women with a spinal cord injury also may benefit from seeing a doctor about changes in their sexuality and fertility. There's usually no physical change in women with a spinal cord injury that inhibits sexual intercourse or pregnancy. But women may lose the ability to produce vaginal lubrication or have orgasms, and any pregnancy will likely be considered high risk. It's important to talk with a doctor before becoming pregnant.

• Pain. You may experience pain as a result of damage to your spinal cord or other parts of your body during your accident. It's even possible to feel pain in areas of your body where there's little or no sensation. People with lower spinal cord injuries and those who were injured by gunshot tend to experience more pain than others do. Anyone with a spinal cord injury can also experience pain from overusing muscles in one part of the body. For example, many people develop shoulder tendinitis from manually operating a wheelchair for a long period of time. Any kind of pain can have a negative impact on daily living. Medications and modified activities can help manage pain.

• New injuries. People with a spinal cord injury are susceptible to injury of any part of the body that has impaired sensation. Someone with a spinal cord injury may even receive a burn or cut without realizing it. Take steps to prevent new injuries and to inspect your body for any cuts or sores that need medical attention.

In the meantime, treatment focuses on preventing further injury and enabling people with a spinal cord injury to return to an active and productive life within the limits of their disability. This requires urgent emergency attention and ongoing care.

Emergency actions
Urgent medical attention is critical to minimizing the long-term effects of any head or neck trauma. So treatment for a spinal cord injury often begins at the scene of the accident.

If you suffer a head or neck injury, you'll likely be treated by paramedics and emergency workers who will attend to three immediate concerns — maintaining your ability to breathe, keeping you from going into shock and immobilizing your neck to prevent further spinal cord damage. Emergency personnel typically immobilize the spine as gently and quickly as possible using a rigid neck collar and a rigid carrying board, which they'll use to transport you to the hospital.

In the emergency room, doctors focus on maintaining your blood pressure, breathing and neck stabilization and avoiding possible complications, such as stool or urine retention, respiratory or cardiovascular difficulty, and formation of deep vein blood clots in the extremities. You may be sedated so that you don't move and cause more damage while undergoing diagnostic tests for spinal cord injury.

If you do have a spinal cord injury, you'll usually be admitted to the intensive care unit for treatment. You may even be transferred to a regional spine injury center that has a team of neurosurgeons, orthopedic surgeons, spinal cord medicine specialists, psychologists, nurses, therapists and social workers with expertise in spinal cord injury.

In the early stages of paraplegia or quadriplegia, your doctor will treat the injury or disease that caused the loss of function. Immediate treatment may include:

• Medications. Methylprednisolone (Medrol) is a standard treatment for acute spinal cord injury. This corticosteroid has been proved to bring about significant and sustained recovery in people with a spinal cord injury, if given within eight hours of injury. Methylprednisolone works by reducing damage to nerve cells and decreasing inflammation near the site of injury.

• Traction. You may need traction to stabilize your spine and bring the spine into proper alignment during healing. Sometimes, traction is accomplished by placing metal braces, attached to weights or a body harness, into your skull to hold it in place.

• Surgery. Occasionally, emergency surgery is necessary to remove fragments of bones, foreign objects, herniated disks or fractured vertebrae that appear to be compressing the spine. Surgery may also be needed to stabilize the spine to prevent future pain or deformity. However, some surgeons believe it's safer to wait for several days before attempting any surgery.

Ongoing care
After the initial injury or disease stabilizes, doctors turn their attention to problems that may arise from immobilization, such as deconditioning, muscle contractures, bedsores, urinary infection and blood clots. Early care will likely include range-of-motion exercises for paralyzed limbs, help with your bladder and bowel functions, applications of skin lotion, and use of soft bed coverings or flotation mattresses, as well as frequently changing your position. Hospitalization can last from several days to several weeks, depending on the cause and extent of the paralysis and the progress of your therapy. But treatment doesn't stop when you check out of the hospital. Here are some of the ongoing treatments you can expect.

Rehabilitation. During your hospital stay, a rehabilitation team will work with you to improve your remaining muscle strength and to give you the greatest possible mobility and independence. Your team may include a physical therapist, occupational therapist, rehabilitation nurse, rehabilitation psychologist, social worker, nutritionist, recreation therapist and a doctor who specializes in physical medicine (physiatrist).

During the initial stages of rehabilitation, therapists usually emphasize regaining leg and arm strength, redeveloping fine motor skills and learning adaptive techniques to accomplish day-to-day tasks. A program typically includes exercise, as well as training on the medical devices you'll need to assist you, such as a wheelchair or equipment that can make it easier to fasten buttons or dial a telephone.

Therapy often begins in the hospital and continues for several weeks in a rehabilitation facility. As therapy continues, you and your family members will receive counseling and assistance on a wide range of topics, from dealing with urinary tract infections and skin care to modifying your home and car to accommodate your disability. Therapists will encourage you to resume your favorite hobbies, participate in athletic activities and return to the workplace, if possible. They'll even help determine what type of assistive equipment you'll need for these vocational and recreational activities and teach you how to use it.

Medications. You may benefit from medications that manage the signs, symptoms and complications of spinal cord injury. These include medications to control pain and muscle spasticity, as well as medications that can improve bladder control, bowel control and sexual functioning. You may also need short-term medications from time to time, such as antibiotics for urinary tract infections.

New technologies. Inventive medical devices can help people with a spinal cord injury become more independent and more mobile. Some apparatuses also may restore function. These include:

• New wheelchairs. Improved, lighter-weight wheelchairs are making people with spinal cord injury more mobile and more comfortable. The Food and Drug Administration has even approved a wheelchair that can climb stairs and elevate a seated passenger to eye level to reach high places without help.

• Computer devices. Computer-driven tools and gadgets can help with daily routines. You can use voice-activated computer technologies to answer and dial a phone, or to use a computer and pay bills. Computer-controlled technologies can also help with bathing, dressing, grooming, cleaning and reading.
• Neural prostheses. These sophisticated devices connect with the nervous system to supplement or replace lost motor and sensory functions. There are functional electrical stimulation (FES) systems, which use electrical stimulators to control arm and leg muscles to allow people with a spinal cord injury to stand, walk, reach and grip. These systems are composed of computer-controlled electrodes that are taped to the skin or surgically implanted and controlled by the user. One of the systems allows someone with a spinal cord injury to trigger hand and arm movements in one arm by shrugging the opposite shoulder. These devices require more research, but they've gained a great deal of attention, in part because the late actor Christopher Reeve was able to rely primarily on an FES bicycle that used computer-controlled electrodes to stimulate his legs to cycle. He also had a system implanted to stimulate his breathing.

• Drive safely. Motor vehicle accidents are the leading cause of spinal cord injuries. Wear a seat belt every time you drive. Make sure that your children wear a seat belt or, if they're very young, use a child safety seat. Don't drive while intoxicated.