January 28, 2021

Spinal Cord Injury (SCI): Is It Possible To Walk Again?

Written by: Marina Peric, M.D.
Reviewed by: Mubashar Rehman, PHD

Have you, or a family member of yours, suffered a spinal cord injury? If so, you are one of several million people worldwide that live with this issue. Being wheelchair-bound is the greatest fear for most of these people, and learning to walk again is their greatest wish.

But should this wish rather be a goal? Is it possible to walk with a broken back?

It is impossible to give a simple ‘yes’ or ‘no’ answer to these questions. You cannot predict by any simple, unambiguous indicators if it is possible to resume normal function after SCI. Instead, there are several known factors, interacting in multiple ways, which can help you estimate the chances for a successful recovery.

Factors that Contribute to Ambulatory potential in Patients with SCI

 

Clinical Examination

Neurological examination is by far the most important prognostic factor for recovery in patients with SCI. Apart from physical examination, other diagnostic procedures such as motor evoked potentials (MEPs), somatosensory evoked potentials (SSEPs), and magnetic resonance imaging (MRI) will also be carried out.

All these will help doctors minutely assess the neurological status and level of the lesion for each patient. The level of lesion refers to the affected point of the spine. Below that level, sensory and motor functions may be compromised, while they’ll not be affected above this level.

American Spinal Injury Association (ASIA) has established the ASIA Impairment Scale (AIS) as a standardized grading system of SCI. After clinical examination, each patient is graded as one of the following:

-         AIS A – ‘Complete’ lesion: the patient has no motor or sensory functions below the level of the lesion;

-         AIS B – ‘Sensory incomplete’ lesion: sensory function is preserved, but without motor function;

-         AIS C – ‘Motor incomplete’ lesion: sensory function is preserved, and motor function is partially preserved;

-         AIS D –‘Motor incomplete’ lesion: sensory function is preserved, and motor function is well preserved;

-         AIS E – Normal sensory and motor function with possible reflex abnormalities.

AIS A is the worst score, and AIS E the best score for SCI. It is worth mentioning that the AIS score at admission is not definite and improves gradually, starting within the first 72h.

 

Age

Age is the second leading factor that can help predict the outcome in patients with SCI. The older the patient, the lower the potential for complete or partial recovery; but this is not a universal rule.

The recovery potential does not depend on age itself, rather, upon the cardiopulmonary status and other general conditions generally compromised in the elderly. Therefore, an older patient will probably have lower chances for walking after SCI.

 

SCI Syndromes

In roughly 20% of patients with SCI, the mechanism of injury and the symptoms can form a syndrome. Till now, six such SCI syndromes have been reported:

- Central cord syndrome (CCS);

- Brown-Sequard syndrome (BSS);

- Anterior cord syndrome (ACS);

- Posterior cord syndrome (PCS);

- Conus medullaris syndrome (CMS);

- Cauda equina syndrome (CES).

Most of the patients with these syndromes have ‘incomplete lesions’, usually AIS C or AIS D paraplegia/tetraplegia, which makes them great candidates for a favorable functional outcome. Due to the bladder and bowel dysfunction, the patients with CMS and CES are more often regarded as AIS A or AIS B and may require a more complex rehabilitation program.

 

Associated Medical Conditions

Physical inactivity in SCI can lead to medical conditions such as diabetes mellitus, cardiac disease, hypertension, thrombophlebitis, or decubitus ulcers. These medical conditions further aggravate SCI and deteriorate the quality of life of the patient. Drug or alcohol abuse is also aggravating factor.

 

Psychosocial Factors

People with SCI require assistance with orthotic devices, wheelchairs, and walking, especially at the beginning of the rehabilitation process. To these patients, SCI means a peculiar psychological trauma.In this scenario, family care and support and a relationship of trust with the physicians are essential. The patient’s responsibility, motivation, and will to participate no less important.

 

The Chances of Walking after being Paralyzed

All the mentioned factors (and probably many more) can help to estimate the chances of walking again. Indeed, many studies were carried out to predict the possible functional outcome after SCI based on the level of lesion, AIS grade at admission, age, etc. A 2014 study by Scivoletto and associates gathered results from several clinical case studies and designed the following predictive scale:

AIS at Admission and other Factors Functional recovery (%) one year after injury
AIS A, cervical lesion 0%
AIS A, thoracic or lumbar lesion 5-8.5%
AIS B, light touch preserved 0-33%
AIS B, light touch, and pinprick preserved 66-89%
AIS C, <50 years 71-91%
AIS C, >50 years 25-42%
AIS D, <50 years 100%
AIS D, >50 years 80-100%

The percentage range of functional recovery represents variability in the results reported in different studies. Variability in results involving human subjects is universal, although negligible, due to demographical differences of the study participants.

The table indicates an association between different factors and functional outcome and gives an estimate of chances for functional walking after SCI.

Every SCI case and every patient has a unique combination of factors, either known or unknown, that can affect their recovery course and define the maximum potential outcome. Therefore, every piece of information you may get about your chances to walk with a broken back should be taken with a grain of salt.

If you’re, for example, an AIS B patient with only light touch preserved, you can be told that your chances to walk again are not that great, but not with certainty in your specific case.

How do I Deal with SCI ?

The early days are the most difficult: you may feel lost, depressed, neglected, or overlooked, and there’s nothing wrong with such feelings. Don’t pity yourself or fall into despair; give yourself time to accept the new circumstances and build the faith that things will get better.

It may seem ridiculous or impossible, but devotion, motivation, and a positive spirit are crucial for rehabilitation and future well-being.

The rehabilitation process will include physical therapy in the first place but also the use of orthotics, a wheelchair, different medications, and sometimes even surgery. You should follow the advice of medical professionals, be committed to the process, and give all of yourself along the way.

Be patient, learning to walk again is not an easy task, and it will take time. Think of an infant: just like a child first sits with arm support, then sits without arm support, learns how to crawl, how to stand up, and eventually how to walk, your recuperation will also be step by step and gradual.

Most of the recovery will take place in the first months after the injury. The more time passes, the less visible the results will be, and this is normal.

Within the first year or two, you will probably reach the point that is going to be your definite state but know that as long as you can feel some improvement, there’s still a place for more.

No matter the outcome, your life will be different after an SCI. You may have to change your job, adapt your house, get used to needing the assistance of others, or using a good wheelchair. The moments of ‘why me’ will happen, but over time, you’ll learn to cope just like several million people worldwide that live with the same issue.

And if a 2016 study by Duggan and associates is to be believed, the chances are you’ll be overall happy and satisfied with your life – just like nearly 90% of patients with an SCI.

References

  1. Subbarao JV. Walking after spinal cord injury – Goal or a wish? West J Med. 1991;154:612-614.
  2. Hsu JL, Cheng MY, Liao MF, et al. The etiologies and prognosis associated with spinal cord infarction. Ann Clin Transl Neurol. 2019;6(8):1456-1464.
  3. Scivoletto G, Tamburella F, Laurenza L, et al. Who is going to walk? A review of the factors influencing walking recovery after spinal cord injury. Front Hum Neurosci. 2014;8:141.
  4. Van Middendorp JJ, Goss B, Urquhart S, et al. Diagnosis and prognosis of traumatic spinal cord injury. Global Spine J. 2011;1(1):1-8.
  5. McKinley W, Santos K, Meade M, et al. Incidence and outcomes of spinal cord injury clinical syndromes. J Spinal Cord Med. 2007;30(3):215-224.
  6. Sweis R, Biller J. Systemic complications of spinal cord injury. Curr Neurol Neurosci Rep. 017;17(1):1-8.
  7. Waters RL, Adkins RH, Yakura JS, et al. Motor and sensory recovery following incomplete paraplegia. Arch Phys Med Rehabil. 1994;75:67-72.
  8. Duggan C, Wilson C, DiPonio L, et al. Resilience and happiness after spinal cord injury: a qualitative study. Top Spinal Cord InjRehabil. 2016;22(2):99-110.

Article written by Marina Peric, M.D.
Marina is a medical doctor from Belgrade, Serbia. She graduated with high honors in 2020 and is aspiring to become a pathologist. During her studies, she took part in several scientific researches, mostly in the pharmacology niche. She was also an assisting teacher at the Department of Histology and Embryology for 5 years (2015-2020). Marina has years of experience as a writer on health-related topics. Apart from English, she fluently speaks several languages, including Spanish, Russian, and Czech.

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