Spinal Cord Injuries
An injury to the spinal cord usually results from serious trauma to the spine (neck or back), such as from an automobile crash, a fall down a flight of stairs, or a diving accident. It is estimated that more than 250,000 Americans are living with some form of spinal cord injury, although some say that the number is about 400,000. Trauma to the spine, when it causes a fracture or dislocation of the vertebrae, can lacerate or even sever the spinal cord. If the spinal cord is contused or bruised, a full neurological recovery is possible. However, if the spinal cord is badly damaged, there may be permanent paralysis.
Spinal cord injuries are classified as “complete” or “incomplete.” As the names imply, a complete spinal cord injury means that there is no neurological function (sensory or motor) below the level of the spinal cord injury, whereas an “incomplete” injury allows some neurological function to exist.
Depending on the level at which the spinal cord is damaged, there may be different symptoms and complications. The higher the level of injury, the more serious the complications. An injury to the spinal cord at the cervical level may result in paralysis in the form of paraplegia or quadriplegia (also called “tetraplegia”). An injury to the thoracic or lumbar cord, may result in less paralysis.
Paraplegia typically occurs when there is a spinal cord injury at the T1 vertebral level. Paraplegics usually have full use of their upper extremities, but they may be completely paralyzed from the waist down.
The diagnosis of spinal cord injury is made by neurological examination, x-rays, CT scans, and MRI. "Spinal concussions" typically result in transient neurological deficits that resolve in a day or two. Spinal cord “contusions” are more serious and produce neurological symptoms that include numbness, tingling, burning, and muscle weakness in the affected extremity. However, they also resolve eventually, although it may take more time. Football players are particularly prone to spinal concussions and contusions, but surfers, skiers, and other types of sporting activities can give rise to these injuries.
According to the National Spinal Cord Injury Statistical Center (NSCISC), the most common level of spinal cord injury occurs at T11/12, and incomplete quadriplegia and paraplegia are the most common types of injury.
Complications of a spinal cord injury may include paralysis, chronic pain, loss of bladder and/or bowel control, impaired sexual function and respiratory function. About a third of patients with injuries to the cervical spine will require breathing support. Pressure ulcers (“bed sores”), deep vein thrombosis or DVT (“blood clots”), pulmonary emboli, and infections (e.g., pneumonia) are common.
According to the Centers for Disease Control and Prevention (CDC), spinal cord injuries account for an estimated $9.7 billion in medical costs each year. About 53% of spinal cord injuries occur in young people from 16-30 years of age. A little over 80% of spinal cord injuries occur in males and many are sports related. Auto accidents, falls and gunshots are other common causes.
Damage to the spinal cord is currently irreparable. Drug treatments, decompression surgery, nerve cell transplantation, nerve regeneration, stem cell therapy, and other modalities are all being investigated in clinical trials being conducted throughout the world. [Ref: ttps://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Spinal-Cord-Injury]
Patients with spinal cord injuries usually die from respiratory diseases, such as pneumonia in over 70% of cases. Heart disease and infections are also common.
Treatment may require surgical debridement and decompression of the spinal cord at the level of the injury. There is on-going debate in neurosurgical circles as to whether early (within 24 hours) or late (after stabilization) surgical intervention produces better outcomes. Treatment with corticosteroids, such as methylprednisolone (Medrol) may reduce the damage to nerve cells if it is given within the first 8 hours after injury.
At some point, after the damage to the spinal cord has stabilized and any surgery that is required has been completed, physical therapy and rehabilitation is undertaken. This can be a slow process, because nerves heal very slowly. It may take 6 months to a year for healing to occur. Physical therapy is fully used to try to stretch and strengthen muscles and joints as much as possible. Psychological and emotional counseling, electrical stimulation to muscles and nerves, and other modalities are used in a comprehensive program to maximize recovery. [Ref: https://www.ninds.nih.gov/Disorders/All-Disorders/Spinal-Cord-Injury-Information-Page]
Stem Cell Treatments
Stem cell therapy is an exciting hope for the future, but, in the treatment of spinal cord injuries, it is not yet ready for “prime time.” In an article entitled “Stem Cell Therapy for Spinal Cord Injury,” published in a peer-reviewed medical journal in 2018 by Gazdic M, et al., in Int J Mol Sci 2018 Apr; 19(4): 1039, the authors concluded that “It is important to highlight that stem cell transplantation alone is not sufficient to bridge a spinal cord lesion, therefore, a repair strategy based on combination of well-established therapeutic modalities, including surgery and medications, and stem cell-derived neural cells is an extremely attractive option for the treatment of this devastating injuries.” [Ref: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5979319/]
In other words, stem cell therapy is still in the investigational stage and not in a treatment stage.
Disability Benefits for Spinal Cord Injury
In order to obtain long-term disability (LTD) benefits under either Social Security (SSDI) and/or under an employer provided disability plan (ERISA), you will need to present your medical records, including a neurological or neurosurgical assessment of your injury, and x-ray and imaging (CT, MRI) evidence of damage to your spinal cord.
For SSDI benefits, spinal cord injuries are listed under Section 1.04—Disorders of the Spine in the “Blue Book.” You may also qualify under Section 11.00—Neurological Disorders. These sections set forth the criteria that Social Security uses to determine your entitlement to benefits.
However, even if you don't meet the criteria in the Blue Book “listings,” you may still be eligible for SSDI and/or ERISA plan disability benefits based on your residual functional capacity (RFC), by showing you are unable to perform your own job or any other suitable job.
Disability law is complicated. At Law Med, we are SSDI and ERISA knowledgeable and experienced.