Spinal Cord Injury And Axial Spondyloarthritis

Reviewed by: HU Medical Review Board | Last reviewed: May 2020 | Last updated: December 2020

There are various conditions or diseases that occur at the same time as conditions on the AxSpA spectrum. These are called comorbid conditions. Some of these are more common than others, and early diagnosis of these disorders can help you get prompt treatment and improve symptoms and quality of life.

Spinal cord injury (SCI) is a little different. Although it’s not quite a comorbid disorder or condition, there is an increased risk of SCI among people living with a condition on the AxSpA spectrum, especially radiographic axial spondyloarthritis (r-AxSpA)/ankylosing spondylitis (AS). Being aware of this increased risk can help you modify lifestyle behaviors in order to minimize your risk of spinal fractures or SCI. It might also be helpful in helping you talk with your doctor about treatment plans.

What is spinal cord injury (SCI)?

There are approximately 450,000 people living with a spinal cord injury (SCI) in the US.1 An SCI is when there is damage to any part of the spinal cord or nerves at the end of the spinal canal (also called the cauda equina).2 The injury affects the ability of the spinal cord to send and get messages from the brain to systems of the body that control things like movement, autonomic function, and sensory function.1 It typically results in permanent changes in strength, feeling, and other bodily functions below the injury.2

Being able to control your arms and legs after an SCI depends on where along the spinal cord the injury is, and how severe the injury is. If all sensory function and all ability to control movements are lost below the injury, it is called complete.2 If there is still some feeling or ability to control movements below the injury, it is called an incomplete injury, and there are multiple levels of incomplete injury.2

Paralysis from an SCI can be either:2

  1. Tetraplegia: also called quadriplegia, where arms, legs, hands, trunk, and pelvic organs are affected by the SCI
  2. Paraplegia: all or part of the trunk, legs, and pelvic organs are affected by the SCI

What causes SCI?

Every year, about 17,000 new SCIs occur in the US.1 Most are caused by trauma to the vertebral column. Motor vehicle accidents are the most common cause of SCI in younger people, but in older people, falls are the most common cause of SCI.1 Other causes can include acts of violence or sports accidents.

In people with conditions on the AxSpA spectrum, the risk for SCIs is increased. This is because as an AxSpA spectrum condition progresses, the bone mineral density gets weaker and weaker. Furthermore, spinal fusion reduces the ability of the spine to move and bend and so it can break instead. This increases the risk of spinal fracture, even from a low-impact event.3

How is SCI diagnosed and treated?

A complete physical exam will be done to evaluate for SCI, including a thorough neurologic exam. Imaging is done and the entire spine will typically be looked at with a CT scan for initial screening or images.1 This will help show any fractures or bony abnormalities. For known or suspected injuries, an MRI can be helpful because it will not only show the spinal cord, but also any blood clots, masses, or herniated discs that can be pressing on the spinal cord.1

Before any specific treatment is done, first responders will stabilize and immobilize the spine. Once diagnosed and admitted, a patient may be put into traction to help align the spine.1 Sometimes surgery is needed to relieve pressure that is being put on the spinal cord or to help stabilize the spine to prevent further damage or future deformity.1

Once an individual is stabilized, a treatment plan is put into place that focuses on supportive care and rehabilitation. This takes into account the nature of the SCI, what kind of motor function there is, and what supports are necessary with activities of daily living. Typically, occupational and physical therapy are part of the treatment plan, as is counseling for emotional support.1

Reducing the risk of SCI

In order to stay as healthy as possible, early diagnosis and treatment of AxSpA spectrum conditions is important. Your treatment will likely change over time as the condition progresses or as certain treatments become less effective, and following treatment plans is important in maintaining strength and overall health. Regular checkups with your doctor or treatment team can help identify any potential areas of weakness.

If you’re concerned about your bone density or risk of spinal fracture, talk with your doctor. She might want to send you for bone density testing, or talk with your about ways to reduce your fall risk at home in order to minimize any potential for fall and subsequent spinal fracture.

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