Spinal cord injury & recovery
With spinal cord injury (SCI), your brain loses the ability to talk to your muscles and tell them to move.
Sometimes, damage to the spinal cord heals on its own, and a person gets back some movement they had lost from their injury. This is called natural recovery. If a person recovers movement, it usually happens within the first 6 months after the injury. Then recovery slows down.
For some people, waiting for more recovery makes sense. But a lot of people tell us they wish they had known more about surgery to get back movement.
How does the spinal cord normally work?
Your spinal cord is a group of nerves that runs from your brain down your spine. It’s like a pathway that your brain uses to talk to the rest of your body. It sends signals from your brain to nerves and muscles to make them move.
To move your body, your brain sends a signal out through your spinal cord. For example, if you want to wave hello, your brain sends a signal to the muscles in your arm.
Other signals go into your brain through your spinal cord. For example, when your hand touches something hot, you feel it because the signal travels from your hand to your brain through your spinal cord.
What is SCI?
SCI damages the pathway between your brain and body. When the spinal cord is injured, some signals can no longer travel along your spinal cord to connect your brain to your body. As a result, SCI can limit movement and feeling in parts of your body.
A cervical SCI is at the neck and blocks signals and limits movement in the arms and hands. A cervical SCI can happen to any of the top vertebrae (bones) in your spine, which are named C1 - T1.
How does SCI happen?
Injury is the most common cause of SCI.
Examples include:
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Car or motorcycle accident
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Fall
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Sports injury
Patterns of injury in SCI
There are different patterns of injury in SCI. The pattern of your injury is the nature of your injury, such as:
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Where your SCI is
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The type of damage it caused
The pattern of your injury is what makes the nerve transfer surgery time sensitive for some people.
Why are some injuries time sensitive?
How can I get movement back after SCI?
Natural recovery (without surgery)
Natural recovery is the recovery you might have without arm or hand surgery.
Sometimes, part of the damage to your spinal cord heals on its own, and you get some movement back. This is called recovery. Your health care team might call this “natural recovery” or “spontaneous recovery.”
Rehabilitation (rehab) is important, such as physical therapy (PT) and occupational therapy (OT). Rehab can help to:
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Strengthen existing muscles and movements
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Keep your range of motion and prevent contractures, which is when muscles and tendons become stiff
or tight -
Learn new ways to do your daily tasks
If a person with SCI recovers strong movement, it usually happens within the first 6 months after the injury. Then, recovery slows down. For some people, waiting for recovery makes sense, but most people tell us they wish they had learned more about surgery to get back movement.
Chance of natural recovery from SCI without surgery
The chance of recovery depends on the movement you lost after SCI.
Researchers have studied the number of people who do and do not recover movement in their arms or hands after SCI. The table below shows the chance of recovery for different movements without surgery within 6-12 months after SCI (this is also the time to think about getting nerve transfer surgery).
The table below shows the chance of recovering certain movements without surgery. To see the chance of recovery for a movement you lost after SCI, find the movement on the left side, and then look to see how many recovered movement without surgery. For example, about 13% of hands recovered strong hand closing (called digit flexion) at 12 months if they did not have the movement at 6 months after SCI.
This table is from: Dengler J, Steeves JD, Curt A, Mehra M, Novak CB; DOD consortium; EMSCI consortium; Fox IK. Spontaneous Motor Recovery after Cervical Spinal Cord Injury: Issues for Nerve Transfer Surgery Decision Making. Spinal Cord. 2022 Oct;60(10):922-927. PMID: 35896613.
What researchers learned from the data in this table
The data in this table is from the European Multi-center Study about Spinal Cord Injury (EMSCI) data set. We used this data set to find information about recovery that is useful when considering surgery to restore arm and hand movement after SCI. Here is what we learned:
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Early after SCI there can be rapid recovery of movement. This is called natural or spontaneous recovery. It is different for each person with SCI and can even be different between the right and left side.
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Within 6-12 months after SCI, the chance of recovery “slows down.”
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Surgery may be an option for you to improve arm and hand movement, but some surgeries may only be an option within 6–12 months after SCI.
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Depending on your preferences and the movement you have, you should think about your choices:
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Continue to wait for more recovery
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Consider surgery
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How can I get movement back after SCI?
Surgery
Surgery can be an option to get some movement back after SCI. There are 2 main types of surgery for the arms and hands:
If you are thinking about surgery, talk to your health care team as soon as possible to learn about all the options and to keep the window of opportunity open.