Living well with a spinal cord injury (SCI) isn't just about handling problems when they come up. A lot of the most serious secondary complications — kidney damage, pressure injuries, broken bones, heart and metabolic disease — build quietly for months or years before you feel anything. The good news is that most of them can be caught early, while they're still easy to treat, with a handful of routine check-ups spread across the year.
Think of this like the scheduled maintenance on a car. You don't wait for the engine to fail; you change the oil and check the brakes on a regular schedule. This page pulls together the preventive surveillance an SCI survivor should think about over time, organized as a scannable, printable checklist. Bring it to your appointments and use it to make sure nothing is falling through the cracks.
1. A yearly visit with your SCI or rehab specialist
The anchor of the whole list is an annual comprehensive visit with a clinician who knows SCI well — usually a physiatrist (a physical medicine and rehabilitation doctor) or an SCI specialty clinic. A regular primary care provider is essential too, but SCI changes how many body systems work, and a specialist knows what to look for.
At least once a year, this visit is a chance to step back and review every system on this page in one place: bladder, bowel, skin, bones, heart and metabolism, breathing, spasticity, pain, mood, equipment, and medications. Many problems show up first as a small change you've gotten used to — more spasticity than usual, a new pressure spot, fatigue, leaking between catheterizations — so it helps to jot these down as they happen and bring the list with you.
- How often: at least once a year, more often in the first year or two after injury or if your health is changing.
- Bring: a current medication list, your bowel and bladder routine, any new symptoms, and questions.
2. Kidney and bladder surveillance
Protecting your kidneys is one of the most important reasons to keep up with check-ups. After SCI, the bladder often doesn't store or empty normally, and over time that can quietly back pressure up toward the kidneys or lead to stones, infections, and scarring — sometimes with no symptoms you'd notice. This is why routine surveillance matters even when you feel fine.
Typical pieces of urologic and kidney monitoring include:
- Kidney function blood tests (such as creatinine and related labs) to check how well your kidneys are filtering — often at least yearly.
- Imaging of the kidneys and bladder (commonly an ultrasound) to look for swelling, stones, or scarring. Many clinicians do upper-tract imaging on a regular schedule, often every one to two years, and sometimes more often depending on your situation.
- Bladder-function (urodynamic) testing in some people, especially when the management plan is being set up or something changes.
- Cystoscopy considerations. A long-term indwelling catheter (urethral or suprapubic) is a known risk factor for bladder problems over many years, and your team will examine the catheter and the skin around it at intervals. Current AUA/SUFU guidance does not recommend routine "screening" cystoscopy based on catheter use alone, but cystoscopy is appropriate when there are warning signs — so it's worth discussing your personal risk and plan rather than assuming you do or don't need it.
3. Skin and pressure-injury review
Pressure injuries (pressure sores) are one of the most common and most preventable SCI complications, and a small spot can become a deep, slow-healing wound surprisingly fast. Daily skin checks at home are your front line, but a periodic professional review adds another layer.
At your visits, your team can look at high-risk areas (sitting bones, tailbone, hips, heels), review how your cushion and mattress are working, and talk through your repositioning and weight-shift routine. If you've had a pressure injury before, that area stays higher-risk for life and deserves closer attention.
- How often: daily self- or caregiver skin checks; a professional review at least yearly and any time a new red area, blister, or open spot appears.
4. Bone health
Below the level of injury, bones lose density quickly — most of the loss happens in the first year or two — which raises the risk of fractures that can happen with very little force (called fragility fractures), often at the knee region (distal femur and proximal tibia). Because you may not feel a break the way someone without SCI would, prevention and monitoring matter.
- Talk with your team about a bone-density (DXA) scan. In SCI, the most useful measurement sites are often the hip and the area around the knee rather than the spine, because standard sites can give misleading numbers.
- Discuss your fracture risk and what to do to lower it, and keep a high index of suspicion for a fracture if a leg becomes swollen, warm, or misshapen after a transfer, fall, or range-of-motion session — even without much pain.
- How often: ask about a baseline DXA, with follow-up scans periodically (often every one to two years) if you're being monitored or treated.
5. Heart and metabolic screening
Heart disease, diabetes, and related conditions are more common, and tend to show up earlier, after SCI. Changes in muscle mass, activity, and metabolism shift the picture, so the usual screening still applies — and some thresholds are interpreted differently for people with SCI. Routine screening typically includes:
- Blood pressure at visits. (Many people with higher-level injuries run lower baseline blood pressures, which is its own reason to know your normal — see autonomic dysreflexia below.)
- Blood sugar screening, such as fasting glucose or an A1c test.
- A lipid (cholesterol) panel — often checked periodically and more often if results are abnormal or you have other risk factors.
- Weight and body composition. Standard BMI underestimates body fat in SCI, so your team may use SCI-specific cutoffs or other measures.
Diet and staying as active as possible are a big part of managing this risk.
6. Breathing health and vaccines
Higher-level injuries can weaken the muscles you use to breathe and cough, which makes chest infections more dangerous. Keeping up with respiratory check-ins and vaccinations is one of the highest-value things on this list.
- Respiratory review: talk with your team about your cough strength, any breathing equipment, and a plan for chest infections so you can act early.
- Vaccines: the CDC recommends staying current on the seasonal influenza (flu) vaccine each year, COVID-19 vaccination per the current schedule, and pneumococcal (pneumonia) vaccination. Pneumococcal timing and which product you need depend on your age and health history, so ask your provider which doses apply to you. Keep other routine adult vaccines up to date too.
7. Bowel and bladder program review
A bowel and bladder routine that worked a year ago may not be working now, and small problems — longer routines, accidents, more constipation, leaking, frequent infections — tend to creep up gradually. A periodic review keeps the plan effective and comfortable, and can prevent bigger complications down the road.
- Bowel program: review timing, products, and any changes in accidents, bloating, or how long the routine takes.
- Bladder program: review your method (intermittent catheterization, indwelling catheter, voiding, or other), how it's working, and infection patterns.
8. Spasticity and pain review
Spasticity and pain are common after SCI, and they can change over time. They're worth reviewing yearly not only for comfort but because a sudden increase can be the body's way of signaling another problem — an infection, a pressure injury, a fracture, a bladder issue, or AD — that you might not feel directly.
- Spasticity: review whether it's helping or interfering, how your medications and stretching are working, and whether anything has changed. A new or worsening pattern deserves a look for an underlying trigger.
- Pain: review what type of pain you have (nerve pain, muscle and joint pain, or both), how well it's controlled, and how it's affecting sleep, function, and mood.
9. Mental-health screening
Mental health is health. Depression, anxiety, and the strain of daily management are common after SCI and can quietly affect everything else — energy, motivation, sleep, relationships, and how well you keep up with the rest of this list. Screening should be a routine, expected part of your care, not something you have to bring up alone.
- How often: at least yearly, and any time your mood, sleep, or outlook shifts. Caregivers' well-being matters too.
10. Seating and equipment re-evaluation
Your body, your weight, your skin, and your activities change over time — and so should your equipment. A wheelchair, cushion, or mattress that fit well at discharge may now be contributing to pressure spots, pain, or poor posture. A periodic seating and equipment evaluation, often with a physical or occupational therapist or seating specialist, keeps everything working for you.
- Review: wheelchair fit and function, cushion and mattress condition, transfer setup, and any new needs.
- How often: periodically, and any time your equipment is wearing out, your needs change, or you develop pressure problems or pain.
11. A yearly medication review
Over the years, medications add up — for spasticity, pain, bladder, bowel, blood pressure, mood, and more — and prescriptions from different providers don't always get reviewed together. An annual medication review catches duplicates, interactions, side effects, and drugs you may no longer need.
- Bring everything: prescriptions, over-the-counter medicines, supplements, vitamins, and anything herbal — they can all interact.
- Ask which medications are still needed, whether any doses should change, and which ones could affect your bladder, bowel, alertness, or fall risk.
Your quick yearly checklist
A printable summary to bring to appointments. Frequencies are general — confirm yours with your care team.
- ☐ Annual SCI/physiatry visit — at least yearly
- ☐ Kidney labs — at least yearly
- ☐ Kidney & bladder imaging — periodically (often every 1–2 years)
- ☐ Cystoscopy considerations — discuss your personal risk, especially with a long-term catheter
- ☐ Skin / pressure-injury review — daily checks at home; professional review at least yearly
- ☐ Bone-density (DXA) discussion — baseline, then periodically if monitored
- ☐ Blood pressure — at visits
- ☐ Blood sugar (glucose/A1c) — periodically
- ☐ Cholesterol (lipid panel) — periodically
- ☐ Weight / body composition — at visits
- ☐ Flu vaccine — every year
- ☐ COVID-19 vaccine — per current CDC schedule
- ☐ Pneumococcal vaccine — ask which doses apply to you
- ☐ Respiratory review — at least yearly
- ☐ Bowel & bladder program review — at least yearly
- ☐ Spasticity & pain review — at least yearly
- ☐ Mental-health screening — at least yearly
- ☐ Seating & equipment re-evaluation — periodically
- ☐ Medication review — yearly, bring everything
Sources
- Model Systems Knowledge Translation Center (MSKTC): Aging and Spinal Cord Injury
- AUA/SUFU: Adult Neurogenic Lower Urinary Tract Dysfunction Guideline (2021)
- Consortium for Spinal Cord Medicine: Cardiometabolic Risk after SCI — Clinical Practice Guideline
- CDC: Recommended Adult Immunization Schedule
- A Primary Care Provider's Guide to Preventive Health After SCI
Information, not medical advice. This page is meant to help you plan and ask good questions, not to replace your clinicians. Your ideal schedule depends on your injury and health history — confirm what's right for you with your care team.