Spinal Cord Levels of Injury

If you or someone you love has a spinal cord injury, you may hear doctors use terms such as C5, T10, complete, incomplete, paraplegia, or tetraplegia. Those terms help describe where the spinal cord was injured and how much function remains below that point.

The SCI level can tell you a lot about what life may look like after the injury. A cervical injury may affect both the arms and legs, while a thoracic injury may leave full use of the arms but affect the trunk and legs. Lower injuries can affect walking, strength, sensation, and bowel or bladder function.

Even at the same SCI levels, no two injuries are exactly alike. Whether the injury is complete or incomplete and how much movement and sensation remain can affect recovery, independence, and the care needed in the years ahead.

When a spinal cord injury was caused by negligence, these same factors can help determine the medical care, rehabilitation, equipment, lost income, and other losses that need to be addressed in a claim.

Call the Brain Injury Law Center at (757) 244-7000 for a free consultation.

"The Brain Injury Law Center is the only law firm in the United States dedicated exclusively in representing brain injury victims, survivors and their families. I have dedicated both my personal and professional life to helping brain injury survivors and their families and other victims of catastrophic events."

— Stephen M. Smith, Founder

Your spine and spinal cord are not the same thing.

The spine is the column of bones, called vertebrae, running from your neck through your lower back. Those bones help support your body and protect the spinal cord.

The spinal cord is the nerve tissue inside the spinal column. It carries messages between your brain and the rest of your body. Those messages control movement and sensation along with functions such as bladder and bowel control.

Someone can fracture a vertebra without permanently damaging the spinal cord. Another person can suffer spinal cord damage that leaves lasting neurological problems.

Doctors look at both where the injury occurred and what function remains below it.

The easiest way to understand the spinal cord is to work from the neck down.

There are four main regions: cervical, thoracic, lumbar, and sacral. Each contains nerves connected to different parts of the body. Generally, the higher the injury, the more functions it can affect.

Cervical: C1-C8

Cervical injuries occur in the neck and can affect both the upper and lower body.

At the highest levels, an injury can interfere with breathing and leave a person dependent on others for many daily activities. Lower cervical injuries may preserve increasing amounts of shoulder, arm, wrist, and hand function.

For example:

• C1-C4: Paralysis can affect the arms, trunk, and legs. Breathing assistance may be necessary.
• C5: Shoulder movement and the ability to bend the elbow may remain, but hand and wrist function can be limited.
• C6: Wrist movement can provide greater independence with eating, grooming, transfers, and wheelchair use.
• C7-C8: Increasing arm, hand, and finger function can make more daily activities possible without assistance.

The ability to use a wrist or straighten an elbow can determine whether someone can feed themselves, transfer into a wheelchair, use a phone, or perform other everyday tasks independently.

Thoracic: T1-T12

Thoracic injuries affect the upper and middle back.

People with these injuries generally retain use of their arms and hands but can have paralysis or weakness involving the trunk and legs. This is commonly called paraplegia.

Someone with a lower thoracic injury may have more trunk control than someone injured higher in this region. Many people with thoracic injuries can use a manual wheelchair independently, and some may be able to stand or walk with braces or other assistance.

Bowel, bladder, and sexual function can also be affected.

Lumbar: L1-L5

Lumbar injuries affect nerves serving the hips and legs.

A person may experience weakness or paralysis in portions of the lower body while retaining complete use of the upper body. Depending on how much function remains, walking may be possible with braces, crutches, a walker, or other assistance.

Some people use a wheelchair for longer distances while walking shorter distances.

Sacral: S1-S5

Sacral injuries occur at the lowest region.

People with these injuries are more likely to retain the ability to walk, although they may have weakness or loss of sensation involving the hips, legs, feet, or pelvic area.

Bowel, bladder, and sexual dysfunction can remain significant. A person can walk and still live with serious neurological problems.

Doctors do not classify an SCI based only on where it occurred. They also determine whether it is complete or incomplete.

This describes how much communication between the brain and body remains below the injured area.

Complete Spinal Cord Injuries

A complete spinal cord injury means there is no sensory or motor function in the lowest sacral segments.

It does not necessarily mean the spinal cord was completely severed. "Complete" refers to what doctors find during neurological testing.

The functional effects still depend heavily on the injury level.

Someone with a complete high cervical injury may have paralysis affecting the arms, trunk, and legs and need assistance breathing. A person with a complete thoracic injury may have normal arm and hand function but no voluntary movement or sensation in the legs.

Rehabilitation can help someone with a complete SCI learn new ways to perform daily activities and become more independent. Depending on the injury, that may include learning wheelchair skills, using adaptive technology, transferring between surfaces, managing personal care, or driving an adapted vehicle.

Neurological recovery is generally more limited after a complete injury than after an incomplete one.

Incomplete Spinal Cord Injuries

With an incomplete SCI, some sensory or motor function remains below the injury, including function in the lowest sacral segments.

There is a wide range of function within this classification.

One person may be able to feel touch below the injury but have little voluntary movement. Another may move the legs but lack enough strength or balance to walk safely. Someone else may eventually walk independently but continue to have weakness, numbness, pain, bowel or bladder problems, or difficulty with fine motor skills.

Incomplete injuries include several recognized patterns:

• Central cord syndrome: Weakness is generally greater in the arms and hands than in the legs.
• Anterior cord syndrome: Movement and certain types of sensation can be severely affected while other sensation remains.
• Brown-Séquard syndrome: Damage concentrated on one side of the spinal cord can produce different motor and sensory problems on opposite sides of the body.

An incomplete injury generally provides more potential for neurological recovery than a complete injury, but doctors cannot predict an individual's final outcome from the word "incomplete" alone.

The amount of movement and sensation preserved immediately after the injury, neurological level, complications, age, treatment, and progress during rehabilitation can all affect recovery.

The vertebra damaged in an accident and the neurological level of the SCI are not always the same.

Doctors test sensation and movement throughout the body to find the lowest area where normal neurological function remains.

A commonly used assessment is the International Standards for Neurological Classification of Spinal Cord Injury, developed by the American Spinal Injury Association (ASIA).

During the examination, a doctor may test whether the patient can feel light touch or a pinprick at specific points on the body. Muscle strength is also tested by asking the patient to perform particular movements against resistance.

The examination helps doctors identify:

• Sensory function;
• Motor function;
• The neurological level of the injury;
• Whether the injury is complete or incomplete; and
• How much function remains below the injury.

Imaging also plays a role. MRI, CT scans, and X-rays can show fractures, dislocations, compression, bleeding, swelling, disc damage, and injuries involving the spinal cord.

The scans show the physical damage. The neurological examination shows how that damage has affected the person's ability to move and feel.

The ASIA Impairment Scale gives doctors a standardized way to describe the severity of an SCI.

The classifications run from A through E:

• AIS A – Complete: No sensory or motor function remains in the lowest sacral segments.
• AIS B – Sensory Incomplete: Sensation remains below the neurological level, including the sacral segments, but the criteria for motor incomplete injury are not met.
• AIS C – Motor Incomplete: Motor function remains below the injury, but more than half of the tested key muscles below that level do not meet the specified strength threshold.
• AIS D – Motor Incomplete: Motor function remains, and at least half of the tested key muscles below the injury meet or exceed the specified strength threshold.
• AIS E – Normal: Sensory and motor testing is normal in someone who previously had neurological deficits from an SCI.

The classification may change as a person recovers. Doctors can repeat the examination during treatment and rehabilitation to see whether sensation or motor function has returned.

Two people with the same ASIA grade can still function differently. Doctors also evaluate what each patient can actually do in daily life.

Recovery does not mean the same thing for every person with an SCI.

For someone with a cervical injury, gaining enough hand function to hold a fork or operate a wheelchair could significantly increase independence. Someone with a thoracic injury may work toward transferring from a bed to a wheelchair without assistance. A person with an incomplete lumbar injury may work toward standing or walking.

Rehabilitation goals can include:

• Breathing without mechanical assistance;
• Sitting upright and maintaining balance;
• Using the arms, wrists, hands, or fingers;
• Transferring between a bed, chair, and wheelchair;
• Dressing, bathing, and eating;
• Using a manual or power wheelchair;
• Standing or walking with assistance;
• Managing bowel and bladder care;
• Driving an adapted vehicle; and
• Returning to work or school.

Recovery can include both regaining neurological function and learning how to perform activities differently.

People with incomplete injuries generally have more potential to regain neurological function than those with complete injuries. How much returns and how quickly varies from person to person.

Progress can also be measured in ways that are easy to overlook. Better grip strength, improved balance, greater trunk control, or the ability to complete a transfer without another person's help can change how much assistance someone needs every day.

A serious spinal cord injury can require medical care and assistance years after the initial hospitalization ends.

Doctors and other specialists help establish what those future needs are likely to include.

Depending on the injury, a legal team may work with neurologists, neurosurgeons, rehabilitation physicians, physical therapists, occupational therapists, vocational specialists, and life-care planners.

They may evaluate:

• Future surgeries and medical treatment;
• Rehabilitation and therapy;
• Wheelchairs and mobility equipment;
• Assistive technology;
• Prescription medications and medical supplies;
• In-home assistance or nursing care;
• Accessible transportation;
• Home modifications;
• Ability to return to work; and
• Medical complications that may require future treatment.

These opinions can also help distinguish between what someone is physically capable of doing in a clinical setting and what they can realistically do every day without assistance.

For example, walking several feet during physical therapy does not necessarily mean someone can safely walk through a grocery store, return to a physical job, or stop using a wheelchair.

Founder Stephen M. Smith has spent decades handling catastrophic neurological injury cases and completed Marquette University's Neuroanatomical Dissection of the Human Brain and Spinal Cord program. That background gives the Brain Injury Law Center experience working through the medical evidence involved in serious neurological injuries.

Medical records describe strength, sensation, reflexes, imaging, and neurological classifications. They do not always show what happens when someone goes home.

Daily life may now involve transferring into a wheelchair before getting out of bed, needing help showering or dressing, managing a catheter or bowel program, scheduling hours of therapy, or relying on another person for transportation.

Some people return to work with accommodations. Others can no longer perform the job they had before the injury. A spouse or family member may reduce their own work hours to provide care.

Functional assessments can evaluate activities such as:

• Eating and grooming;
• Bathing and dressing;
• Toileting;
• Getting in and out of bed;
• Wheelchair mobility;
• Walking;
• Communication; and
• Other activities needed to live independently.

Those day-to-day limitations can also help medical and legal professionals determine the amount of care, equipment, and assistance someone will need going forward.

Your Claim Should Account for the Life You Have to Live Now

Hospital bills are only one part of the financial impact of a spinal cord injury. Rehabilitation, mobility equipment, home care, accessible transportation, lost income, and future treatment can continue for years.

The Brain Injury Law Center works with medical and other qualified experts to identify those needs and determine how they should be addressed in a catastrophic injury claim.

Call (757) 244-7000 for a free consultation with the Brain Injury Law Center.

The type of accident does not determine the neurological level. The location and extent of damage to the spinal cord do.

Some accidents, however, expose particular areas of the spine to tremendous force.

Motor Vehicle Accidents

Car, truck, and motorcycle crashes can injure the neck, middle back, or lower back.

A violent impact can flex, extend, rotate, or compress the spine. A collision may also fracture or dislocate vertebrae, which can compress or damage the spinal cord.

Falls

Falls from roofs, ladders, scaffolding, balconies, stairs, and other elevated surfaces can cause cervical, thoracic, or lumbar injuries depending on how the person lands.

A head-first fall can cause severe cervical damage, while landing on the feet or buttocks can send force upward through the lower spine.

Construction and Workplace Accidents

Falls from heights, falling materials, heavy machinery, vehicle collisions, and equipment failures can cause spinal cord trauma.

A workplace injury may also involve someone other than the injured person's employer. Contractors, equipment manufacturers, property owners, or other companies could become part of the investigation depending on what caused the accident.

Sports and Recreational Accidents

Diving into shallow water can cause a high cervical injury when the head strikes the bottom. Football, gymnastics, skiing, horseback riding, and other activities can also cause spinal trauma.

Acts of Violence

Gunshot wounds and other penetrating trauma can directly damage the spinal cord. The resulting loss of function depends on where and how extensively the cord was injured.

There is no predetermined amount of compensation for a C5 injury, T10 injury, or any of the other spinal cord levels of injury.

The medical classification helps show what the person has lost and what they are likely to need in the future.

Consider two people with very different injuries. One has a high cervical SCI and needs a power wheelchair, daily personal assistance, accessible housing, and continuing respiratory care. Another has an incomplete lumbar injury and can walk but cannot return to a physically demanding career.

Both have serious injuries, but their medical expenses, care needs, lost income, and daily limitations are different.

Compensation in a spinal cord injury claim may include:

• Hospital and surgical expenses;
• Future medical care;
• Rehabilitation and therapy;
• Wheelchairs and mobility equipment;
• Medical supplies;
• Assistive technology;
• Home healthcare and attendant care;
• Home and vehicle modifications;
• Lost wages;
• Loss of future earning capacity;
• Pain and suffering; and
• Other damages available under applicable law.

A life-care planner may estimate the cost of future medical care, equipment, assistance, and other needs over the injured person's lifetime. Vocational and economic experts can evaluate how the SCI has affected the person's ability to work and earn income.

The claim should account for what the injury is expected to cost over time, not only the bills that have already arrived.

Loss of movement is only one effect of an SCI.

Depending on the spinal cord levels of injury involved, a person may also experience:

• Breathing problems;
• Chronic pain;
• Pressure injuries;
• Muscle spasms or spasticity;
• Blood clots;
• Urinary tract infections;
• Bladder and bowel dysfunction;
• Changes in blood pressure;
• Autonomic dysreflexia;
• Sexual dysfunction;
• Loss of bone density; and
• Difficulty regulating body temperature.

Some of these problems can continue long after rehabilitation or appear later. They can also increase the amount of medical monitoring, medication, equipment, and assistance someone needs over a lifetime.

A catastrophic neurological injury case can involve thousands of pages of medical records, multiple specialists, imaging studies, rehabilitation records, expert opinions, and projections of care that may be needed for decades.

The Brain Injury Law Center has focused its practice on people with serious neurological injuries.

Stephen M. Smith has nearly five decades of legal experience and specialized neuroanatomical training involving the brain and spinal cord. Our firm has recovered more than $1 billion in verdicts and settlements for clients.

That experience can be used to investigate how the injury happened, work with medical and rehabilitation experts, document its effect on the client's life, calculate future needs, and pursue the people or companies responsible.

“When the doctors explained that I had some slight but significant brain damage, my wife called the Brain Injury Law Center. Not only did he [Stephen Smith] pick up the phone, the number we called went directly to his cell phone.

From that moment on, we knew we called the right guy. His professionalism and order-of-procedure ended up making the difference in court and ultimately making the difference in my quality of life moving forward.

Stephen M. Smith and the Brain Injury Law Center were the only lawyers educated and sophisticated enough to try my case. I have no idea where I’d be today without them.”

— Tommy B., Client