Levels of Spinal Cord Injury

Motor vehicle accidents can be catastrophic in the damage they cause, especially to the human body. Vehicular collisions are the number one cause of spinal cord injury (SCI) in the United States, accounting for 38% of all spinal cord injuries since 2010. Falls, acts of violence, and sports injuries are common causes of SCI, as are infections and surgical error.

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In all instances, injury to the spinal cord results in changes to the body’s normal motor, sensory or autonomic functions. Whether these changes are temporary or long-term very much depends on the location and level of injury to the spinal cord. The cost of caring for such injuries can be astronomical, putting additional pressure on individuals and families already facing stress and uncertainty.

If you or someone you love has a spinal cord injury caused by another person’s negligence, you’ve come to the right place to learn what your legal options are.

What’s the Difference Between the Spine and Spinal Cord?

Before we delve into the levels of spinal cord injury, it may help to differentiate the “spine” from the “spinal cord.” The term “spine” is used to describe the entire structure of 33 individual vertebrae (bones) that make up some of our skeletal system.

The “spinal cord” includes bundles of nerve fiber and surrounding tissue that allows the brain to communicate with the body through the central and sympathetic nervous systems. The nerves of the spinal cord are responsible for controlling movement, as well as the skin’s sense of touch.

Due to the spinal cord’s importance in relaying electrical impulses from the brain to the body, most SCIs require significant long-term physical and occupational therapy. The severity of injury and limitations experienced by the victim depends on the section of the spinal cord effected.

What Are the Levels of Spinal Cord Injury?

The anatomy of the spinal cord is divided into four sections. The cervical spine consists of the vertebrae of the neck and skull. The thoracic spine consists of the bones that comprise the chest cavity. The lumbosacral regions make up the bones of the lower back and the pelvis.

Cervical Nerves (C1 – C8)

The cervical spine has eight distinct vertebrae. Damage to the cervical nerves accounts for almost 57% of spinal cord injuries. Trauma to C1 - C8 can result in full or partial paralysis. Common cervical injury symptoms include low heart rate, low blood pressure, problems regulating body temperature and trouble breathing.

The cervical nerves control movement for the head, arms, wrists, hands and diaphragm. Effects of injuries to the specific segments are as follows:

• C1 – C4: unable to breath without mechanical ventilation and full paralysis of the limbs.
• C5 – C6: difficulty coughing and paralysis of wrists, hands and triceps.
• C7 – C8: difficulty coughing, and some hand muscle weakness.

Damage to C1 – C4 results in the greatest level of paralysis, also known as quadriplegia. A person who is quadriplegic may need to be on a ventilator and use a power wheelchair complete with adaptive technology, such as the Touch2Chat App to help with speech. A quadriplegic or tetraplegic will require a caregiver’s assistance for the rest of their life.

Thoracic Nerves (T1 - T12)

Thoracic spinal cord injuries are those affecting the chest and/or lower extremities. They result in the inability to control the abdominal muscles, and are usually classified as thoracic paraplegics. Often the patient can control their hands, arm, neck and breathing muscles. However, mobility, bladder and bowl care can be problematic.

Lumbar Nerves (L1 – L5)

Injuries to the lumbar region of the spinal cord results in decreased control of the legs and hips, as well as bowel and bladder control. Many people with lumbar nerve injuries can walk with assisted devices, such as leg braces and manual wheelchairs. Lumbar paraplegics can function independently and drive cars that are specially equipped for their needs.

Sacral Nerves (S1 – S5)

The sacral region holds the last of the spinal cord nerves. Injuries to this area results in limited hip and leg function, as well as some urinary and fecal inconvenience. Generally, individuals with this injury can walk on their own.

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Types of Spinal Cord Injuries

SCI carries both primary and secondary injuries. The primary event occurs when the injury does, and ushers in cell death and tissue damage from the incident causing the original injury. In the secondary event, inadequate blood supply causes inflammation, swelling, neurotransmitter malfunction and cell suicide.Tetraplegia, Quadriplegia and Paraplegia are common types of spinal cord injury.

Tetraplegia and Quadriplegia both mean a patient has lost function of all or most of the limbs. In paraplegia, a patient is paralyzed in all or part of the legs, pelvis and torso.

Spinal cord injuries can be classified as traumatic or non-traumatic; complete or incomplete.

Complete Spinal Cord Injuries

In a “complete” injury, some motor and/or sensory function remains below the level of injury. A spinal cord injury is complete if the person injured has no sensation or ability to manipulate their sphincter.

Incomplete Spinal Cord Injuries

In an “incomplete” spinal injury, all bodily functions below the injured area are lost. Incomplete injuries include Anterior Cord Syndrome, Posterior Cord Syndrome, Central Cord Syndrome, and Brown Séquard Syndrome.

Classification of Spinal Cord Injuries

A person who suffers a spinal cord injury will have to see a team of doctors, including neurologists and surgeons. To increase understanding of patient needs across medical fields, two classification scales were created to better understand both the level of impairment and the future capabilities of those who have suffered a spinal cord injury.

ASIA Impairment Scale

Named after the organization, the ASIA scale provides a classification system that better assists specialists plan for patient surgical and therapy needs. To further classify sensory and motor control damages on the neurological level, the American Spinal Injury Association also created the International Standards for Neurological Classification of Spinal Cord Injuries.

In both scales, injuries are graded as follows:

• A: Complete Injury. No motor or sensory function below the level of injury, including the sacral cord. Patient is quadriplegic or tetraplegic.
• B: Sensory Incomplete. Sensory but no motor function below the level of injury. Patient can be tetraplegic or paraplegic.
• C: Motor Incomplete. Motor function is preserved below the level of injury, more than half of key muscles have full range of motion and increased strength.
• D: Motor Incomplete. Motor function and muscle control below the level of injury are normal or a little below normal range.
• E: Normal. No sensory, motor or muscle control malfunction, but issues exited in the past.

Other tests that determine a patient’s level of motor and sensory function include the Electrical Perceptual Threshold (EPT) and Neurological level of Injury (NLOI) scales.

Functional Outcome Measures

As part of the assessment and treatment plan of a person with SCI, doctors often use the Functional Independence measurement (FIM) scale to determine the level of independence a person with a spinal cord injury can expect moving forward.

The FIM is a numeric scale; numbers between 1 and 7 correspond with the level of assistance required from a caregiver or assistive device to perform skills such as self-care, bathroom use and clean-up, communication and social cognition. Functional outcome measures provide further classification of the injury as well as the level of care the victim will require for the rest of their life.