When people talk about a ‘spinal cord injury’, it is important to establish where the injury took place on the spinal cord. Because different specialists explain an injury using different terminology, you may feel more confused after having met with several specialists than you would otherwise.
Understanding basic spinal cord anatomy
In order to have a better understanding of what you are being told and to clear up any confusion, you have to understand basic spinal anatomy. Remember that the spinal cord and the spine itself are two different structures. The spinal cord runs from the base of the brain to just above the tailbone and is a series of fibers and nerve cells. It has some protection because of the bony vertebrae of the spine.
The spinal cord relays the nerve signals from the brain to our extremities and carries messages from these extremities back to the brain. Part of the confusion regarding the level of spinal cord injury starts because the spinal cord and the spine have differently named segments that sometimes do not correspond. Medical professionals divide the spine into vertebral segments that correspond to each of the vertebrae.
However, they divide the spinal cord into “neurological” segmental levels. This means that the focus when naming these specific areas was on the body part that is controlled by the nerves of each section of the spinal cord. The division of the spine is as follows:
- 5 tail (sacral) vertebrae
- 5 back (lumbar) vertebrae
- 7 neck (cervical) vertebrae
- 12 chest (thoracic) vertebra
Letters and numbers designate the segments of the spinal cord and the spine. The letters correspond to the location on the spinal cord or the spine. For example:
- T1 (thoracic) refers to the first vertebra in the chest area
- C1 (cervical) refers to the first vertebra in the neck
Where the confusion starts when it comes to identifying a spinal cord injury
Even though the segments of the spinal cord are named the same way, the spinal segment’s location and the indicated location of the spinal cord do not necessarily correspond with one another. The spinal cord assists with nerve messages responsible for voluntary and involuntary movement of the bladder, bowels, and diaphragm. An injury to the spinal cord can disrupt bodily functions. Depending on the location of the injury and the degree of damage, the amount of the impairment may vary per patient.
A complete injury
For many years, a ‘complete spinal cord injury’ meant there was no voluntary muscle use or conscious sensations below the site of the injury. However, this did not take into account that it is fairly common for patients to experience partial preservation of function below the injury site. It also did not account for the fact that some patients retained function on one side (lateral preservation). Making matters even more complicated was the fact that patients may regain a degree of function later on, despite having been classified as a ‘complete’ injury earlier.
The ASIA Scale
This is exactly why the American Spinal Cord Association tried to come up with a simple definition of complete injury in 1992. Using the ASIA scale, a complete injury means the patient has no motor or sensory function in the anal and perineal region. These areas correspond with S4-S5 – the lowest part of the sacral cord. The classification of the ASIA Scale is as follows:
- A – Complete – This means that there is no motor function or sensory sensation in S4 or S5.
- B – Sensory incomplete – The patient has some sensation below the injury level. These include segments S4 and S5.
- C – Motor incomplete – Most of the key muscles are weak, but there is some motor function below the injury motor level and voluntary anal sphincter contraction.
- D – Motor incomplete – Similar to C, but in this classification the key muscles are fairly strong.
- E – Normal – While hyperreflexia (overactive or overresponsive reflexes) may be present, the patient exhibits normal motor and sensory recovery.
What does this mean for you?
After reading that information, you may find yourself even more confused about spinal cord injuries than before. How does this affect the daily life of someone having to live with these injuries? We can provide a basic overview that helps make sense of the different injuries:
- C1-C4 Tetraplegia – This is the highest level of paralysis, also referred to as quadriplegia. At the C1-C3, it means the person may need long-term ventilator assistance. Meanwhile C1-C4 tetraplegia would mean the patient’s extremities have no motor function. For those suffering C1-C4 quadriplegia, they will need assistance from a caregiver for all or most of their daily needs.
- C5 Tetraplegia – People with C5 tetraplegia may learn feed and groom themselves or hold objects with the help of assistive devices. With some help, those with C5 Tetraplegia may be able to change positions in bed and dress their upper body. Assistance is required with dressing the lower body, bathing, bladder and bowel management, and transfers from the chair to a bed etc. It is possible for patients to be independent in many areas thanks to adaptive technology
- C6 Tetraplegia – Those with C6 tetraplegia can use the wrist and elbow and are able to grasp objects with assistive support. By using a slide board, they can learn to transfer independently. While difficult, they may be able to handle bowel and bladder movements with assistive devices. These patients will still need assistance from caregivers at times.
- C7 Tetraplegia – Patients with C7 Tetraplegia have a greater freedom of movement because they can extend their elbow. It is possible for these patients to live independently. They can learn to dress their upper body and feed themselves autonomously. Some may require help using computers, answering phones, write, or type, while others do not.
- C8 Tetraplegia – patients with C8 tetraplegia can get a better grip on objects because they are able to flex their fingers. These patients are capable of caring for themselves.
The consequences of a spinal cord injury
The effects of a severe spinal cord injury may go beyond the clear physical impairments. Learning to live life with a disability, oftentimes confined to a wheelchair, is not easy to do. Patients will often experience emotional pain and suffering as a result. Remember that there are valid concerns regarding their personal relationships, their financial situation, and their lifestyle.
Make sure to get an spinal cord injury lawyer who can represent your best interests
If you or someone close to you suffered a spinal cord injury, it is important that you think beyond medical help as well. A complete evaluation of what the person has to live with in regards to the full effects of the injury is an important step that needs to be taken before you can set rehabilitation goals. If victims were not at fault, they should not bear the financial cost of accidents that led to spinal cord injury. Make sure that you get the monetary settlement to which you are entitled and hold the liable party accountable for its actions.
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