Cervical Spinal Cord Injury Symptoms
The symptoms will vary depending on where the injury occurs. For example, a C1-C4 level injury will often mean that the individual has severe difficulty with breathing and speaking. There will be loss of feeling as well as some tingling sensation below the level of the injury.
For all cervical spinal cord injuries,there will be total or partial paralysis of the lower body including the legs,depending on the extent of the damage. Individuals will also face issues aroundbowel and bladder management.
Lumbar And Sacral Lesions
Individuals with a lumbar or sacral spinal cord injury have varying degrees of lower limb paralysis but tend to achieve ambulation without the need for orthoses or aids. Where there is imbalance around the ankle joint or foot an orthotic may be used to prevent the development of contractures.
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L1 – L2 Paraplegia
Can achieve ambulation with a four-point gait. Have full function of internal and external obliques and partial function of the iliopsoas and quadratus lumborum.
L3 – L4 Paraplegia
Can achieve ambulation with AFOs. Have significant function of the quadriceps musculature actual strength will impact ability to ambulate with AFOs. Have partial function of the tibialis anterior and posterior, extensor digitorum longus and brevis, extensor hallucis longus and brevis at L4. With good function of both the gastrocnemius and soleus muscle from S1.
Check Water Depth Before Diving
Diving accidentsparticularly headfirst dives into shallow watercan easily lead to spinal cord injuries and even death. When preparing to dive into water, it is important to check the waters depth first to confirm that there is enough room to dive safely.
Additionally, if jumping into water, it may be helpful to avoid diving headfirst to limit the risk of spine or head injury.
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Cervical Spinal Cord Injury: What To Expect At Each Level Of Injury
Elizabeth Denslow, OTR/L Flint Rehab
A cervical spinal cord injury is a serious, life-threatening emergency that can cause paralysis and loss of sensation throughout the entire body. Depending on the level and severity of a cervical spinal cord injury, it can affect major body functions like breathing and mobility from your neck down.
This article will help you understand what to expect after a cervical SCI by guiding you through the functions affected at each level of injury. Use the links below to jump straight to any section:
Effects Of Cervical Spinal Cord Injury
Depending on the severity and level of your injury, cervical spinal cord injuries can affect a wide variety of functions.
Survivors of cervical spinal cord injury may experience difficulties in following areas:
Each spinal cord injury is unique and may result in various secondary effects. By taking a personalized approach to treatment and addressing complications individually, individuals can significantly improve their quality of life.
To help you get a better idea of what to expect at each level of injury, the following section will discuss which sensory and motor functions may be affected each level.
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Coping With Your Diagnosis
Coping with an SCI diagnosis can be incredibly difficult. Any spinal cord injury, even an incomplete one, can be life-altering. Suddenly, plans and future expectations will changethings that would be easy when in perfect health may become near-impossible after losing the use of a limb.
It will take time to cope and to relearn how to do things after a major injury. Basic tasks like eating, going to the bathroom, and getting dressed may become much more difficult and frustrating. This can quickly become emotionally draining.
Here, seeking the help of friends, family, and even other SCI survivors can prove to be invaluable. The emotional support of loved ones, and the practical advice from SCI support groups, can make adapting to life after a spinal cord injury much easier.
Spinal Cord Injury Levels
Differences between neurological and rehabilitation definitions of spinal cord injury levels. Doctors use two different definitions for spinal cord injury levels. Given the same neurological examination and findings, neurologists and physiatrists may not assign the same spinal cord injury level. In general, neurologists define the level of injury as the first spinal segmental level that shows abnormal neurological loss. Thus, for example, if a person has loss of biceps, the motor level of the injury is often said to be C4. In contrast, physiatrists or rehabilitation doctors tend to define level of injury as the lowest spinal segmental level that is normal. Thus, if a patient has normal C3 sensations and absent C4 sensation, a physiatrist would say the sensory level is C3 whereas a neurologist or neurosurgeon would call it a C4 injury level. Most orthopedic surgeons tend to refer to the bony level of injury as the level of injury.
Discrepant lower thoracic vertebral and cord levels. The spinal vertebral and cord segmental levels become increasingly discrepant further down the spinal column. For example, a T8 vertebral injury will result in a T12 spinal cord or neurological level. A T11 vertebral injury, in fact, will result in a L5 lumbar spinal cord level. Most patients and even many doctors do not understand how discrepant the vertebral and spinal cord levels can get in the lower spinal cord.
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How Is A Spinal Cord Injury Diagnosed
In an emergency, a healthcare provider makes sure a spinal cord injury isnt affecting your breathing or heart rate. Next, theyll assess how well your nerves are working. The provider checks:
- Motor function, or your ability to move parts of your body.
- Sensory function, or your ability to feel touch.
Certain imaging tests can help diagnose a spinal cord injury:
- CT scan, to see broken bones, blood clots or blood vessel damage.
- MRI, to see the spinal cord or soft tissues.
- X-ray, to show broken bones or dislocations .
A healthcare provider may also use an electromyogram to check electrical activity in muscles and nerve cells if there are co-exist peripheral nerve injury.
Sensory Versus Motor Levels
A dermatome is a patch of skin that is innervated by a given spinal cord level. Figure 2 is taken from the ASIA classification manual, obtainable from the ASIA web site. Each dermatome has a specific point recommended for testing and shown in the figure. After injury, the dermatomes can expand or contract, depending on plasticity of the spinal cord.
C2 to C4. The C2 dermatome covers the occiput and the top part of the neck. C3 covers the lower part of the neck to the clavicle (the horizontal bone that goes to the shoulder. C4 covers the area just below the clavicle.
C5 to T1. These dermatomes are all situated in the arms. C5 covers the lateral arm at and above the elbow. C6 covers the forearm and the radial side of the hand. C7 is the middle finger, C8 is the lateral aspects of the hand, and T1 covers the medial side of the forearm.
T2 to T12. The thoracic covers the axillary and chest region. T3 to T12 covers the chest and back to the hip girdle. The nipples are situated in the middle of T4. T10 is situated at the umbilicus. T12 ends just above the hip girdle.
L1 to L5. The cutaneous dermatome representating the hip girdle and groin area is innervated by L1 spinal cord. L2 and 3 cover the front part of the thighs. L4 and L5 cover medial and lateral aspects of the lower leg.
Arm and hand muscles. C5 represents the elbow flexors , C6 the wrist extensors, C7 the elbow extensors , C8 the finger flexors, and T1 the little finger abductor .
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Cervical Spinal Cord Injury Recovery And Prognosis
Spinal cord injury prognosis varies depending on the severity of the injury. After swelling in the spinal cord decreases and any necessary surgery is performed, patients can stabilize and begin the recovery process.
- Recovery will focus on stabilization of the injured area of the spinal cord, but most injuries are permanent.
- Steroid and anti-inflammatory drugs administered shortly after injury, such as methylprednisolone, can help reduce swelling, which is a common cause of secondary damage at the time of injury.
- Rehabilitation often will focus on learning to use the non-paralyzed portions of the body to regain varying levels of autonomy.
- Many people who experience a cervical spinal cord injury will require permanent, 24-hour care for the remainder of their lives.
Learn more about spinal cord injuries, including coping, recovery and adaptation at MyShepherdConnection.org.
Body Areas Controlled By Spinal Cord Sections
Note: sensation is affected from the level of injury and below.
Cervical Spinal Cord Section
The nerves exiting the vertebrae in the neck area or cervical segments are referred to as C1 through C8. These nerve control signals to the neck, arms, hands, and internal organs. Injuries to these areas result in tetraplegia. Injuries at the cervical level can distort where your body is positioned in space
An injury above the C3 level may require a ventilator for breathing.
Individuals who have an injury above the C4 level usually means loss of movement and sensation in all four limbs, although often shoulder and neck movement is available to facilitate sip and puff devices for mobility, environmental control and communication.
Individuals with C5 injuries often have control of shoulder and biceps, but there is not much control at the wrist or hand. Individuals with a C5 level of injury typically can feed themselves and perform some activities of daily living.
An individual with an injury at C6 generally has enough wrist control to be able to drive adapted vehicles and handle some toileting activities but lack fine motor control.
Thoracic Spinal Cord Section
Nerves in the thoracic or rib cage area relay signals to the torso and some parts of the arms.
Individuals with injuries from T1 to T8 usually affect control of the upper torso, limiting trunk movement and sensation as the result of a lack of abdominal muscle control. This can affect balance as well as proprioception .
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Symptoms Of A C5 Spinal Cord Injury
Damage to the spinal cord at the C5 vertebra affects the vocal cords, biceps, and deltoid muscles in the upper arms. Unlike some of the higher cervical injuries, a patient with a C5 spinal cord injury will likely be able to breathe and speak on their own. Symptoms of a spinal cord injury corresponding to C5 vertebrae include:
- Retaining the ability to speak and breathe without assistance, though respiration may be weak
- Paralysis in the torso, legs, wrists, and hands
- Paralysis may be experienced on one or both sides of the body
- Patients may be able to raise their arms and/or bend their elbows
- Patients will need assistance with daily living, but may have some independent function
Potential Complications Of A C7 Spinal Cord Injury
A C7 spinal cord injury can result in loss of movement and sensation, which can affect other functions in the body. The more severe an injury, the higher the risk of developing complications such as pressure sores.
Pressure sores typically develop in bony areas such as the elbows, sit bones, tailbone, hip bones, heels, ankles, and knees. Remaining in the same position for prolonged periods of time can cause excess pressure to build up. This can restrict blood flow and allow for skin to break down. If left untreated, this skin breakdown can penetrate into the bone.
To prevent pressure sores from developing, be sure to change positions frequently, such as every two hours when in bed, and every 30 minutes when sitting up in your wheelchair. Its also important to inspect your skin daily. In the hospital, your doctor can provide proper care tips.
For example, immobility can slow down blood circulation throughout the body, decrease heart rate, and even interfere with your metabolism. This can cause blood to pool in the arms and legs, reducing blood supply returned to the heart. Insufficient blood supply can cause dysfunction in your major organs. To lower the risk of complications, its important to promote movement in the affected muscles.
Potential complications of a C7 spinal cord injury can include:
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Complete Vs Incomplete C8 Spinal Cord Injury
The severity of a C8 spinal cord injury plays a significant role in determining recovery outlook. One important factor to consider is whether the spinal cord injury is complete or incomplete.
A complete spinal cord injury is caused by damage that affects all connections between the brain and areas below the level of injury. Messages cannot get past the damage, resulting in no movement or sensation below the level of injury.
In contrast, an incomplete spinal cord injury indicates that some connections in the spinal cord were not damaged. Consequently, messages can still be sent, allowing individuals to potentially feel or move some areas below their level of injury.
However, its also possible for C8 spinal cord injury patients to mistake their incomplete injuries for complete ones.
Spinal shock describes the temporary loss of functions and reflexes below your level of injury. However, once inflammation in the spinal cord starts to die down after the initial injury, functions and reflexes may gradually start to return. As a result, some individuals may discover that their spinal cord injury is not as severe as it initially appeared.
In the following section, well discuss how damage to the C8 nerve roots affect movement and sensation.
What Is Acute Spinal Cord Injury In Children
The spinal cord is a bundle of nerves that carries messages between the brain and the rest of the body. It sends data from the brain to the body, and carries sensory information from the skin, bones, muscles, and organs back to the brain.
Acute spinal cord injury is when the spinal cord is damaged from an accident or other situation. An SCI may be a bruise , a partial tear, or a complete tear in the spinal cord. SCI is a common cause of long-lasting disability and death in children. Acute SCI is a medical emergency.
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Recovery After A Spinal Cord Injury
The road to recovery after an SCI can be a long and complicated journey. While an incomplete SCI is usually faster and easier to recover from than a complete SCI, it is still a long road.
Unfortunately, considering how varied the effects of an incomplete spinal cord injury can be, there is no one size fits all recovery solution. It is important to consult with a doctor to identify the best therapy options for an incomplete SCI and create a recovery plan.
Spinal Cord Injury Facts And Figures
SCI from medical and trauma causes
A 2013 survey performed by researchers at the Christopher and Dana Reeve Paralysis Foundation indicates 1.7 percent of the U.S. population, or 5,357,970 people self-identify as living with some sort of paralysis. This number includes those with a central nervous system medical diagnosis as well as trauma. Estimating the total number of individuals with spinal cord injury is challenging as those with SCI as a complication from medical illness do not necessarily identify as having a spinal cord injury but rather identify with their diagnosis.
Medical Causes of Spinal Cord Injury
There are many medical diagnoses that can result in spinal cord injury. Most individuals do not think of themselves as having a spinal cord injury but rather attribute their injury by their diagnosis. It is perfectly natural to think of disease by the medical diagnosis or cause, however, the consequences of the medical diagnosis is spinal cord injury. Other parts of the body may also be affected by the medical diagnosis especially the brain since it is part of the central nervous system. Additional complications can be attributed to spinal cord injury.
Medical causes of spinal cord injury can include the following and others:
- Amyotrophic lateral sclerosis
- Complete Tetraplegia 12.3%
These data are obtained from: National Spinal Cord Injury Statistical Center, Facts and Figures at a Glance. Birmingham, AL: University of Alabama at Birmingham, 2019.
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C5 Spinal Cord Injury Rehabilitation
Every C5 spinal cord injury is different, so a personalized rehabilitation plan that addresses each individuals unique needs is essential.
Management interventions for C5 spinal cord injuries include:
C5 SCI patients should also practice being mindful of their surroundings. Due to impaired sensation, individuals may not be able to sense that what they are touching is too hot or sharp.
Likewise, regular skin examinations are crucial to identify signs of pressure sores or other irritations early and prevent them from worsening.
How Can I Help My Child Live With An Acute Spinal Cord Injury
Acute spinal cord injury can be very upsetting to your child and to your whole family. Your child’s healthcare team will teach family members how to best care for a child with SCI. They will note what problems will need medical attention right away. Your child will need frequent healthcare visits and tests over time to track his or her progress.
It is important to focus on maximizing your child’s abilities at home and in the community. You can encourage your child to strengthen his or her self-esteem and have independence.
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C6 Spinal Cord Injury
After a C6 spinal cord injury, individuals usually retain most arm mobility. With the help of specialized adaptive tools like grip attachments, individuals with a C6 spinal cord injury should be able to perform everyday tasks like eating, grooming, and getting dressed on their own.
Some positive outcomes of C6 spinal cord injury include:
- Preservation of head, neck, and shoulder movements
- Ability to raise the arms, bend the elbows, flip hand palm up and palm down, and extend the wrists
- Normal sensation in the head, neck, shoulders, and outer areas of the arms
- Ability to use tenodesis grasp patterns