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Spinal Cord Injury: Overview

Males account for 80% of new spinal cord injuries. Motor vehicle accidents and falls account for two thirds of these injuries. The American Spinal Injury Association (ASIA) developed the ASIA Impairment Scale (AIS):

  • Grade A: Complete--no sensory or motor function is preserved in the S4-5 segments

  • Grade B: Incomplete--sensory but not motor function is preserved below the neurological level and includes presence of sensory function at S4-5

  • Grade C: Incomplete--motor function is preserved below the neurological level, and more than half of key muscles below the neurological level had a grade of strength below 3 out of 5.

  • Grade D: Incomplete--motor function is preserved below the neurological level, and more than half of key muscles below the neurological level have a juscle grade greater or equal to 3 out of 5.

  • Grade E: Normal--sensory and motor functions are normal.

Motor grades for testing are: 0--complete paralysis, 1--flicker of contraction present, grade 2--active movement with gravity eliminated, grade 3--active movement against gravity, grade 4--active movement against gravity and some resistance, grade 5--normal power.

Incomplete spinal cord syndromes include:

  • Central cord syndrome: swelling or a syrinx, with relative weakness in upper extremities, loss of temperature, and pin prick sensation 1-2 level below the level of injury , and urinary retention

  • Brown-Sequard syndrome: hemisection of the spinal cord resulting in ipsilateral weakness below the lesion, and contralateral sensory loss 1-2 level below the lesion level

  • Conus medullaris syndrome: bowel and bladder dyscontrol, sexual dysfunction, and paraparesis

  • Cauda equina syndrome: loss of function to lumbar plexus below conus medullaris (lower motor neuron lesion), with sensory impairment in saddle distribution, back pain, lower extremity weakness, bowel, bladder and sexual dysfunction

Function by Neurological Level of Injury

  • All levels: sexual functions are impaired

  • C1-4: breathing is compromised and physically dependent for all functions

  • C5: motorized wheelchair ambulation and nearly full eating skills are possible

  • C6: independence in eating, sitting and driving, but physical assistance is needed

  • C7-T12: independent ambulation is by wheelchair and most become completely independent

  • L1-4: bipedal ambulation can become independent for short distances, and wheelchairs are used

  • L5-S2: complete independence in bipedal ambulation with assistance of 2 canes/crutches/or short leg braces (AFOs). No wheelchair is necessary.

  • S2-4: Only bowel/bladder function is impaired initially, but could improve

Common complications include:

  • Cardiovascular (T6 and higher): orthostatic hypotension and autonomic dysreflexia

  • Respiratory (T12 and higher): ventilator dependent C3 and above, pulmonary embolism, atelectasis, pneumonia, inspiratory/expiratory function impaired

  • Gastrointestinal: GI bleeds, paralytic ileus, choelilithiasis, hemorrhoids and rectal fissures, constipation and impaction of fecal matter

  • Genitourinary: bladder distention, urinary tract infections, urinary incontinence

  • Skin: decubitus ulcers

  • Musculoskeletal: myositis ossificans, poikilothermia, osteoporosis, spasticity, contractures

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