Extending from the base of the brain and all the way to the buttocks is a nerve bundle known as the spinal cord. The spinal cord relays messages from the brain to the rest of the body, through spinal nerves. The ability to walk, bend over, and wave the hand require that information be transmitted from the brain, through the spinal cord and out to the corresponding part of the body via the spinal nerves. This connection also works in reverse. Fall, hit your head, or break a toe, and spinal nerves send a pain or pressure signal back up to the brain. A group of backbones known as the vertebrae protect the spinal cord. Spinal Cord Injury (SCI) occurs when a vertebra is broken or gets forced out of alignment; causing the signal between the brain and spinal cord to become reduced or severed. No one is immune from spinal cord injuries: children, the elderly, all races, and genders are affected.
Spinal Cord Injury Terms
Anterior Spinal Artery Syndrome – The anterior spinal artery rests at the base of the brain and extends downward, covering two-thirds of the surface of the spinal cord and supplying blood. If a disruption of blood flow occurs due to aortic lesions, surgery, trauma, disc herniation, or other causes, paralysis can occur at the site of injury. Symptoms include weakness, motor loss, bladder dysfunction, and decreased sensitivity to temperature. Typically, motor loss is more severe in the legs than the arms and some crude sensations may be possible. This injury is also known as Anterior Cord Syndrome.
ASIA Impairment Scale – Created by the American Spinal Injury Association (AISA) this scale provides a standard method for clinicians to determine the severity of a spinal cord injury. The scale has five grades ranging from A to E. Patients with an E grade show no motor or sensory impairments from their injury. Functioning decreases along the scale and those with an A grade have no voluntary control of muscles and no perception of temperature, pain, pressure, or touch.
Brown-Sequard Syndrome – In this rare neurological condition a lesion on the spinal cord results in one half of the body experiencing motor loss while the other side of the body has sensory loss. The cause of the lesion may be due to blunt trauma, spinal cord tumors, or blood vessel obstruction. Infections and inflammatory diseases such as Meningitis may also be the underlying cause.
Cauda Equina Syndrome (CES) – Refers to a rare neurological nerve disorder sometimes mistakenly diagnosed as low back pain. In CES, the bundle of nerves at the base of the spine becomes compressed. The cause could be due to trauma from a car accident, gunshot, stabbing, or fall from height. A slipped vertebrae, ruptured disk, or inflammation could also be the cause. Symptoms may be most noticeable in the legs with pain, weakness, and lack of muscle control. Loss of bladder control and sexual dysfunction do occur in many cases. With CES, immediate medical surgery may be needed to prevent or reverse neural dysfunction.
Central Cord Syndrome (CCS) – CCS is the most common form of Incomplete SCI. With CCS, individuals experience a type of injury where the cervical cord is damaged due to spinal trauma directed towards the central part of the cord. Due to the location of cord damage, impairment is greater in the upper exterminates and less pronounced in lower extremities.
Complete Spinal Cord Injury (CSCI) – With a CSCI no motor or sensor functions exist below the level of injury. Around half of all spinal cord injuries fit this diagnosis. It is not uncommon however, for those labeled with a CSCI to have some functioning on one side of the body or to recover some functioning as time passes.
Conus Medullaris Syndrome (CMS) – At the tip of the spinal cord and above the cauda equina is the conus medullaris; injuries to this nerve root can result in lower limb paralysis. Due to the proximity of the conus medullaris to the cauda equina, CES and CMS have similar causes and symptoms. Injuries responsible for causing CMS include spinal fractures, abscesses, spinal bifida, and anesthesia used on the spine. Symptoms can include urinary and fecal incontinence, leg numbness, and low back pain.
Dermatome – Nerve fibers allowing for the sensation of touch or feeling pain to a corresponding sensory sector of the skin are dermatomes. These nerves originate from the spine and therefore can be useful in spinal injuries to evaluate the level of deficit. Pain, lack of sensation, or abnormal functioning of dermatomes can help pinpoint spinal nerve damage.
Incomplete Spinal Cord Injury (ISCI) – Though the spinal cord is injured, those with ISCI retain some functioning below the injury level. One side of the body may have more movement than the other, or there may be feeling but not the ability to move. With an ISCI, individuals retain more freedom and motor or sensory functioning can improve depending on the cause of injury.
Motor Exam – An important part of neurological examinations is the motor exam, a form of examination indicating patient ability to control voluntary motor movement. Coordination, power, and muscular tone are tested on both sides of the body in upper and lower extremities. The ability to flex the elbow, flex the hip, and extend the wrist are some of the tests used to determine muscle strength.
Myotome – Spinal nerve fibers and the corresponding muscle make up a myotome. Myotomes are necessary for proper motor functioning; making it possible to bend the knee, straighten the elbow, flex fingers, and manipulate other muscle groups. Myotome charts and motor exams are useful for determining if myotome functioning is impaired.
Neurological Examination – Through physical exams, physicians can classify the type of spinal cord injury, its severity, and determine neurological level. A neurological examination has several parts. A mental exam is usually done first to test a patient’s alertness, awareness of surroundings, memory, and ability to articulate. Cranial nerve testing will be done to monitor ability to hear, see, smell, and feel facial stimuli. Reflex, motor, sensory, and walking functions are also accessed.
Neurological Level of Injury – Depending on the type of spinal injury suffered, the ability to feel sensations and move can be different on the left and right side of the body. A single level is determined by figuring out where motor and sensory levels are equal. In cases where this is not possible, the sensory and motor levels are recorded independently. Neurological levels range from 0 to 5; at 0 normal muscle movement is present while a patient at 5 shows no muscle movement.
Paraplegia – A type of paralysis which may be complete or incomplete. Both legs, the trunk and feet may be paralyzed but the arms and upper body are not usually affected. Symptoms may vary but some bladder control issues and sexual dysfunctions are likely. Some paraplegics may be able to walk with assistance devices and drive with the aid of specially equipped vehicles.
Sensory Exam – A sensory exam is the part of the neurological exam focusing on the ability to perceive sensation. The exam may check the patients’ ability to perceive pain, pressure, and temperature. The patient’s eyes are closed during the exam to avoid subjective answers and reactions are tested on both sides of the body. A toothpick can be used to perceive pain, a vibration tuning fork to perceive vibration, and a cotton tip swab to test ability to feel a light touch.
Sensory Level and Motor Level – Sensory and motor nerve coordination are essential to coordination, balance, and gait. Sensory and motor level testing provides results helpful to determine neurological level. To determine sensory level, 28 sensory points on dermatomes are examined with light touch or pin prick. For determining motor level, 10 muscles within myotomes are tested.
Tetraplegia – A type of spinal cord injury more commonly called quadriplegia. In tetraplegia, loss of functioning in both arms and legs, the neck, trunk, head, neck, shoulders, or upper chest can occur. Depending on the severity of the injury, breathing help may be needed with the use of a ventilator. Patients may also require wheelchairs, assistance with bathing, and help to relieve the bowels and bladder.
Zone of Partial Preservation – A standard only applying to injuries with an A grade on the ASIA impairment scale. Patients with this classification retain some spinal cord functioning, either motor or sensory based. The functioning is always below the neurological level of injury occurrence.
Spinal Cord Injury Resources
- A Family & Survivor’s Guide to Spinal Cord Injury: Detailed guide explaining spinal cord injuries, the team approach to patient care, and support for handling the emotional aspects of spinal injuries.
- American Academy of Orthopedic Surgeons: Find out about the causes of spine and neck injuries and gain insight into prevention techniques and treatment options.
- Christopher & Dana Reeve Spinal Cord Injury and Paralysis Foundation: Useful information about spinal cord injuries is provided to families, caregivers, and military veterans through fact sheets, articles, and videos.
- National Spinal Cord Injury Association (NSCIA): The nation’s largest and most active organization for those living with spinal cord injuries. NSCIA provides education, updated medical news, and peer support for the spinal cord injury community.
- Paralyzed Veterans of America: Spinal cord injuries and paralysis can occur from car accidents, sports trauma, or falls at work. Find out exactly how the body responds when the spinal cord is injured.
- Spinal Cord Central: Locate physicians, read up on spinal cord disorders, learn about rehabilitation, and look for service animals.
- Spinal Cord Tumor Association Inc. – Get answers to common concerns faced when dealing with spinal cord tumors. Patient stories are also provided.
- The Miami Project to Cure Paralysis: For the best care of spinal cord injuries, patients need to remain informed. Statistics, common questions, clinical trials, and assisted living resources can get you started.