Patterns of spinal cord injury

Sections of the spinal cord

The cervical spinal cord:This is the topmost portion of the spinal

cord, where the brain connects to the spinal cord. This region
consists of seven vertebrae, commonly referred to as C1-C7. All
spinal cord numbers are descending, so C1 is the highest vertebra,
while C7 is the lowest in this region.
The thoracic spinal cord:This section forms the middle of the
spinal cord, containing twelve vertebrae numbered T1-T12.
The lumbar spinal cord: This is the region of the spinal cord below
the thoracic section it contains five lumbar vertebrae, numbered
L1-L5.
Sections of the spinal cord continued

The sacral spine:This is the lower, triangle-shaped region

of the spine which also contain five vertebrae, numbered
S1-S5. While the lumbar cord bends inward, the vertebrae
of the sacral region bend slightly outward. As the spinal
cord ends at L2 there is actually no spinal cord in this
section, it is made up of nerve roots which exit the spine
at their respective vertebral levels.
The coccygeal region, sometimes known as the coccyx or
tail bone, consists of a single vertebra at the very base of
the spinal cord.
Types of spinal cord injuries

Incomplete spinal cord injuries: With incomplete injuries, the

spinal cord is compressed or injured, but the brain's ability to send
signals below the site of the injury is not completely removed thus,
allowing the injured person to retain some function. In these cases,
the degree of function depends on the extent of the injuries.
Complete spinal cord injuries: Complete injuries occur when the
spinal cord is fully severed or compressed, completely eliminating
the brain's ability to send signals below the point of injury thus
eliminating function. Though, with treatment and physical therapy,
it may be possible to regain some function.
Identifying an incomplete spinal cord
injury
When trying to distinguish between a complete and incomplete spinal cord
injury shortly after the accident has occurred it is important to note that, the
symptoms of a complete and incomplete spinal cord injury are virtually
indistinguishable. Over time, though, small differences may begin to emerge.
With an incomplete spinal cord injury, the spinal cord's functions are only
partially compromised. Thus effects of an incomplete spinal cord injury, as a
result, vary more widely, with the degree of function dependent on the
extent and location of injury. For example, someone with an incomplete
spinal cord injury due to an infection may retain significant function, but a
gunshot wound survivors whose injury is high on the spine but incomplete may
face obstacles similar to those faced by a complete spinal cord injury
survivor.
Identifying an incomplete spinal cord
injury
Some characteristics of an incomplete spinal cord injury may include:
Retaining some sensation below the site of the injury. The feelings may come
and go, and may be much weaker than the sensations normally experienced.
Being able to move some muscles below the site of the injury. The extent of
movement may vary, and there maybe good control over some muscles, but
no control over others.
Pain below the injury; many incomplete spinal cord injury survivors report
issues with chronic pain.
 Identifying an incomplete spinal cord
injury
Some of the most common types of incomplete or partial spinal cord injuries include:
Brown-Sequard syndrome: This injury is the product of damage to one side of the spinal
cord. The injury may be more pronounced on one side of the body; and the degree to
which Brown-Sequard patients are injured greatly varies from patient to patient. Due to
some fibers crossing within the cord whilst others cross in the brainstem, the neurology is
bilateral:
Ipsilaterally:
Damage to ascending dorsal columns result in ipsilateral loss of proprioception, touch,
and vibration sense
Damage to descending lateral corticospinal tracts result in ipsilateral spastic paralysis
Contralaterally:
Damage to ascending lateral spinothalamic tract (which cross 1-2 levels above the level of
their respective dorsal root) result in contralateral loss of pain and temperature sensation
Identifying an incomplete spinal cord
injury
Central cord syndrome: This injury is a result of damage to the center of the
cord, and damages nerves that carry signals from the brain to the spinal cord.
This is the most common type of incompletespinal cord injury, accounting for
~10% of all spinal cord injuries. Patients present with upper limb weakness,
urinary retention (due to bladder dysfunction) and sensory loss below the
level of the injury. The upper extremities are classically more affected than
the lower extremities, with motor function more severely impaired than
sensory function.
Cauda equina syndrome: This kind of injury refers to a characteristic
pattern of neuromuscular and urogenital symptoms resulting from the
simultaneous compression of multiple lumbosacral nerve roots below the
level of the conus medullaris. These symptoms include low back pain, bladder
and bowel dysfunction, and variable lower extremity motor and sensory loss.
Identifying an incomplete spinal cord
injury
Anterior cord syndrome (also known as Beck's syndrome or anterior spinal artery
syndrome): is a clinical subset of spinal cord injury syndromes, due to
ischaemia/infarction of the anterior two-thirds of the spinal cord, typically
sparing posterior third.
Patient present with following features:
complete motor paralysis below the level of the lesion due to involvement
ofcorticospinal tracts
loss of pain and temperature at and below the level of injury due to
involvement oflateral spinothalamic tract
intact 2-point discrimination, proprioception and vibratory senses due to
intactposterior column
Identifying a complete spinal cord injury

A complete spinal cord injury removes the brain's ability to send signals down the
spinal cord below the site of the injury. Thus, for example a complete spinal cord
injury in thelumbar spinal cordmight lead to paralysis below the waist though
movement in your arms and upper body is preserved.
Some characteristics of an complete spinal cord injury may include:
Loss of sensation below the site of the injury.
Complete loss of motion below the site of the injury.
Difficulty controlling bladder and bowels.
If the injury is high enough in your spinal cord, difficulty breathing may occur.
Classifications of spinal cord injuries

Tetraplegia: These injuries, which are commonly as a result of damage to T1 or

above, are typically the most severe, producing varying degrees of paralysis of
all limbs. Sometimes known asquadriplegia, tetraplegiaeliminates your ability
to move below the site of the injury, and may produce difficulties with bladder
and bowel control, respiration, and other routine functions. The higher up on
the cervical spinal cord the injury is, the more severe symptoms will likely be.
Paraplegia: This occurs when sensation and movement are removed from the
lower half of the body, including the legs. These injuries are the product of
damage to the thoracic spinal cord. In most cases, arms and hands are not
affected. With these types of injuries most patients initially wear a brace on
the trunk to provide extra stability and help build up core muscles.
Triplegia: Triplegia causes loss of sensation and movement in one arm and both
legs, and is typically the product of an incomplete spinal cord injury.
Ways in which spinal cord injury can
occur
There are many causes of Spinal Cord Injury. The more common injuries happen
when the area of the spine or neck is bent or compressed, as in the following:
Birth injuries, which usually affect the spinal cord in the neck area
Falls
Motor vehicle accidents. These can be either whena person is riding as a
passenger in the car or is struck as a pedestrian.
Sports injuries
Diving accidents
Trampoline accidents
Violence. This involves penetrating injuries that pierce the cord, such as
gunshots and stab wounds.