Primary Classification Systems

Complete vs. Incomplete Spinal Cord Injuries

Medical professionals divide spinal cord injuries into two primary categories based on the extent of nerve damage:

Complete Spinal Cord Injuries

Complete injuries occur when the spinal cord sustains damage that prevents nerve signals from traveling between the brain and body below the injury site. These injuries typically result in total loss of voluntary movement and sensation below the point of damage. Complete injuries often lead to either paraplegia or quadriplegia/tetraplegia, depending on the location along the spine where the injury occurred.

While complete injuries represent the most severe category, some individuals may experience limited recovery of motor function over time through intensive therapy and medical intervention.

Incomplete Spinal Cord Injuries

Incomplete injuries involve partial preservation of nerve pathways, allowing some communication between the brain and body below the injury site. These injuries typically result in partial loss of movement and sensation, though the extent varies significantly between individuals.

Individuals with incomplete injuries may retain certain functions and, with proper medical treatment and rehabilitation, may experience substantial recovery. Medical professionals evaluate incomplete injuries by testing patients’ ability to generate force against resistance or lift limbs against gravity.

Incomplete Spinal Cord Injury Syndromes

Medical professionals recognize several distinct patterns of incomplete spinal cord injury, each with characteristic symptoms and recovery patterns:

Central Cord Syndrome

Central cord syndrome represents the most common type of incomplete spinal cord injury. Damage occurs in the center portion of the spinal cord, typically resulting in greater impairment in the upper extremities compared to the lower body. This pattern often develops from hyperextension injuries and generally carries a better prognosis for walking recovery.

Brown-Séquard Syndrome

This relatively rare condition (affecting 2-4% of spinal cord injuries) involves damage limited to one side of the spinal cord. Individuals experience loss of motor function on the same side as the injury while losing pain and temperature sensation on the opposite side of the body. Brown-Séquard syndrome often results from penetrating trauma such as knife or gunshot wounds.

Anterior Cord Syndrome

Anterior cord syndrome involves damage to the front portion of the spinal cord, commonly associated with loss of motor function, pain sensation, and temperature sensation below the injury location. Individuals typically retain touch and position awareness. This syndrome generally carries a poor prognosis for motor function recovery.

Posterior Cord Syndrome

Posterior cord syndrome represents the rarest type of incomplete spinal cord injury. Damage affects the back portion of the spinal cord, characterized by difficulty with movement coordination while general motor function remains intact. Individuals typically retain pain and temperature sensation but may lose fine touch, vibration, and position sense.

ASIA Impairment Scale

The American Spinal Cord Injury Association uses a standardized letter grading system (A through E) to classify the severity of spinal cord injuries:

• Grade A – Complete: No motor or sensory function preserved, including no function in the sacral segments S4-S5
• Grade B – Sensory Incomplete: Sensory function preserved below the neurological level, including sacral segments S4-S5, but no motor function
• Grade C – Motor Incomplete: Motor function preserved below the neurological level, with more than half of key muscle groups below the injury level grading less than 3/5 strength
• Grade D – Motor Incomplete: Motor function preserved below the neurological level, with at least half of key muscle groups below the injury level grading 3/5 strength or better
• Grade E – Normal: Normal sensory and motor function (may indicate recovery from previous deficits)

Anatomical Classification by Spinal Region

Spinal Cord Anatomy and Function

The spine consists of vertebrae interconnected with nerves that control different bodily functions. Medical professionals use an alphanumerical system to classify specific vertebrae and the muscle functions they control:

• Cervical Region (C1-C8): Controls neck, shoulders, arms, hands, and diaphragm
• Thoracic Region (T1-T12): Controls chest, abdominal muscles, and back
• Lumbar Region (L1-L5): Controls hips, legs, and some pelvic functions
• Sacral Region (S1-S5): Controls bowel, bladder, and sexual function

Injuries to higher levels of the spinal cord typically affect more body systems. Cervical spine injuries (C1-C7) can be the most severe, as injuries to C4 or above may result in quadriplegia and loss of motor function in both arms and legs. Injuries at the C1 or C2 level can cause life-threatening breathing difficulties.

Functional Classifications

Tetraplegia/Quadriplegia

These terms describe impairment affecting the arms, trunk, legs, and pelvic organs. This condition results from cervical spinal cord lesions and can be either complete or incomplete. Individuals may require extensive assistance with daily activities and mobility.

Paraplegia

Paraplegia involves impairment of the trunk, legs, and pelvic organs while arm function remains normal. This condition results from thoracic, lumbar, or sacral spinal cord lesions. Individuals often retain upper body strength and may achieve significant independence with proper equipment and training.

Secondary Complications of Spinal Cord Damage

Spinal cord injuries extend beyond paralysis and can cause numerous secondary health complications that affect quality of life and increase care costs:

Autonomic Dysreflexia

This potentially life-threatening condition occurs when the body below the injury level experiences pain but cannot communicate this information to the brain. Blood vessels constrict reflexively, causing dangerous blood pressure spikes. Without proper management, autonomic dysreflexia can lead to stroke, seizure, or death.

Bowel and Bladder Dysfunction

Nerves in the sacral spine regulate bowel and bladder function. Most spinal cord injuries affect these nerves, potentially resulting in flaccid bladder (sluggish function) or spastic bladder (constant emptying). Additional complications may include hemorrhoids, constipation, rectal bleeding, and impaction. Management requires careful regulation through medication, diet, and routine. Severe cases may require surgical intervention.

Deep Vein Thrombosis

Individuals with paralysis face increased risk for blood clots in critical veins and arteries due to immobility, altered blood pressure, and tissue trauma. Warning signs include swollen limbs, skin changes, and discomfort. Treatment may involve medication, compression stockings, or surgery. Untreated deep vein thrombosis significantly increases risks of stroke, heart attack, and pulmonary embolism.

Osteoporosis

Reduced activity and exercise cause bone weakening as bones lose calcium and phosphorus, making them unable to bear weight effectively. Most individuals with paralysis from spinal cord injuries develop osteoporosis. While this condition cannot be reversed, medication and specialized physical therapy can help maintain bone health.

Pressure Sores

These sores develop from excessive pressure on the back and lower body. Spinal cord injuries alter blood supply patterns, and without proper care, skin loses elasticity and muscle tone. The body becomes unable to withstand sitting or lying pressure. Since spinal cord damage disrupts the brain’s signals to shift position, conditions may worsen. Skin can deteriorate, become infected, and develop open wounds. Prevention involves special pressure-reducing equipment, medication, and physical therapy.

Respiratory Complications

Spinal cord injuries in the cervical vertebrae (C4 or higher) often cause respiratory problems. Nerve pairs in these segments control respiratory muscles including the neck, abdomen, diaphragm, and intercostal muscles. Severe cases may require ventilator assistance. Additional complications can include pneumonia, lung collapse, blood clots in the lungs, circulatory diseases, and sleep apnea.

Spasticity

Spasticity commonly occurs after paralyzing spinal cord injuries. The spinal cord normally regulates automatic body functions like reflexes. After injury, reflex signals become blocked, but the body continues receiving stimulation to contract muscles. Without brain regulation, these contractions become exaggerated spasms. Spasms can occur without warning and worsen with skin conditions or infections. Management includes regular physical therapy and medications.

Sexual Function Changes

Spinal cord injuries can affect sexual function in both men and women. While women typically experience no fertility changes, both genders may face psychological challenges including anxiety and depression. Support groups, medical treatment, and prescription medications can help address both physical and mental aspects. The brain normally sends arousal signals through the spinal cord to reproductive organs. Spinal cord damage can interrupt these signals, potentially causing erectile dysfunction in men. Men seeking to father children may require fertility treatments.

Legal Resources and Support

Understanding the complex medical aspects of spinal cord injuries is crucial for pursuing appropriate legal compensation. Each type of injury presents unique challenges that require thorough documentation and expert medical testimony.

Your initial consultation with The Ammons Law Firm is free. Call us at (281) 801-5617 to get started.