Understanding Spinal Cord Injury



Levels of Injury: 

Vertebrae are grouped into sections. The higher the injury on the spinal cord, the more dysfunction can occur. High-Cervical Nerves (C1 – C4)

  • Most severe of the spinal cord injury levels
  • Paralysis in arms, hands, trunk and legs
  • Patient may not be able to breathe on his or her own, cough, or control bowel or bladder movements.
  • Ability to speak is sometimes impaired or reduced.
  • When all four limbs are affected, this is called tetraplegia or quadriplegia.
  • Requires complete assistance with activities of daily living, such as eating, dressing, bathing, and getting in or out of bed
  • May be able to use powered wheelchairs with special controls to move around on their own
  • Will not be able to drive a car on their own
  • Requires 24-hour-a-day personal care

Low-Cervical Nerves (C5 – C8)

  • Corresponding nerves control arms and hands.
  • A person with this level of injury may be able to breathe on their own and speak normally.

C5 injury 

  • Person can raise his or her arms and bend elbows.
  • Likely to have some or total paralysis of wrists, hands, trunk and legs
  • Can speak and use diaphragm, but breathing will be weakened
  • Will need assistance with most activities of daily living, but once in a power wheelchair, can move from one place to another independently

C6 injury 

  • Nerves affect wrist extension.
  • Paralysis in hands, trunk and legs, typically.
  • Should be able to bend wrists back.
  • Can speak and use diaphragm, but breathing will be weakened
  • Can move in and out of wheelchair and bed with assistive equipment.
  • May also be able to drive an adapted vehicle.
  • Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment .

C7 injury 

  • Nerves control elbow extension and some finger extension.
  • Most can straighten their arm and have normal movement of their shoulders.
  • Can do most activities of daily living by themselves, but may need assistance with more difficult tasks.
  • May also be able to drive an adapted vehicle.
  • Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment.

C8 injury 

  • Nerves control some hand movement.
  • Should be able to grasp and release objects.
  • Can do most activities of daily living by themselves, but may need assistance with more difficult task.
  • May also be able to drive an adapted vehicle.
  • Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment Thoracic vertebrae are located in the mid-back.

Thoracic Nerves (T1 – T5) 

  • Corresponding nerves affect muscles, upper chest, mid-back and abdominal muscles.
  • Arm and hand function is usually normal.
  • Injuries usually affect the trunk and legs(also known as paraplegia).
  • Most likely use a manual wheelchair.
  • Can learn to drive a modified car.
  • Can stand in a standing frame, while others may walk with braces.

Thoracic Nerves (T6 – T12)

  • Nerves affect muscles of the trunk (abdominal and back muscles) depending on the level of injury.
  • Usually results in paraplegia.
  • Normal upper-body movement .
  • Fair to good ability to control and balance trunk while in the seated position.
  • Should be able to cough productively (if abdominal muscles are intact)
  • Little or no voluntary control of bowel or bladder but can manage on their own with special equipment .
  • Most likely use a manual wheelchair.
  • Can learn to drive a modified .
  • Some can stand in a standing frame, while others may walk with braces.

Lumbar Nerves (L1 – L5)

  • Injuries generally result in some loss of function in the hips and legs.
  • Little or no voluntary control of bowel or bladder, but can manage on their own with special equipment.
  • Depending on strength in the legs, may need a wheelchair and may also walk with braces.

Sacral Nerves (S1 – S5)

  • Injuries generally result in some loss of function in the hips and legs.
  • Little or no voluntary control of bowel or bladder, but can manage on their own with special equipment .
  • Most likely will be able to walk.

Spinal Column Anatomy: The Basics 

When a spinal cord injury occurs, sensation and movement may be interrupted, resulting in a temporary or permanent loss of function, paralysis and loss of sensation. Here are some basic anatomy facts:

  • The brain is surrounded by the skull.
  • The spinal cord is surrounded by rings of bone called vertebrae.
  • Both are covered by a protective membrane.
  • Together, the vertebrae and the membrane make up the spinal column, or backbone.
  • The backbone, which protects the spinal cord, starts at the base of the skull and ends just above the hips.
  • The spinal cord is about 18 inches long. It extends from the base of the brain, down the middle of the back, to just below the last rib in the waist area.
  • The main job of the spinal cord is to be the communication system between the brain and the body by carrying messages that allow people to move and feel sensation.
  • Spinal nerve cells, called neurons, carry messages to and from the spinal cord, via spinal nerves.
  • Messages carried by the spinal nerves leave the spinal cord through openings in the vertebrae.
  • Spinal nerve roots branch off the spinal cord in pairs, one going to each side of the body.
  • Every nerve has a special job for movement and feeling. They tell the muscles in the arms, hands, fingers, legs, toes, chest and other parts of the body how and when to move. They also carry messages back to the brain about sensations, such as pain, temperature and touch.

All of this information is courtesy of the Shepherd Center in Atlanta, GA.