Spinal Cord Injury (SCI)

Authors
Affiliations

Nate Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

Resources

Level of injury

Level of injury can be defined using two different anatomical methods:

  1. Vertebral column level
  2. Spinal cord level

Vertebral column

The level of injury could communicated relative to the vertebral column. For example one could say a spinal cord injury at T12 vertebral body.

Spinal cord level

Completeness

Completeness of the spinal cord injury refers to how much of the the spinal cord was damaged in the injury. For example, a “complete” spinal cord injury would injury the entire cross-section and no sensation would be able to come up the spinal cord and no motor would be able to be sent inferior of this section.

Functional Categories

Spinal cord injuries can be divided into two functional categories: tetraplegia and paraplegia

Tetraplegia

  • Motor and/or sensory impairment of all four extremities and trunk
    • Including the respiratory muscles
  • Results from lesions of the cervical cord

Paraplegia

  • Motor and/or sensory impairment of all or part of the trunk and both lower extremities (LEs)
  • Results from lesions of the thoracic or lumbar spinal cord or cauda equina

Anatomy

Spinal Cord Cross section2

Spinal Cord Cross section

Read more about the Anatomy and function of the spinal cord.

Determining Lesion Level and Severity

It is important for clinicians to be able to determine lesion level and completeness in order to establish prognosis. The standardized method to assess this is the ISNCSCI.

Clinical Syndromes

  • Clinical syndromes refer to common patterns in SCI presentations.
  • ~15 of clinical presentations follow clinical SCI syndromes.
Clinical Significance

Clinicians should use clinical syndromes to anticipate sensory and motor functions, which they can use for goal-setting, predicting outcomes, and guiding the plan of care (POC).

Brown-Sequard Syndrome

Anterior Cord Syndrome

Central Cord Syndrome

  • The most common SCI syndrome
  • C/S Hyperextension injury

Cardiovascular complications

Disruptions of cardiovascular control following spinal cord injury are directly related to the level and degree of the injury

Timing

Acute

“Immediately after a spinal cord injury, there is in almost all patients a sudden loss of the autonomic effect of the smooth muscle in the walls of the blood vessels, and as a result vasodilation occurs. The acute loss of sympathetic stimulation results in bradycardia. During the acute phase, the arterial hypotension (neurogenic shock) may be misinterpreted as loss of volume.”

Peripheral Nerves

Vagus Nerve

  • The vagus nerve is hypersensitive immediately after an injury.
  • This normally lasts for 2–3 weeks, but can last longer.
  • Treatment
    • Implantation of a temporary or permanent pacemaker is required.
    • Atropine should be available
  • Precautions:
    • During this period, it is important to avoid activating the n. vagus to avoid reinforcing the vagal reflexes.
    • Avoid Hyperventilation (Hypoxia increases vagal activity)
    • All forms of tube in the nose/mouth and throat may cause bradycardia and increased vagal reflexes.
  • This can be a life-long problem in patients with high, complete injuries, whereas in patients with lower and/or incomplete injuries the situation may normalise after 4–5 weeks

Complete Cervical

“complete cervical injury, the connection between the upper autonomic centres in the brain and the intermediolateral cell column at level T1–L2 of the spinal cord will be destroyed. Patients with cervical injuries have a higher risk of bradycardia (29 %), sudden unprovoked cardiac arrest (16 %) and conduction system disturbances, particularly in the first few weeks after the injury (5). Sudden death is not unusual either.”

Injuries by Segments

Muscle groups associated with spinal segments
Level Muscle Group
C5 Elbow flexors
C6 Wrist extensors
C7 Elbow Extensors
C8 Finger Flexors
T1 5th Finger Abductors
L2 Hip flexors
L3 Knee extensors
L4 Ankle Dorsiflexors
L5 Long Toe Extensors
S1 Ankle plantarflexors
Segmental level Transfers Wheelchair
C1-4 Mechanical lift Power WC with head/chin/mouth control
C5 Dependint sliding board transfer Manual WC with Plastic coated hand rims
C6 Independent sliding board transfer Manual WC with Plastic coated hand rims
C7/8 Even: Independent without sliding board
Uneven: Dependent on sliding board
C8: May be able to perform Floor→WC 		Manual WC with Plastic coated hand rims
C7: Independent on even surfaces but not independent on ramps, curbs
T1 Floor to Wheelchair Independent
T4 Sitting pivot Independent
L3 Standing pivot Independent

Clinical Presentation

Pain

Note
  • Bonica’s Managmenet of Pain ch40: Pain Following Spinal Cord Injury
  • Welzack Chapter 68 Pain Following Spinal Cord Injury

Intervention

Stem Cells

  • Paul video:
    • one guy said that it significantly worsened pain and spasticity
  • See “Systematic Review of Cell Therapy Efficacy in Human Chronic Spinal Cord Injury”

Virtual Reality

Examination

Participation

QOL:

  • Sickness Impact Profile 68 (SIP-68)

References

1.
Fulk GD, Chui KK, eds. O’Sullivan and Schmitz’s Physical Rehabilitation. 8th ed. F. A. Davis Company; 2024.
2.
O’Sullivan SB, Schmitz TJ, Fulk GD, eds. Physical Rehabilitation. 7th ed. F.A. Davis Company; 2019.
3.
Hagen EM, Rekand T, Grønning M, Færestrand S. Cardiovascular complications of spinal cord injury. Tidsskrift for Den Norske Laegeforening: Tidsskrift for Praktisk Medicin, Ny Raekke. 2012;132(9):1115-1120. doi:10.4045/tidsskr.11.0551
4.
Ballantyne J, Fishman S, Rathmell JP, eds. Bonica’s Management of Pain. 5th ed. Wolters Kluwer; 2019.
5.
McMahon SB, ed. Wall and Melzack’s Textbook of Pain. 6th ed. Elsevier/Saunders; 2013.
6.
Abolghasemi R, Davoudi-Monfared E, Allahyari F, Farzanegan G. Systematic Review of Cell Therapy Efficacy in Human Chronic Spinal Cord Injury. Tissue Engineering Part B, Reviews. Published online December 2023. doi:10.1089/ten.TEB.2023.0130

Citation

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