Incomplete Spinal Cord Injuries

Contents

Diagnosis of Incomplete Spinal Cord Injuries

In order to diagnose someone with an incomplete spinal cord injury, a thorough neurological examination must be performed upon admission to the hospital and re-evaluated on an on-going basis months after spinal shock and inflammation of the spinal cord has subsided.

Incomplete spinal cord injuries can present themselves in a multitude of ways. It only takes several nerve fibres within the spinal cord to be preserved to carry messages to or from the brain for someone to be classified with an incomplete spinal cord injury resulting in incomplete paraplegia or incomplete tetraplegia (quadriplegia).

If after an initial neurological examination of an individual 24 hours after the spinal cord injury the diagnosis is determined to be incomplete with preservation of motor or sensory function, the chances of recovery are greatly increased. Incomplete spinal cord injuries can present themselves generally in three ways:

  • The damage to the spinal cord can be so mild that the muscle weakness or sensory impairment can be hardly noticeable.
  • The damage to the spinal cord can be so severe that the muscle or sensory weakness or loss can resemble that of a complete injury.
  • The symptom of the incomplete spinal cord injury can be somewhere between the two above examples.

Incomplete Spinal Cord Injury Classification

Incomplete spinal cord injuries are classified using the American Spinal Association (ASIA) Impairment scale. The examination to determine the ASIA classification is based on touch and pinprick sensations, tested at key dermatome levels. Motor (muscle) function is also tested at key points on each side of the body. The resultant evaluation is categorised into five different classifications of spinal cord injury.

  • A indicates a "complete" spinal cord injury where no motor or sensory function is preserved in the sacral segments S4-S5.
  • B indicates an "incomplete" spinal cord injury where sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5. This is typically a transient phase and if the person recovers any motor function below the neurological level, that person essentially becomes a motor incomplete, i.e. ASIA C or D.
  • C indicates an "incomplete" spinal cord injury where motor function is preserved below the neurological level and more than half of key muscles below the neurological level have a muscle grade of less than 3, which indicates active movement with full range of motion against gravity.
  • D indicates an "incomplete" spinal cord injury where motor function is preserved below the neurological level and at least half of the key muscles below the neurological level have a muscle grade of 3 or more.
  • E indicates "normal" where motor and sensory scores are normal. Note that it is possible to have spinal cord injury and neurological deficits with completely normal motor and sensory scores.

Incomplete Spinal Cord Injury Statistics Upon Discharge From Hospital

At the time of discharge neurologically incomplete tetraplegia ranked first for level of injury at time of discharge (30.9%), followed by neurologically complete paraplegia (25.1%),neurologically complete tetraplegia (19.8%), and neurologically incomplete paraplegia (18.6%). Source: 2011 NSCISC Annual Statistical Report. The degree of incompleteness is unique from person to person, and may or may not be an indicator to full recovery from a spinal cord injury.

Types of Incomplete Spinal Cord Injury

The symptoms of incomplete spinal cord lesions depend upon the area of the spinal cord (front, back, side, etc) damaged. The part of the cord affected depends on the direction and power of the forces involved during the initial injury.

There are four types of incomplete spinal cord injury:

It is not uncommon for a spinal cord injury to result in a combination of the above injury types which result in incomplete paraplegia or incomplete tetraplegia.
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