Incomplete Spinal Cord Injuries

Spine In the blog, there is a lot of discussion about paralysis for individuals with brain or spinal cord injury, and neurological diseases. Today, I am going to highlight a particular type of spinal cord issue which is incomplete injury. It is important to note that incomplete spinal cord injury can occur from trauma or disease. It occurs when there is an injury to the spinal cord that affects only part of it. This can be from trauma but also from patchy areas of the spinal cord affected by areas of disease. Incomplete spinal cord injury can be short or long-lasting as in trauma, or it can be progressive as a disease progresses.

The study of incomplete spinal cord injury is extensive however, it can be difficult to find information specific to your incomplete injury. This is because there is so much variability in incomplete injuries. Some individuals will have minimal limitations in function with an incomplete spinal cord injury such as a patch of skin with limited sensation or a weak muscle. Others will have multiple issues similar to a complete injury. Incomplete spinal cord injury is dependent upon where the injury is and what nerves are affected. Also, especially with disease processes, the areas of the body affected may vary on each side of the body or may be a location affected here and there.

Many disease processes can affect the nervous system. These include multiple sclerosis, transverse myelitis, cancer, Friedreich Ataxia, AIDS, myelopathy, disk herniation, stroke in the spinal cord, syringomyelia, polio, ALS, spinal stenosis, and trauma, among many others.

The ASIA Scale is a measurement system that classifies spinal cord injuries so there is proper communication between healthcare professionals and changes can be assessed. It is copyrighted by the American Spinal Injury Association. Variability in incomplete injuries is reflected in the ASIA Scale, which is an assessment of spinal cord injury. A complete spinal cord injury has one classification, but incomplete spinal cord injuries have three classification categories. I have summarized the levels of injury here:

The ASIA Scale has five categories:

Grade A is a complete spinal cord injury with no motor or sensory function below the level of injury.
Grade B is an incomplete spinal cord injury with sensory function preserved below the level of injury but not motor function. There is some sensation in S4 and S5.
Grade C is an incomplete spinal cord injury with some motor function below the level of injury with half of the muscles unable to move against gravity.
Grade D is an incomplete spinal cord injury with half of the muscles below the level of injury able to move against gravity.
Grade E consists of the ability to engage and control motor and sensory functions.

The classifications of Grades B, C, and D are ratings of incomplete injuries as there is some motor or sensory function grouped by movement ability against gravity. This collects the many possibilities of incomplete injury into like groupings. Injury or disease affecting different nerve fibers instead of the entire spinal cord can be assessed collectively using the ASIA Scale.

Incomplete injuries occur when there are some messages carried through to the end of the spinal cord and out to the body. As listed in the classification system above, there can be some movement and/or sensation, but these are not completely engageable. The location of decreased sensation and/or movement varies by the location of the injury.

Some individuals have incomplete spinal cord injury that is patchy or just in one location in the spinal cord. Others have an injury to a particular anatomical section within the spinal cord. These injuries are referred to as spinal cord syndromes. This is a list of spinal cord syndromes and their effects.

Syndrome	Location in the Spinal Cord	Outcome
Anterior Cord Syndrome	The front part of the spinal cord is affected	Changes in touch, pain, and temperature. Movement can be improved with therapy.
Central Cord Syndrome	Injury is in the center of the spinal cord.	Loss of sensation and movement below the level of injury. Typically, there is more loss in the arms than in the legs which may even function as usual. Therapy can improve function.
Posterior Cord Syndrome	Injury to the back portion of the spinal cord.	Muscle function is preserved but coordination is affected. Therapy and mobility stabilization devices such as a cane, walker, or wheelchair can assist.
Brown-Sequard Syndrome	Injury to the left or right side of the spinal cord only.	Paresis or paralysis to one side or one limb of the body with sensation changes in pain and temperature to the other side of the body. Therapy with bracing and assistive devices is helpful.
Conus Medullaris Syndrome	Last part of the spinal cord.	Bladder and bowel dysfunction, numbness in the area where you would sit on a saddle (saddle anesthesia).
Cauda Equina Syndrome	Injury to the nerve roots at the end (tail) of the spinal cord.	Severe back pain, sensory loss, bowel, bladder, sexual dysfunction, and/or paralysis. Early treatment with therapy or surgery can help prevent further injury. Nerve transfer surgery may improve function.
Pure Motor Syndrome	Occurs anywhere in the spinal cord, most usually from disease.	Loss of motor function but preserved sensory function.

Early treatment for incomplete spinal cord injury can help preserve function. If the incomplete spinal cord injury is from trauma, you can quickly say something has changed and receive emergency treatment in the E.R. or even start with the EMTs in the trauma van. However, noticing changes in disease can be a bit more difficult to isolate. You may notice a small change in ability but think, ‘Oh, I am a bit stiff today,’ or ‘I slept on the wrong side.’ With disease, your symptoms can change very slowly over time. Listen to your body to be able to notice when a change has occurred. Symptoms are critical to contacting your healthcare professional to ensure your condition has not progressed and that you need treatment to avoid permanent changes.

As incomplete injuries vary, it is difficult to present treatments as this is not a one size fits all condition. Some treatments may include:

Medication such as anti-inflammatories to reduce swelling which puts more pressure on those precious nerves, steroids to reduce swelling, pain medications, or antibiotics if the issue is from infection.
Testing by CT scan or MRI may be needed to visualize the process occurring in your body.
Surgery may be needed to stabilize the area of concern or later to transfer nerves to provide function where needed. This is very individual-specific.
Therapy with a physical therapist and occupational therapist to provide strengthening, mobility, and activities of daily living adaptions. If possible, you may be able to engage other muscles to be able to improve your mobility and adapt to the needs of your daily life.
Mental health counseling can help with adjustment to your new way of functioning. Any major change in your lifestyle can affect your mental wellness. Even if you do not feel challenged at this moment, it can be good to be prepared for life changes.

The outcomes of an incomplete spinal cord injury may include the same issues as with any source of paralysis, such as respiratory concerns, autonomic dysreflexia (AD), bowel and bladder control, pressure injury to the skin, movement and mobility, sexual function, infection, numbness, tingling, edema, and general wellness. These may not be as noticeable but may be more subtle. Keeping in tune with your body is essential to your health.

Pediatric Consideration:

Children can have incomplete spinal cord injury through trauma or due to disease. Being aware of these conditions will help you notice changes in your child. Keeping your child well is a parent’s top priority.

One of the issues that can affect spinal cord function in children is the development of scoliosis. Scoliosis is an imbalance in the muscles of the back. Early intervention can assist with delaying scoliosis development, but in some conditions, it does occur. Be sure to maintain your child’s body alignment to avoid this condition, which can place additional pressure on the spinal cord.

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