Spinal Cord Injuries

Dr. Wajeeha Mahmood

BSPT, PPDPT
 Incidence and Prevalence
• The incidence is estimated to be
approximately 40 cases per million in the
United States, roughly 12,000 new cases per
year.
 Cause of Injury
• Trauma is the primary cause of spinal cord injury,
accounting for at least 93% of all SCI. Since 2000,
motor vehicle crashes (MVCs) account for 42% of SCI,
falls 27.1%, violence 15.3%, and sports injuries 7.4%.
The remaining 8.1% are other and unknown causes.
• In those under age 20, violence and sports injuries
are more common than falls. The sports most
commonly associated with SCI are American football,
ice hockey, wrestling, diving, skiing, snowboarding,
rugby, and cheerleading
 CLASSIFICATION OF SPINAL
CORD INJURY
• Level of Injury-ASIA Impairment Scale
• The most common method of classifying
impairment from SCI is the American Spinal Injury
Association (ASIA) impairment scale.
• A strength grade of 3 is considered normal for a
muscle group if the level above has grade 5
strength.
• This implies that the grade 3 muscle group is only
partially innervated and the more proximal
innervation level is intact.
• Sensory examination is performed using pinprick and light touch at key
points, and grades as 0 for absent, 1 for impaired, and 2 for normal.
These results are summed as well for total light touch and pinprick
scores. Again, a rectal exam is necessary to assess anal sensation, also
scored yes/no.
• The ASIA neurologic level is the most caudal segment with intact motor
and sensory exam. In addition to the level is whether the injury is
complete or incomplete.
• With a complete injury, there is no motor or sensory function in the
lowest sacral segment (ie, no anal sensation or voluntary anal
contraction). A complete injury is classified as ASIA-A. Incomplete
injuries are classified as B–E. While an “E” is described as normal
sensory and motor function, this is in the context of a previously
abnormal examination.
• Paraplegia affects the lower extremities and, to
varying degrees, the trunk. It does not affect the
upper extremities; thus, T2 must be normal and
any deficits are below that sensory and motor
level. The preferred term from ASIA for
involvement of all four extremities is tetraplegia,
though quadriplegia is much more commonly
used. Any injury that affects motor and/or
sensation at or above the T2 level is tetraplegia.
 Central Cord Syndrome
• This is damage to the central area of the spinal cord. This
most commonly happens in the cervical region. Disruption of
decussating spinothalamic fibers at the site of the lesion
results in impaired pain and temperature sensation at those
dermatomes. Dermatomes above and below the lesion may
have normal sensation. As a lesion enlarges, damage may
extend into the anterior horn cells and medial corticospinal
tracts, causing weakness. Reflexes may be lost at the level of
the lesion as well, with possible hyperreflexia at lower levels.
As this is primarily a cervical syndrome, there are typically
motor and sensory changes in the arms, with sparing of the
legs, bowel, and bladder function.