Males account for 80% of new spinal cord injuries. Motor vehicle accidents and falls account for two thirds of these injuries. The American Spinal Injury Association (ASIA) developed the ASIA Impairment Scale (AIS):
Grade A: Complete--no sensory or motor function is preserved in the S4-5 segments
Grade B: Incomplete--sensory but not motor function is preserved below the neurological level and includes presence of sensory function at S4-5
Grade C: Incomplete--motor function is preserved below the neurological level, and more than half of key muscles below the neurological level had a grade of strength below 3 out of 5.
Grade D: Incomplete--motor function is preserved below the neurological level, and more than half of key muscles below the neurological level have a juscle grade greater or equal to 3 out of 5.
Grade E: Normal--sensory and motor functions are normal.
Motor grades for testing are: 0--complete paralysis, 1--flicker of contraction present, grade 2--active movement with gravity eliminated, grade 3--active movement against gravity, grade 4--active movement against gravity and some resistance, grade 5--normal power.
Incomplete spinal cord syndromes include:
Central cord syndrome: swelling or a syrinx, with relative weakness in upper extremities, loss of temperature, and pin prick sensation 1-2 level below the level of injury , and urinary retention
Brown-Sequard syndrome: hemisection of the spinal cord resulting in ipsilateral weakness below the lesion, and contralateral sensory loss 1-2 level below the lesion level
Conus medullaris syndrome: bowel and bladder dyscontrol, sexual dysfunction, and paraparesis
Cauda equina syndrome: loss of function to lumbar plexus below conus medullaris (lower motor neuron lesion), with sensory impairment in saddle distribution, back pain, lower extremity weakness, bowel, bladder and sexual dysfunction
Function by Neurological Level of Injury
All levels: sexual functions are impaired
C1-4: breathing is compromised and physically dependent for all functions
C5: motorized wheelchair ambulation and nearly full eating skills are possible
C6: independence in eating, sitting and driving, but physical assistance is needed
C7-T12: independent ambulation is by wheelchair and most become completely independent
L1-4: bipedal ambulation can become independent for short distances, and wheelchairs are used
L5-S2: complete independence in bipedal ambulation with assistance of 2 canes/crutches/or short leg braces (AFOs). No wheelchair is necessary.
S2-4: Only bowel/bladder function is impaired initially, but could improve
Common complications include:
Cardiovascular (T6 and higher): orthostatic hypotension and autonomic dysreflexia
Respiratory (T12 and higher): ventilator dependent C3 and above, pulmonary embolism, atelectasis, pneumonia, inspiratory/expiratory function impaired
Gastrointestinal: GI bleeds, paralytic ileus, choelilithiasis, hemorrhoids and rectal fissures, constipation and impaction of fecal matter
Genitourinary: bladder distention, urinary tract infections, urinary incontinence
Skin: decubitus ulcers
Musculoskeletal: myositis ossificans, poikilothermia, osteoporosis, spasticity, contractures
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