Spinal Cord Injury Levels: A Complete Overview of Each Type (2023)

The level of a spinal cord injury refers to the lowest region of the spinal cord where normal motor control and sensation exist. Knowing one’s level of injury will help individuals determine what functions may be affected after an injury.

To help you understand each of the spinal cord injury levels, this article will discuss:

  • What your level of injury means
  • Anatomy of the spinal cord before injury
  • Cervical SCI
  • Thoracic SCI
  • Lumbar SCI
  • Sacral SCI
  • Coccygeal SCI

How the Level of Spinal Cord Injury Affects Movement and Sensation

The spinal cord is the neural passageway that allows for communication between the brain and body. After a spinal cord injury, that connection is disrupted, and areas below the level of injury may no longer effectively send or receive communication from the brain.

The spinal cord in particular is essential for the functions of movement and sensation. As such, common complications of spinal cord injury involve paralysis and/or changes in sensation, such as numbness.

To determine which secondary effects may occur, it is essential to understand your level of spinal cord injury.

When determining your level of injury, a physician will test your sensory and motor functions using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), also called the ASIA exam.

Each level of the spinal cord sends motor signals from the brain to different muscles throughout the body. The muscles designated to each level of the spinal cord are called myotomes.

Additionally, each level of the spinal cord receives sensory information from a different area of skin called a dermatome. This information travels through the spinal cord to the brain for processing and to allow the brain to decide how to appropriately respond.

In the next section, you’ll learn more about how different spinal cord injury levels affect different dermatomes and myotomes and, as a result, affect sensation and movement. Before we get there, let’s discuss the anatomy of the spinal column.

(Video) Spinal Cord Injury | Levels of injury

Anatomy of the Spinal Cord Before Injury

Spinal Cord Injury Levels: A Complete Overview of Each Type (1)

The spinal cord is protected by the spine, which is composed of 33 vertebrae. Spinal nerves branch out from the spinal cord and exit above or below their corresponding vertebrae.

For each spinal cord level, there is a pair of spinal nerves (31 pairs in total), with one nerve going to the left side of the body and one going to the right. Furthermore, each spinal nerve contains a sensory nerve root that sends messages from the body to the brain, and a motor nerve root that sends messages from the brain to the corresponding area of the body.

Additionally, the spinal cord is divided into 5 regions (from top to bottom):

  • Cervical
  • Thoracic
  • Lumbar
  • Sacral
  • Coccygeal

Motor signals from the brain and sensory signals from the body cannot travel past damaged regions of the spinal cord. As a result, all motor functions and sensations innervated below the level of injury may be affected, depending on the severity of the injury.

If the spinal cord was completely severed, it’s called a complete spinal cord injury; and if some connections within the spinal cord were left intact, it’s called an incomplete spinal cord injury. The higher your level of injury and the more complete the spinal cord injury, the more functions will be affected.

In the next section, we’ll go over what functions are affected at each of the spinal cord injury levels.

Cervical Level of Spinal Cord Injury

Spinal Cord Injury Levels: A Complete Overview of Each Type (2)

The cervical region of the spinal cord consists of 7 vertebrae and 8 cervical nerve roots in the neck area. Cervical spinal cord injuries are the most prevalent, making up nearly60% of all SCIs. They are also generally the most debilitating because the entire body can potentially be affected.

Completecervical spinal cord injuriesresult inquadriplegia, which describes paralysis in both the upper and lower limbs.

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Here are the functions that correspond with each specific level of cervical spinal cord injury:

  • C1 spinal cord injury– can affect most sensory and motor functions throughout the body.
  • C2 spinal cord injury– may still have some motion of the neck, while the rest of the body may be paralyzed. Sensation in the back of the head, ears, and upper area of the neck are intact.
  • C3 spinal cord injury– can affect your ability to breathe and may require a ventilator, at least initially. This is because the C3-C5 nerve roots innervate the diaphragm, which is essential for breathing. Those with a C3 SCI will be able to move and feel the majority of the neck.
  • C4 spinal cord injury– may also affect breathing. However, those with a C4 SCI are able to raise their shoulders and have sensation in the shoulders, upper back, and upper chest.
  • C5 spinal cord injury– will have intact sensation at the outer area of the upper arm and the ability to raise the arm to the side (shoulder abduction) and bend the elbows (elbow flexion). However, breathing can still be affected.
  • C6 spinal cord injury–sensation at the outer forearms down to the thumbs and part of the index fingers will be intact. Wrist extension will also be intact, allowing grasping to be possible through a technique calledtenodesis.
  • C7 spinal cord injury– increasing sensation in the hand, including intact sensation of the middle finger. Those with a C7 SCI will be able to straighten the elbows and bend the wrists.
  • C8 spinal cord injury– will be able to bend the fingers and grasp objects. Sensation and most movement in the hand will be intact at this level of injury. It’s worth noting that there is no C8 vertebrae. Thus, the C8 level of spinal cord injury refers to injury at the C8 nerve root.

Learn more about cervical spinal cord injuries »

Thoracic Level of Spinal Cord Injury

Spinal Cord Injury Levels: A Complete Overview of Each Type (3)

Below the cervical region is the thoracic region of the spinal cord. This region of the spinal cord consists of 12 levels.

Thoracic-level spinal cord injuriesprimarily affect sensation in the trunk and abdomen, as well as the muscles that make up your trunk and chest. As a result, individuals may experience difficulties with balance, posture, breathing, and coughing.Thoracic spinal cord injuries may also affect innervation of important organs, including the lungs, heart, liver, and small intestine.

Because the thoracic region is located below the cervical region, all functions corresponding to the cervical region remain intact. Therefore, individuals with SCIs below the T1 level should be able to use their hands and arms normally.

Spinal Cord Injury Levels: A Complete Overview of Each Type (4)

The lowermost functions left intact at each level of thoracic spinal cord injury include:

  • T1 spinal cord injury– intact sensation of the inner forearm and the ability to separate your fingers (finger abduction).
  • T2 spinal cord injury– the uppermost chest muscles and sensation near the armpit and upper chest are intact.
  • T3,T4andT5 spinal cord injury– intact sensation at the back, as well as in the upper, mid, and low chest respectively. Intercostal muscles, which are located between the ribs and play a key role in breathing, are often affected during T3-T5 spinal cord injury.
  • T6 spinal cord injurythroughT12 spinal cord injury– can affect the abdominal muscles as well as sensation in the abdomen and low back. A T6 spinal cord injury will leave sensation intact at the top of the abdomen. Lower level thoracic injuries result in sensation deficits in progressively lower areas of the abdomen and low back. For reference, those with a T10 spinal cord injury generally have intact sensation down to the level of the belly button.

Learn more about thoracic spinal cord injuries »

(Video) Levels of Spinal Cord Injury

Lumbar Level of Spinal Cord Injury

Spinal Cord Injury Levels: A Complete Overview of Each Type (5)

Following the thoracic region is the lumbar region. This region of the spinal cord consists of 5 levels.

Lumbar spinal cord injuriesonly affect the lower body, so individuals should have unaffected motor control and sensation in their hands, arms, and trunk. Because individuals with lumbar spinal cord injuries experience weakness or paralysis in their legs, they may struggle with walking and balance.

The lowermost functions left intact at each level of the lumbar spinal cord injury include:

  • L1 spinal cord injury– will have sensation at the pelvic region, as well as the ability to flex the trunk. Those with a L1 spinal cord injury will have minimal hip movement. Functions of the legs may still be affected.
  • L2 spinal cord injury– will be able to use the hip flexors, which are the muscles near the top of the thighs that allow you to raise your upper legs (such as during walking or marching). Sensation of the upper thighs will also be intact.
  • L3 spinal cord injury– will have sensation at the lower thighs and knees and the ability to straighten the knees (knee extension).
  • L4 spinal cord injury– will be able to lift the foot upwards (ankle dorsiflexion) as well as feel of the front and inner regions of the lower legs.
  • L5 spinal cord injury– will be able to bend and straighten the big toe and have sensation of the front and outer areas of the lower legs down to the big, second, and middle toes.

Learn more about lumbar spinal cord injuries »

Sacral Spinal Cord Injury

The sacral region of the spinal cord consists of 5 levels. Individuals with sacral-level spinal cord injuries have unaffected upper body functions and partial leg functions.

Because bowel and bladder functions are innervated by the bottommost segments of the sacral spinal cord, individuals with nearly any level of spinal cord injury are likely to experience bowel and bladder problems.

The functions left intact at each level of the sacral region of the spinal cord include:

  • S1 spinal cord injury– will have sensation at the fourth and pinky toes, heel, and part of the calf. Those with an S1 spinal cord injury can also extend the ankle so that the foot points down (ankle plantarflexion).
  • S2 spinal cord injury– will have sensation in most areas of the back of the legs, as well as the ability to bend the knees (knee flexion). The S2, S3, and S4 spinal nerves innervate the pelvic cavity, which is responsible for sexual, bladder, and bowel-related functions. Therefore, these functions may be more or less affected, depending on the level of injury.
  • S3 spinal cord injury– will have sensation around the medial buttocks.
  • S4 and S5 spinal cord injury– some functions within the perianal area may be left intact.

Coccygeal Level Spinal Cord Injury

At the very end of the spinal cord is a single coccygeal nerve. This nerve innervates the skin around the tailbone. As a result, individuals may experience pain, discomfort, or complete loss of sensation in the tailbone area.

However, because this nerve makes up the lowest level of the spinal cord, individuals should have normal motor control and sensation throughout most of their bodies.

(Video) Spinal Cord Injury (SCI) Levels C1-T1 Made Easy | OT DUDE Occupational Therapy

Understanding Spinal Cord Injury Levels and Functions

Functional loss after spinal cord injury depends on the severity and level of injury. The severity of your SCI will determine to what extent functions innervated below your level of injury are affected. Likewise, the level of injury will determine which functions may or may not be affected.

We hope this article helped you better understand spinal cord injury levels and what sensorimotor functions may be impacted.

FAQs

What are the levels of spinal cord injury? ›

Levels of Spinal Cord Injury

There are four sections of the spinal cord that impact the level of spinal cord injury: cervical, thoracic, lumbar and sacral. Each section of the spine protects different groups of nerves that control the body.

What are the 5 levels of the spinal cord? ›

As mentioned above, our vertebrae are numbered and divided into five regions: cervical, thoracic, lumbar, sacrum, and coccyx.

What is spinal cord injury PDF? ›

Spinal cord injury occurs when there is any damage to the spinal cord that blocks communication between the brain and the body. After a spinal cord injury, a person's sensory, motor and reflex messages are affected and may not be able to get past the damage in the spinal cord.

What does a complete spinal cord injury at thoracic level 7 result in? ›

Following a thoracic spinal cord injury, individuals experience loss of motor control and sensation in the trunk and/or legs, referred to as paraplegia.

What is the most common level of spinal cord injury? ›

SCI typically affects the cervical level of the spinal cord (50%) with the single most common level affected being C5 (1). Other injuries include the thoracic level (35%) and lumbar region (11%).

What does level of injury mean? ›

The level of injury: Refers to the point where the spinal cord is injured. Marks a border between areas of the body that are affected and not affected by the spinal cord injury.

What is a T5 spinal injury? ›

When the spinal cord is injured at or below thoracic level 5 (T5), cardiovascular control is markedly unbalanced as the heart and blood vessels innervated by upper thoracic segments remain under brain stem control, whereas the vasculature of the lower body is affected by unregulated spinal reflexes.

What are the 5 signs of a spinal injury? ›

Emergency signs and symptoms
  • Extreme back pain or pressure in your neck, head or back.
  • Weakness, incoordination or paralysis in any part of your body.
  • Numbness, tingling or loss of sensation in your hands, fingers, feet or toes.
  • Loss of bladder or bowel control.
  • Difficulty with balance and walking.
2 Oct 2021

What are the 5 types of vertebrae? ›

Vertebrae are the 33 individual bones that interlock with each other to form the spinal column. The vertebrae are numbered and divided into regions: cervical, thoracic, lumbar, sacrum, and coccyx (Fig.

How is spinal cord injury diagnosed? ›

Diagnostic tests for spinal cord injuries may include a CT scan, MRI or X-ray These tests will help the doctors get a better look at abnormalities within the spinal cord. Your doctor will be able to see exactly where the spinal cord injury has occurred.

What is an L3 spinal cord injury? ›

What Are the Symptoms of an L3 Injury? This is the middle vertebra of the lumbar spine, and the first vertebra to not contain a section of the spinal cord. Common symptoms of an L3 lumbar spinal injury include weakness, numbness, and loss of flexibility in the legs, hips, and/or groin.

What is a primary spinal cord injury? ›

The initial mechanical forces delivered to the spinal cord at the time of injury is known as primary injury where “displaced bone fragments, disc materials, and/or ligaments bruise or tear into the spinal cord tissue” (7–9).

What is a T12 complete spinal cord injury? ›

Last updated on December 8, 2020. A T12 spinal cord injury affects lower body functions such as walking and bowel and bladder functions. Fortunately, individuals with T12 spinal cord injuries generally have normal, full functioning of their upper bodies, which allows a great deal of independence.

What is a t9 complete spinal cord injury? ›

Home » T-9 to T-12. These injuries occur in the lower thoracic region of the spinal cord, and can result in either complete or incomplete paraplegia, in which the voluntary movement and sensation in the areas of the body below the point of injury are compromised.

What is T4 complete spinal cord injury? ›

The T4 spinal nerves directly affect sensation around the 4th intercostal space (the area between your 4th and 5th rib), which is generally level with the nipples. Therefore, depending on the severity of their injury, someone with a T4 spinal cord injury may not be able to feel or move anything from their chest down.

Can you recover from a C3 spinal injury? ›

A C3 spinal cord injury can affect movement and sensation from the neck down. Fortunately, by participating in rehabilitative therapies and effectively managing secondary complications, individuals can learn to become as functional as possible and maybe even recover movement.

What nerves are affected by L1 and L2? ›

L1 spinal nerve provides sensation to your groin and genital area and helps move your hip muscles. L2, L3 and L4 spinal nerves provide sensation to the front part of your thigh and inner side of your lower leg. These nerves also control hip and knee muscle movements.

Can you recover from a C4 spinal injury? ›

There are few survivors of C1–C3 spinal cord injury, but individuals may survive C4 spinal cord injury if treated in time. Spinal cord injury below C4 (C5–C8) is generally not life threatening, but patients often show upper extremity segmental sensory and motor dysfunction after injury.

What level of spinal cord injury causes paraplegia? ›

Lumbar spinal cord injury L1-L5

Lumbar level injuries result in paralysis or weakness of the legs (paraplegia). Loss of physical sensation, bowel, bladder, and sexual dysfunction can occur.

Does spinal cord injury qualify for disability? ›

Anyone with a spinal cord injury can file a claim for Social Security disability benefits as long as the injury has lasted at least three months and is expected to make it impossible for you to work for at least 12 months.

Where is C3 C4 in spine? ›

The C3, C4, and C5 vertebrae form the midsection of the cervical spine, near the base of the neck.

What nerves are affected by C3 C4 C5-C6 C7? ›

C5, as mentioned earlier, along with C3 and C4, contributes to the phrenic nerve that innervates the diaphragm. Roots C5, C6, and C7 produce the long thoracic nerve, responsible for controlling the serratus anterior.

What nerves are affected by C6 and C7? ›

The C6-C7 disc is 6th cervical disc near the lower part of the neck, near the top of the shoulders. The nerve root that would be affected by the C6-C7 disc herniation controls the arms, the shoulders, the heart, the lungs, and more.

What is a T6 spinal injury? ›

Last updated on August 17, 2020. A T6 spinal cord injury can affect motor control and sensation from the top of the abdomen down. Luckily, T6 spinal cord injury patients usually have normal upper extremity functions; therefore, control of the head, neck, shoulders, arms, hands, and chest are often unaffected.

What is the best treatment for spinal cord injury? ›

Options include soft neck collars and various braces. Surgery. Often surgery is necessary to remove fragments of bones, foreign objects, herniated disks or fractured vertebrae that appear to be compressing the spine. Surgery might also be needed to stabilize the spine to prevent future pain or deformity.

What are two common signs symptoms of a spinal cord injury? ›

These are the most common symptoms of acute spinal cord injuries:
  • Muscle weakness.
  • Loss of voluntary muscle movement in the chest, arms, or legs.
  • Breathing problems.
  • Loss of feeling in the chest, arms, or legs.
  • Loss of bowel and bladder function.

Which medicine is best for spinal cord? ›

Medication may include non-steroidal anti-inflammatory drugs (NSAIDS), gabapentin (Neurontin), muscle relaxants, anti-depressants, and painkillers.

What are the 4 main functions of the spine? ›

Your spine, or backbone, is your body's central support structure. It connects different parts of your musculoskeletal system. Your spine helps you sit, stand, walk, twist and bend.

What are the 4 types of vertebra? ›

The mammalian vertebral column consists of five morphologically differentiated groups of vertebrae: cervical, thoracic, lumbar, sacral and coccygeal (caudal) (Fig 3.1).

What are the three main functions of the spine? ›

The three main functions of the spine are to: Protect the spinal cord, nerve roots and several of the body's internal organs. Provide structural support and balance to maintain an upright posture. Enable flexible motion.

What are the three types of spinal cord injuries? ›

There are three types of complete spinal cord injuries: Tetraplegia. Paraplegia. Triplegia.

What is a T5 spinal injury? ›

When the spinal cord is injured at or below thoracic level 5 (T5), cardiovascular control is markedly unbalanced as the heart and blood vessels innervated by upper thoracic segments remain under brain stem control, whereas the vasculature of the lower body is affected by unregulated spinal reflexes.

Can you recover from a C3 spinal injury? ›

A C3 spinal cord injury can affect movement and sensation from the neck down. Fortunately, by participating in rehabilitative therapies and effectively managing secondary complications, individuals can learn to become as functional as possible and maybe even recover movement.

What are the 5 signs of a spinal injury? ›

Emergency signs and symptoms
  • Extreme back pain or pressure in your neck, head or back.
  • Weakness, incoordination or paralysis in any part of your body.
  • Numbness, tingling or loss of sensation in your hands, fingers, feet or toes.
  • Loss of bladder or bowel control.
  • Difficulty with balance and walking.
2 Oct 2021

What are the three levels of injury? ›

Risks for injuries occur at three different levels: the individual level, the societal level, and the environmental/engineering level. Preventing injuries requires different approaches at each level of risk.

How many types of spinal cords are there? ›

There are four types of spinal cord injury: cervical, thoracic, lumbar and sacral. The spinal cord is surrounded by rings of bone called vertebra. These bones constitute the spinal column (back bones). In general, the higher in the spinal column the injury occurs, the more dysfunction a person will experience.

How do you name spinal cord injuries? ›

An SCI is described by its level, type, and severity. The level of injury for a person with SCI is the lowest point on the spinal cord below which sensory feeling and motor movement diminish or disappear. The level is denoted by the letter-and-number name of the vertebra at the injury site (such as C3, T2, or L4).

What is a T4 spinal injury? ›

The T4 spinal nerves directly affect sensation around the 4th intercostal space (the area between your 4th and 5th rib), which is generally level with the nipples. Therefore, depending on the severity of their injury, someone with a T4 spinal cord injury may not be able to feel or move anything from their chest down.

What nerves are affected by C3 C4 C5 C6 C7? ›

C5, as mentioned earlier, along with C3 and C4, contributes to the phrenic nerve that innervates the diaphragm. Roots C5, C6, and C7 produce the long thoracic nerve, responsible for controlling the serratus anterior.

What is a T12 injury? ›

A T12 spinal cord injury affects lower body functions such as walking and bowel and bladder functions. Fortunately, individuals with T12 spinal cord injuries generally have normal, full functioning of their upper bodies, which allows a great deal of independence.

Which medicine is best for spinal cord? ›

Medication may include non-steroidal anti-inflammatory drugs (NSAIDS), gabapentin (Neurontin), muscle relaxants, anti-depressants, and painkillers.

Does C3 affect breathing? ›

Levels of Spinal Cord Injury Affecting Breathing

Individuals with a C1 or C2 spinal cord injury may be entirely dependent on ventilatory assistance for breathing. Individuals with a C3 spinal cord injury may occasionally weaned from ventilatory assistance, but typically require some sort of breathing assistance.

What pain does C3 C4 cause? ›

C3 root compression is very rare and may present with pain and numbness around the mastoid and pinna. C4 root compression may cause pain and numbness in the back of the neck, over the scapula, and sometimes the anterior chest.

What are two common signs symptoms of a spinal cord injury? ›

These are the most common symptoms of acute spinal cord injuries:
  • Muscle weakness.
  • Loss of voluntary muscle movement in the chest, arms, or legs.
  • Breathing problems.
  • Loss of feeling in the chest, arms, or legs.
  • Loss of bowel and bladder function.

What is the first aid treatment for a spinal injury? ›

If you suspect someone has a spinal injury:
  1. Get help. Call 911 or emergency medical help.
  2. Keep the person still. Place heavy towels or rolled sheets on both sides of the neck or hold the head and neck to prevent movement.
  3. Avoid moving the head or neck. ...
  4. Keep helmet on. ...
  5. Don't roll alone.

What are the complications of spinal cord injury? ›

Long-term complications of a spinal cord injury may include:
  • Inability to regulate blood pressure or body temperature.
  • Increased risk of heart or lung problems.
  • Loss of bladder or bowel control.
  • Paralysis in the arms or legs.
  • Persistent pain.
  • Spasticity, joint contracture.
  • Sexual dysfunction.
1 Dec 2020

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