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Sep 17
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Non-traumatic Spinal Cord Injury

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Author: Dominik Zbogar, Kelsey Zhao | Reviewer: Peter New | Published: 17 September 2024 | Updated: ~

Key Points

  • NTSCI can be broken down into three major categories: congenital, genetic, and acquired which accounts for the large majority of cases.
  • Rates of NTSCI vary widely worldwide and much information is lacking. Developed countries tend to have a higher proportion of cases caused by degenerative conditions and tumours. Developing countries tend to have a higher proportion of NTSCI acquired from infection.
  • Those with NTSCI are more likely to be older, female, have paraplegia and have an incomplete injury when compared to those with traumatic SCI.
  • Much of NTSCI rehabilitation is similar to traumatic SCI rehabilitation, though the rehabilitation stay is shorter.

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What is non-traumatic SCI?

Spinal cord injuries (SCI) can have traumatic or non-traumatic causes. Traumatic SCIs are caused by external forces in events such as car accidents and falls. Non-traumatic spinal cord injuries (NTSCI) occur without an external physical force and are typically caused by an underlying health condition.

What causes non-traumatic SCI?

Causes of NTSCI can be divided into three major categories: congenital, genetic, and most commonly – acquired.

Congenital (present at birth)

Congenital NTSCIs are developmental defects, malformations, and abnormalities affecting the spinal cord which are present at birth. An infant can have one congenital condition, or multiple conditions at the same time. For example, Type 2 Chiari malformations almost always occurs in association with myelomeningocele, a severe form of spina bifida

Spinal dysraphism

Myelomeningocele is the most severe type of spina bifida as the spinal cord itself protrudes through the opening of the unfused portion of the spinal column.2

Spinal dysraphism is a defect in the development of the neural tube (an early form of the brain and spine) where the canal that houses the spinal cord does not completely close and causes damage to the spinal cord and nerves. A well know type of spinal dysraphism is spina bifida.

Chiari malformations

Chiari malformations are a condition where a part of the brain known as the cerebellum is pushed into the space where the brain connects to the spinal cord.

Skeletal malformations

Skeletal malformations include any deformities or abnormalities in the development of bones or ligaments that affects the spine. These malformations can put the person at higher risk of spine instability which can cause pressure on the spinal cord that can result in NTSCI.

Congenital syringomyelia

Congenital syringomyelia is the formation of a fluid-filled sac, known as a cyst or syrinx, in the spinal cord. This often occurs in association with spina bifida or Chiari malformations, but can also happen on its own, spontaneously.

Genetic

A genetic NTSCI comes from an abnormality in a person’s genes that affects the spinal cord. This abnormaility can be inherited from one’s parents or be a spontaneous mutation that occurred during development. The effects of this genetic abnormality can be present at birth or show up later in life. Most genetic NTSCIs lead to loss of movement and/or sensation from the degeneration of nerve cells.

Some examples of genetic NTSCI types include hereditary spastic paraplegia, spinocerebellar ataxias (e.g. Freidrich’s ataxia), adrenomyeloneuropathies, leukodystrophies, and spinal muscular atrophy.

Acquired

Acquired conditions include the most common causes of NTSCI, such as degenerative spinal cord conditions, tumours, and vascular problems. This is a diverse category and the conditions become more common in older age.

Degenerative

Degenerative NTSCIs include any condition that causes damage to the spinal cord through the degeneration of its bone or ligaments. For example, spondylosis is a condition where there is an abnormal and painful degeneration in the bones and cartilage of the neck that can lead to loss of control or sensation over parts of the body.

Metabolic

Metabolism is the processes in the body that turns food into energy and the components that make up and maintain the body. Nutrient deficiencies like vitamin B12 and folate deficiency, or diseases that affect the maintenance of bone like osteoporosis and Piaget’s disease, can cause degeneration or damage to the spinal cord.

Vascular

Vascular causes of NTSCI refer to spinal cord damage caused by problems with the vessels that carry blood through the body. For example, if a blood vessel bursts and bleeds, if there are issues with abnormal connections between vessels, or if the blood supply is blocked, the spinal cord could be damaged. These issues can happen anywhere in the body and can cause NTSCI when they happen in the spinal cord.

Inflammatory or auto-immune

Inflammatory and auto-immune conditions involve immune system activity that damages the spinal cord through swelling (inflammation) or direct attack on healthy cells (auto-immune). The immune system is normally responsible for protecting us from viruses, bacteria, and other orgamisms but different conditions can cause overactive or innapropriate immune reactions. Examples include transverse myelitis and multiple sclerosis.

Spinal tumors may be (left to right) intramedullary, intradural-extramedullary, or extradural.5

Tumors and masses

Benign or malignant tumours can cause a NTSCI if the growth of the mass puts pressure on the spinal cord or interferes with the blood supply.

Infection

The spinal cord can be infected by bacteria, viruses or other organisms. Infections can put pressure on the spinal cord due to an abcess (pocket of infection) or interfere with the blood supply.

Other

Other uncommon causes of NTSCI include damage to the spinal cord due to radiation exposure and exposure to toxic substances. Amyotrophic lateral sclerosis and primary lateral sclerosis are both rare degenerative diseases that affect the motor neurons which are the nerve cells involved in the control and coordination of movement.

Are Multiple Sclerosis and ALS types of NTSCI?

Multiple sclerosis (MS) is an auto-immune disease where the immune system attacks the protective covering (myelin) of nerve fibers in the central nervous system, which is made up of the brain and spinal cord. Amyotrophic lateral sclerosis (ALS) is a progressive nervous system disease that affects nerve cells in the brain and spinal cord. Because lesions can occur not only in the spinal cord but in the brain too, categorizing them is a challenge. Some studies include MS and ALS with their SCI sample while others choose to exclude these conditions.

Who gets non-traumatic SCI?

TSCI = traumatic spinal cord injury; NTSCI = non-traumatic spinal cord injury

Although NTSCI still affects males more overall, the proportion of females with NTSCI is higher relative to traumatic SCI. NTSCI is also more likely to affect older people.

The numbers by cause

The incidence of NTSCIs varies depending on the cause and the health services in the country where you live. Although there are many gaps in the research data, existing studies provide an idea how different NTSCI causes are distributed.

Congenital & Genetic

  • In the few studies that recorded cases of congenital causes of NTSCI, spina bifida and other congenital conditions cause between 1 to 6% of cases. Overall, congenital and genetic NTSCI make up a very small proportion of NTSCI.

Acquired

  • Malignant and benign tumours are common causes of NTSCI globally. Studies from all over the world since 1975 report that tumours are the cause of 14-44% of NTSCI cases
  • Degenerative conditions of the spine are a very common cause of NTSCI in high-income developed countries. The percentage of NTSCI cases caused by degenerative conditions ranges from 13 to 62%. Many of these conditions become more prevalent with age.
  • In the regions of Sub-Saharan Africa and South Asia, tuberculosis has been reported to cause 15 to 30 % of NTSCI cases. Tuberculosis is an infectious disease caused by bacteria that typically attacks the lungs but can also damage other parts of the body like the spine and brain.
  • Other causes of NTSCI commonly reported in research include inflammatory/auto-immune conditions, vascular conditions, and infections.

Pediatric SCI

Traumatic injury is the most common cause of SCI in adults, while non-traumatic causes are more common in children. The most common non-traumatic causes of pediatric SCI include congenital anomalies, spinal cord tumors, infections, and vascular malformations. Common traumatic causes of pediatric SCIs include motor vehicle accidents, falls, sports-related injuries and iatrogenic harm.

Visit SCIRE Professional for more information on Pediatric SCI.

Where in the World?

An estimated 20.6 million individuals live with SCI globally. It appears that the incidence of NTSCI is increasing due to the ageing population in many countries. Indeed, in some countries the incidence of NTSCI is now higher than that of traumatic SCI.

There is a general lack of information about incidence and types of NTSCI worldwide. That said, developed countries tend to have a higher proportion of cases caused by degenerative conditions (32%) and from tumours (25%) in Western Europe. Developing countries, in comparison, tend to have a higher proportion of NTSCI acquired from infection, particularly tuberculosis and HIV, though tumours are also reported as a major cause. There are many gaps in tracking the global rates of NTSCI.

How does non-traumatic SCI present?

The onset of NTSCI may be slow and gradual and be related to a progressive condition or a complication from another medical event. Onset can range from minutes to months depending on the cause of injury.

Compared to traumatic SCI, those with NTSCI:

TSCI = traumatic spinal cord injury; NTSCI = non-traumatic spinal cord injury

  • are more likely to have paraplegia
  • are more likely to have an incomplete injury
  • spend less time in rehabilitation and have reduced hospital charges
  • have similar discharge destinations.

“Invisible” disability

Compared to people with traumatic SCI, people with NTSCI are more likely to have regained some walking ability when they are discharged from rehabilitation. People with SCI who can walk may face unique physical and psychosocial challenges. The use of mobility devices for walking likes canes and walkers might cause more fatigue and/or pain then a wheelchair. The absence of a wheelchair as a clear indicator of disability can result in misunderstanding and judgement from others due to lack of awareness about people with SCI who can walk. Some feel that they exist in a “grey zone” where they are neither fully abled nor disabled and experience “invisible” challenges.

Some examples of challenges include:

  • Misunderstanding from others about the severity of their injury and the impairments they live with.
  • Feeling out of place in SCI programs or in the SCI community, especially when the program or space is not built with people who can walk in mind (e.g., no places to sit).
  • Unwanted attention and scrutiny when in public or in social situations due to an abnormal gait or assistive devices.
  • Lack of empathy from others when they pass as not disabled (e.g., “Can you hurry up? Why are you so slow?”).

There is a need for more programs and services that are welcoming to and consider the needs of people with SCI who can walk. If you or someone you know is struggling with finding community and services as a person with SCI who can walk, it can be helpful to talk to health professionals or peers with similar injuries and experiences. Peer support has been proven to improve adjustment to life after injury and general wellbeing through social/emotional support and sharing knowledge. If pain or fatigue with walking are a problem, it may also be beneficial to consider the intermittent use of wheeled mobility devices.

Read our article on SCI Basics for more information about types of SCI!

How is non-traumatic SCI treated?

Rehabilitation common to all types of SCI

Most of the rehabilitation process will be similar between traumatic and NTSCI while treatment of the underlying conditions that cause NTSCI will vary. Rehabilitation common to both traumatic SCI and NTSCI includes:

  • Education about the SCI and the related medical problems that need to be managed.
  • Complication management and prevention: In people with all types of SCI, complications like urinary tract infection, pneumonia, pressure ulcers, spasticity and neuropathic pain are common and managed in rehabilitation. Prevention and education are essential to minimize complications.
  • Physical and occupational therapy: Physical therapists work with patients to regain mobility, strength, and coordination. Occupational therapists focus on helping patients adapt to their new circumstances, relearn daily living skills, and regain independence. Both are critical essential to rehabilitation after SCI.
  • Assistive devices: Mobility aids, adaptive equipment, assistive technologies, and other supports like cushions and mattresses can significantly improve the quality of life for people with SCIs. These devices help with mobility, communication, daily tasks, and prevent complications like pressure ulcers.
  • Pain management: Chronic pain is a common issue in that can be managed with medications, nerve blocks, or other interventions to alleviate discomfort.
  • Bladder and bowel training: Medical treatments can be used to treat bladder and bowel problems. Training also includes learning how to manage your bladder and bowel care after rehabilitation.
  • Psychological support: Psychological support and counseling can help individuals and their families navigate the challenging emotional aspects of coping with SCI.
  • Community reintegration: In preparation for leaving rehabilitation, the health team should provide support in finding local resources and services, managing finances, returning to regular life activities, and adapting the home for SCI.

Read our article on Understanding Rehabilitation for more information!

Read our articles on the areas listed here and many other Topics!

Rehabilitation unique to non-traumatic SCI

Predicting recovery

NTSCI presents unique rehabilitation challenges. Given that those with NTSCI tend to be older, there is an increased likelihood of chronic conditions such as arthritis, diabetes, cardiovascular disease, obesity, and other conditions. These comorbidities can negatively impact rehabilitation and recovery.

Predicting rehabilitation outcomes after injury is particularly difficult in those with a progressive NTSCI, where the condition underlying the SCI leads to a deterioration over time compared to those with a non-progressive cause of NTSCI. The cause of NTSCI is an important predictor of outcomes, length of stay, and survival.

Considering the older age of many people with NTSCI, the various possible chronic health conditions that they may have, and that many NTSCI are incomplete, it can be very hard to predict the recovery from NTSCI. Making comparisons with traumatic SCI is also very hard for the same reasons.

Access to rehabilitation services

People with NTSCI have improved recovery outcomes when they are treated in a spinal-specific rehabilitation unit rather than in general rehabilitation. Clinicians agree that that a spinal rehabilitation unit that specializes in NTSCI is the ideal setting for treatment. However, there is a tendency for spinal rehabilitation units to give preference to traumatic SCI when admitting clients as NTSCI is considered less urgent and they may exclude older patients or those with metastatic cancer presumably referring them to gerontology and oncology units, respectively.

Concurrent treatment

Depending on the cause of the NTSCI, some people will undergo treatments for the underlying condition at the same time as rehabilitation. This could include surgeries, radiation therapy and chemotherapy for tumours, immunosuppressant medications for auto-immune conditions, antibiotics for bacterial infections, etc. The rehabilitation unit needs to be aware of these treatments for safety and to optimally plan treatments and rehabilitation therapy. Some treatments for underlying conditions can be draining and negatively impact rehabilitation if therapy is scheduled soon after.

Diagnosis of underlying cause

There is also a possibility for people with NTSCI to be admitted to rehabilitation without a diagnosis or with an incorrect diagnosis of the underlying condition. In these situations, rehabilitation clinicians and therapists may end up being involved in determining the correct diagnosis.

The bottom line

The many different types of NTSCI can be grouped into three categories: congenital, genetic, and acquired. Each will have their unique presentation and treatment needs. That said, the large majority of NTSCIs result from acquired conditions. In developed countries, most acquired NTSCIs are degenerative conditions and tumors, while developing countries tend to have a higher proportion from infection.

Those with NTSCI are more likely to be older, female, have paraplegia and have an incomplete injury when compared to those with traumatic SCI.

Much of NTSCI rehabilitation is similar to traumatic SCI rehabilitation, though the rehabilitation stay is shorter and less costly.

 

For a review of how we assess evidence at SCIRE Community and advice on making decisions, please see SCIRE Community Evidence.

Reference list

Parts of this page have been adapted from the SCIRE Professional “Rehabilitation Practices” Module available from: scireproject.com/evidence/rehabilitation-practices/factors-affecting-rehabilitation-outcomes/traumatic-vs-non-traumatic-sci/

Evidence for “What causes non-traumatic SCI?” is based on:

Molinares DM, Gater DR, Daniel S, Pontee NL. Nontraumatic Spinal Cord Injury: Epidemiology, Etiology and Management. J Pers Med. 2022 Nov 8;12(11):1872.

New PW, Reeves RK, Smith É, Eriks-Hoogland I, Gupta A, Scivoletto G, et al. International retrospective comparison of inpatient rehabilitation for patients with spinal cord dysfunction: Differences according to etiology presented in part to the international spinal cord society, September 2-5, 2012, London, United Kingdom. Arch Phys Med Rehabil. 2016 Mar 1;97(3):380–5.

New PW, Marshall R. International Spinal Cord Injury Data Sets for non-traumatic spinal cord injury. Spinal Cord. 2014 Feb 8;52(2):123–32.

Klimo P, Rao G, Brockmeyer D. Congenital Anomalies of the Cervical Spine. Neurosurg Clin N Am. 2007 Jul;18(3):463–78.

Hart DJ. Syringomyelia. Encyclopedia of the Neurological Sciences. 2014 Jan 1;378–81.

Kuo DT, Tadi P. Cervical Spondylosis. In: StatPearls. StatPearls Publishing; 2023.

Evidence for “Who gets non-traumatic SCI?” is based on:

Cosar SNS, Yemisci OU, Oztop P, Cetin N, Sarifakioglu B, Yalbuzdag SA, et al. Demographic characteristics after traumatic and non-traumatic spinal cord injury: a retrospective comparison study. Spinal Cord 2010 48:12. 2010 May 4;48(12):862–6.

McCaughey EJ, Purcell M, McLean AN, Fraser MH, Bewick A, Borotkanics RJ, et al. Changing demographics of spinal cord injury over a 20-year period: a longitudinal population-based study in Scotland. Spinal Cord. 2016 Apr 13;54(4):270–6.

New PW, Cripps RA, Bonne Lee B. Global maps of non-traumatic spinal cord injury epidemiology: towards a living data repository. Spinal Cord 2013 52:2. 2013 Jan 15;52(2):97–109.

Niemi-Nikkola V, Koskinen E, Väärälä E, Kauppila AM, Kallinen M, Vainionpää A. Incidence of Acquired Nontraumatic Spinal Cord Injury in Finland: A 4-Year Prospective Multicenter Study. Arch Phys Med Rehabil. 2021 Jan;102(1):44–9.

Smith É, Fitzpatrick P, Lyons F, Morris S, Synnott K. Epidemiology of non-traumatic spinal cord injury in Ireland – a prospective population-based study. J Spinal Cord Med. 2022;45(1):76–81.

Choi Y, Leigh JH, Jeon J, Lee GJ, Shin HI, Bang MS. Trends in the Incidence and Etiology of Non-Traumatic Spinal Cord Injury in Korea: A Nationwide Population-Based Study From 2007 to 2020. J Korean Med Sci. 2023 May 5;38(18).

Cunha NSC, Malvea A, Sadat S, Ibrahim GM, Fehlings MG. Pediatric Spinal Cord Injury: A Review. Children. 2023 Sep 1;10(9).

Jain NB, Ayers GD, Peterson EN, Harris MB, Morse L, O’Connor KC, et al. Traumatic Spinal Cord Injury in the United States, 1993–2012. JAMA. 2015 Jun 6;313(22):2236

DeVivo MJ, Vogel LC. Epidemiology of spinal cord injury in children and adolescents. J Spinal Cord Med. 2004;27 Suppl 1.

Safdarian M, Trinka E, Rahimi-Movaghar V, Thomschewski A, Aali A, Abady GG, et al. Global, regional, and national burden of spinal cord injury, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2023 Nov 1;22(11):1026–47.

New PW, Epi MC, Biering-Sørensen F. Review of the History of Non-traumatic Spinal Cord Dysfunction. Top Spinal Cord Inj Rehabil. 2017 Sep 1;23(4):285.

Kennedy P, Hasson L. An audit of demographics and rehabilitation outcomes in non-traumatic spinal cord injury. Spinal Cord 2016 54:11. 2016 Mar 22;54(11):1020–4.

Evidence for “How does non-traumatic SCI present?” is based on:

New PW, Marshall R. International Spinal Cord Injury Data Sets for non-traumatic spinal cord injury. Spinal Cord. 2014 Feb 8;52(2):123–32.

New PW, Cripps RA, Bonne Lee B. Global maps of non-traumatic spinal cord injury epidemiology: towards a living data repository. Spinal Cord 2013 52:2. 2013 Jan 15;52(2):97–109.

McKinley WO, Seel RT, Gadi RK, Tewksbury MA. Nontraumatic vs. traumatic spinal cord injury : A rehabilitation outcome comparison. Am J Phys Med Rehabil. 2001;80(9):693–9.

Citterio A, Franceschini M, Spizzichino L, Reggio A, Rossi B, Stampacchia G. Nontraumatic spinal cord injury: An Italian survey. Arch Phys Med Rehabil. 2004 Sep 1;85(9):1483–7.

Dionne A, Richard-Denis A, Lim • Victor, Mac-Thiong JM. Factors associated with discharge destination following inpatient functional rehabilitation in patients with traumatic spinal cord injury. Spinal Cord. 2021;59:642–8.

Franceschini M, Bonavita J, Cecconi L, Ferro S, Pagliacci MC, Ferro S, et al. Traumatic spinal cord injury in Italy 20 years later: current epidemiological trend and early predictors of rehabilitation outcome. Spinal Cord 2020 58:7. 2020 Jan 29;58(7):768–77.

Halvorsen A, Pettersen AL, Nilsen SM, Halle KK, Schaanning EE, Rekand T. Non-traumatic spinal cord injury in Norway 2012–2016: analysis from a national registry and comparison with traumatic spinal cord injury. Spinal Cord. 2019 Apr 14;57(4):324–30.

McKinley WO, Conti-Wyneken AR, Vokac CW, Cifu DX. Rehabilitative functional outcome of patients with neoplastic spinal cord compression. Arch Phys Med Rehabil [Internet]. 1996 Sep 1;77(9):892–5.

Jeawon M, Hase B, Miller S, Eng J, Bundon A, Chaudhury H, et al. Exploring the Quality of Life of People with Incomplete Spinal Cord Injury Who Can Ambulate. Disabilities. 2023 Oct 6;3(4):455–76.

Jeawon M, Hase B, Miller S, Eng JJ, Bundon A, Chaudhury H, et al. Understanding the experiences, needs, and strengths of people with incomplete spinal cord injury who can ambulate. Disabil Rehabil. 2024 Jan 30;46(3):546–55.

Evidence for “How is non-traumatic SCI treated?” is based on:

New PW. Non-traumatic spinal cord injury: what is the ideal setting for rehabilitation? Australian Health Review. 2006;30(3):353.

New PW, Eriks-Hoogland I, Scivoletto G, Reeves RK, Townson A, Marshall R, et al. Important Clinical Rehabilitation Principles Unique to People with Non-traumatic Spinal Cord Dysfunction. Top Spinal Cord Inj Rehabil. 2017 Oct;23(4):299–312.

Image credits

  1. Baby by Nick Abrams
  2. Different types of spina bifida by Centers for Disease Control and Prevention, Public Domain
  3. DNA by Adrien Coquet
  4. old man by Gan Khoon Lay
  5. Spinal Tumors Illustration by Thom Graves, CMI; used with permission of Weill Cornell Medicine Neurological Surgery.
  6. The Blue Marble (remastered) NASA/Apollo 17 Crew, Public Domain
  7. TSCI/NTSCI 1 ©SCIRE
  8. TSCI/NTSCI 2 ©SCIRE

 

Disclaimer: This document does not provide medical advice. This information is provided for educational purposes only. Consult a qualified health professional for further information or specific medical advice. The SCIRE Project, its partners and collaborators disclaim any liability to any party for any loss or damage by errors or omissions in this publication.
Sep 21
0

Spinal Cord Anatomy

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Author: SCIRE Community Team | Reviewer: Riley Louie | Published: 21 September 2017 | Updated: ~

This page provides an overview of the structures of the spinal cord and how the spinal cord works.

Key Points

  • The spine is a long column of 33 small back bones (vertebrae) that are connected together by ligaments and discs.
  • The main areas of the spine are the cervical spine (neck), thoracic spine (upper and mid back), lumbar spine (low back), sacrum (part of the pelvis), and coccyx (tailbone).
  • The spinal cord is a large bundle of nerve tissues located within the center of the spine.
  • The spinal cord is made up of nerve cells (neurons) that relay nerve signals between the brain and body to control movement, sensation, and other functions. The spinal cord is also the centre for reflexes.

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What is the spine?

The spine is a long column of 33 small back bones called vertebrae that are connected together by strong fibrous ligaments and shock-absorbing fibrous discs. The spine is part of the skeleton.

The spine supports the weight of the body, allows the torso to move, anchors many of the muscles, and protects the spinal cord from damage. The spine is also called the vertebral column, spinal column, or backbone.

Image of a body from the side with the spine visible. The cervical spine is at the top of the spine, the thoracic spine is in the upper middle of the spine the lumbar spine is in the lower part of the spine, the sacrum is part of the pelvis, and the coccyx is the tailbone.

The five major areas of the spine.1

Areas of the spine:

  • The cervical spine has 7 cervical vertebrae and forms the neck.
  • The thoracic spine has 12 thoracic vertebrae and forms the upper and mid back.
  • The lumbar spine has 5 lumbar vertebrae and forms the low back.
  • The sacrum is made up of 5 sacral vertebrae that are fused together to form a wedge-shaped bone that is part of the pelvis.
  • The coccyx is made up of 3 to 5 coccygeal vertebrae that are fused together to form the tailbone.

The spine has a hollow canal in its centre that runs the length of the spine from the base of the skull down to the sacrum called the spinal canal. The spinal canal contains the spinal cord.

Naming the bones of the spine

The bones of the spine are named and numbered according to:Cartoon depiction of spine bones

  • The area of the spine that the bone is located in (cervical, thoracic, lumbar, or sacral), which is often abbreviated simply as a letter (i.e. ‘C’ for ‘cervical spine’ or ‘C-spine’, ‘T’ for ‘thoracic spine’ or ‘T-spine’); and
  • The number of the bone within that area. The numbering begins at ‘1’ for the vertebra closest to the head and increases with each vertebra down to the tailbone (counting up as you move down the spine). The numbering then begins again at ‘1’ in the next area of the spine.

For example, the bone at the top of the lumbar area of the spine (the low back) is called the ‘first lumbar vertebra’ or ‘L1’.  

What is the spinal cord?

Image of a body from the side with the spine visible. It is broken into the cervical, thoracic, lumbar, sacral, and coccygeal spine. The conus medullaris and cauda equina are also labelled.

The spinal cord is divided into 31 segments, which each give rise to a pair of spinal nerves.3

The spinal cord is a long bundle of nerve tissue that is located in the spine. It is the main pathway for nerve signals travelling between the brain and the rest of the body. It is also the centre for the body’s reflexes.

The spinal cord is made up of millions of microscopic nerve cells. Protective layers of tissue called meninges cover the spinal cord and a special fluid called cerebrospinal fluid cushions the spinal cord within the spine.

The path of the spinal cord

The spinal cord begins at the base of the skull, where it connects to the brain through the brainstem. The spinal cord then runs down through the spine’s hollow central spinal canal.

The spinal cord is shorter than the spine, so it does not travel the full length of the spine. It ends at a point called the conus medullaris near the first or second lumbar vertebra. From this point down, spinal nerves branching from the end of the spinal cord sit within the spinal canal in a bundle called the cauda equina.

Spinal cord segments

A model of the spine and spinal nerves

Spinal nerves extending from the spine.4

The spinal cord is divided into 31 nerve segments from top to bottom:

• 8 cervical segments

• 12 thoracic segments

• 5 lumbar segments

• 5 sacral segments

• 1 coccygeal segment

Each segment is a part of the spinal cord that gives rise to a pair of spinal nerves (one right and one left). The spinal nerves exit the spine through archways between the bones and continue outward to become the nerves of the arms, legs, and body.

How does the spinal cord work?

The spinal cord is part of the nervous system. The nervous system is the body’s main communication system. It allows messages to be passed from one area of the body to another. This is possible because of special cells called neurons.


Image of a purple cell with short appendages labelled 'dendrites' and one long appendage labeled as the 'axon'

Neurons are cells that transmit nerve signals in the body.5

Neurons

Neurons are the main cells of the nervous system. Neurons generate, conduct, and pass along nerve signals within the nerves, spinal cord, and brain.

Neurons communicate with other cells (such as other neurons, muscle cells and sensory receptors) through connections called synapses. These connections allow the cells to pass electrical and chemical nerve signals to other cells.

 

The brain and spinal cord together make up the central nervous system. The central nervous system is the main control system of the body.

  • The brain is the command center of the nervous system. It sends commands to the rest of the body which control movement, breathing, and other functions. The brain also receives signals about sensations from the whole body, which it interprets to help manage bodily functions.
  • The spinal cord is the main pathway for information travelling between the brain and the rest of the body. It acts like a highway along which nerve signals can travel between distant areas of the body. This includes both commands sent from the brain to the body and sensations from the body to the brain. The spinal cord is also the center for reflexes (a reflex is a muscle response to a touch stimulus).

The main functions of the spinal cord are to pass along information related to movement, sensation, reflexes, and organ function.

Movement (motor neurons)

A woman lifting weightsThe spinal cord provides a pathway for movement commands to travel from the brain to the muscles. This is called motor function. Neurons that send movement commands are called motor neurons.

Movement begins in special movement (motor) areas of the brain that plan and generate nerve signals to create movements. Upper motor neurons from this area of the brain have long nerve fibers (axons) that project down the spinal cord, where they pass their signals to lower motor neurons that travel out of the spinal cord and into the body. These lower motor neurons connect with muscle cells to pass along movement commands that tell the muscles to contract.

Sensation (sensory neurons)

The spinal cord is also a pathway for sensations traveling from the body to the brain. This is called sensory function. Neurons that send sensory information are called sensory neurons.

The body’s tissues (like the skin, muscles, and organs) contain special sensory receptors. Sensory receptors detect sensations such as touch, pressure, vibration, or temperature. When a sensation is detected, a signal is sent along the nerve fiber (axon) of a sensory neuron to the spinal cord.

The signal then travels up the spinal cord where it is passed along to other neurons in the brainstem and brain. When these signals reach the sensation centers in the brain, they are interpreted and the person feels the sensation.

Spinal reflexes

Image of a man touching the flame of a candle. A red line connects to a muscle in the arm and up to the spinal cord. From there, a blue line travels from the spinal cord and back down the arm.

Pain signals from touching something hot travels to the spinal cord and back to the muscles without going to the brain first.7

Reflexes are automatic responses that happen in the spinal cord and do not travel to the brain first. For example, when the tendon below the knee cap is tapped, it causes the knee jerk reflex.

Spinal reflexes involve neurons for both sensation and movement. When certain sensory receptors are activated, a nerve signal is sent through sensory neurons to the spinal cord. In the spinal cord, the signal is passed on to lower motor neurons involved in the reflex movement. The motor neurons then send a signal out of the spinal cord to the muscles, causing an immediate muscular response.

Internal organ (autonomic) function

The spinal cord also plays a role in controlling some of the functions of the internal organs through the autonomic nervous system.

The autonomic nervous system

The autonomic nervous system controls largely unconscious bodily processes such as blood pressure, heart rate, breathing rate, body temperature, digestion, bladder, bowel, and sexual function.

It has two divisions:

  • The sympathetic nervous system prepares the body for stressful or emergency situations. It is often called the ‘fight or flight’ system, because it prepares the body for action. For example, it increases heart rate and slows digestion.
  • The parasympathetic nervous system prepares the body for normal, non-emergency situations. It is often called the ‘rest and digest’ system, because it allows the body to restore itself. For example, it slows heart rate and increases digestion.

The sympathetic and parasympathetic systems have different (and often opposite) effects on the organs and work together to control bodily functions according to the situation.

Cartoon images of the lungs, heart, digestive system, and urinary tract system.

The autonomic nervous system controls various body functions.8-11


 

Neurons that control the function of the autonomic nervous system begin in the brain or brainstem. Some of these neurons leave in the cranial nerves (nerves that arise directly from the brain and brainstem), and the rest travel down the spinal cord, where they branch from certain areas:

  • The nerves of the sympathetic nervous system arise from the thoracic and lumbar spinal cord from the levels of T1 to L2.
  • Some of the nerves of parasympathetic nervous system arise from the sacral spinal cord, from S2 to S4 (the others leave from the brainstem).

After leaving the spinal cord, the neurons connect (synapse) with other neurons in clusters of nerve cells called ganglia. From these ganglia, motor neurons project out to the organs and signal changes to their function.

Reference list

Bican O, Minagar A, Pruitt AA. The spinal cord: a review of functional neuroanatomy. Neurol Clin. 2013 Feb;31(1):1-18.

Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2010.

Image credits

  1. Image by SCIRE Community Team
  2. Spinal cord ©Vectors Market, CC BY 3.0 US
  3. Image by SCIRE Community Team
  4. BIO 120 Lab Spinal Cord 035 ©djneight, CC BY-NC-ND 2.0
  5. Image by SCIRE Community Team
  6. Lifting weights ©skeeze, CC0 1.0
  7. Imgnotraçat arc reflex eng ©MartaAguayo, CC BY-SA 3.0
  8. Lung ©mungang kim, CC BY 3.0 US
  9. Heart ©Laymik, CC BY 3.0 US
  10. Digestive System ©Design Science, CC0 1.0
  11. Excretory system ©Olena Panasovska, CC BY 3.0 US

 

Disclaimer: This document does not provide medical advice. This information is provided for educational purposes only. Consult a qualified health professional for further information or specific medical advice. The SCIRE Project, its partners and collaborators disclaim any liability to any party for any loss or damage by errors or omissions in this publication.

Feb 17
0

Spinal Cord Injury Basics

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Author: SCIRE Community Team | Reviewers: Shannon Sproule, Tova Plashkes, Amrit Dhaliwal | Published: 17 February 2017 | Updated: 26 March 2024

This page provides an overview of background information about spinal cord injury. For information about what the spinal cord is and how it works, see Spinal Cord Anatomy.

Key Points

  • Spinal cord injury occurs when the spinal cord or the nerves at the end of the spinal canal are damaged and causes changes to how the body works.
  • Spinal cord injury may cause changes in strength, sensation, bladder, bowel and other functions below the injury.
  • There are many different types of spinal cord injury and the effects of the injury can be very different from one person to the next.
  • The amount of function affected largely depends on where the injury occurs and how severe the damage is.
  • Health providers use a standardized physical exam called the International Standards for Neurological Classification of Spinal Cord Injury exam to determine the level of injury and whether the injury is complete or incomplete. This is referred to as the AIS classification.

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What is spinal cord injury?

A spinal cord injury (SCI) occurs when the spinal cord or the nerves at the end of the spinal canal are damaged and causes changes to how the body works.

SCI can be a life-changing injury. It can affect many different body systems and often causes permanent changes to strength, sensation, and other functions below the injury. There are many different types of spinal cord injury and the effects of the injury can be very different from one person to the next.

What causes spinal cord injury?

SCI can have many causes, which are commonly divided into traumatic or non-traumatic causes.

Traumatic spinal cord injury

Traumatic spinal cord injury is damage to the spinal cord that is caused by direct trauma from an outside force. This is usually caused by a sudden blow to the spine (such as something falling on the spine), compression of the spine (from the force of a car of a car accident, for example) or a penetrating injury (such as a gunshot wound).


A broken spinal bone (vertebra) in the neck causes pieces of bone or tissue to move out of place, damaging the fragile nearby spinal cord.2

How does damage to the spine cause spinal cord injury?

A forceful blow or compression of the spine can cause the spinal bones (vertebrae) or other tissues (such as the gel-like discs between the vertebrae) to break and/or dislocate. The spinal cord is located within the hollow center of the spine, so if pieces of bone or tissue move out of place and pressure and or excessive swelling take place they can put pressure on, tear, or otherwise damage the fragile spinal cord.

Although a large force is usually needed to damage the spine, smaller forces can also cause traumatic injuries in people with certain medical conditions. For example, people with osteoporosis have weak bones that can break from lesser forces, such as a fall from a standing position.

Non-traumatic spinal cord injury

Non-traumatic spinal cord injury is damage to the spinal cord that is caused by anything other than direct trauma. This includes complications from an illness, degeneration of the spine from arthritis, or certain conditions that people are born with (like spina bifida). Non-traumatic injuries often develop gradually over time, compared to the sudden onset of traumatic injuries.

Read our article on Non-traumatic SCI for more information (coming soon)!

Common causes of spinal cord injury

Traumatic spinal cord injury Non-traumatic spinal cord injury
  • Car or motorcycle accidents
  • Spinal stenosis (narrowing of the spinal canal)
  • Falls from a height
  • Arthritis of the spine
  • Slips and trips
  • Tumors on or near the spine
  • Sports accidents
  • Spina bifida
  • Violence
  • Blockage or bleeding of the spinal cord’s blood vessels
  • Infections

What are the signs and symptoms of spinal cord injury?

Spinal cord injury can cause a wide range of different signs and symptoms. The effects of the injury can be very different from one person to the next, depending on the person and the characteristics of the injury. Symptoms can be temporary or permanent and may change over time.

The earliest period after a spinal cord injury often involves a phase of shock. This is usually a temporary period that resolves after a few days or weeks.

Early symptoms of spinal cord injury

A cartoon of a person wearing a blood pressure cuffSpinal shock happens right after injury and causes the muscles below the injury to be floppy and unmoving (called flaccid paralysis). This happens because the spinal reflexes below the injury are temporarily impaired in response to the injury. Spinal shock often happens together with neurogenic shock.

Neurogenic shock is when low blood pressure, slow heart rate, and low body temperature happen early after SCI because of how the injury affects the autonomic nervous system. Neurogenic shock typically affects people with cervical or upper thoracic injuries. If severe and untreated, neurogenic shock can be life-threatening.


Each level of the spinal cord provides sensation to a different part of the body.4

After shock resolves, the longer-lasting symptoms of spinal cord injury may be experienced. These may include the following symptoms.

Changes in sensation

Changes in sensation occur below the spinal cord injury. This may include total or partial loss of sensation as well as abnormal sensations like tingling, numbness, or pain.

The amount of sensation affected depends on whether the injury is complete or incomplete and the level of the injury. Each level of injury causes changes to the sensation in a specific area of the body. For example, an injury at C3 affects sensation from the neck down, whereas an injury at L1 affects sensation of the legs and groin.

People with incomplete spinal cord injuries may have only parts of their sensation below the injury affected. Those with complete injuries may also have some sensation in select areas below the injury, which are called zones of partial preservation.

Pain below the injury

Pain originating from the spinal cord injury is called neuropathic pain. It can be felt in areas at or below the injury, even if sensation is not present, and is an especially distressing symptom for many people.

Read our article on Pain After SCI for more information!

Changes in strength and muscle control

Changes to the strength and control of the muscles also happens below the injury. This can include both paralysis (loss of movement) and weakness of the muscles.

The amount of strength and movement affected depends on whether the injury is complete or incomplete and the level of injury. Each level of injury affects specific muscles. For example, an injury at C3 can cause paralysis from the neck down, whereas an injury at L1 can cause paralysis of the hips and legs.

People with incomplete injuries may have strength in some of the muscles below the injury.

Spasticity

Spasticity is a common symptom of spinal cord injury. It involves muscle spasms, muscle tightness or tension, involuntary jerking movements, and overactive reflexes below the injury.

Read our article on Spasticity for more information!

Changes in breathing

Some people with SCI need help with breathing and coughing.5                                   

People who have cervical and thoracic spinal cord injuries may experience problems with breathing. This is because the diaphragm (the main muscle of breathing), as well as the muscles of the neck, chest, and abdomen are needed to breathe and cough normally. This can affect the ability to breathe, cough, and clear mucus from the lungs without assistance.

Injuries at C5 and above affect the diaphragm and sometimes people with injuries at these levels cannot breathe long-term without the support of a ventilator or other device. People with lower cervical and thoracic injuries may also experience problems breathing because they cannot control other important muscles of the neck and rib cage that help with breathing and coughing.

Read our articles related to Breathing for more information!

Changes in bladder function

There are a number of changes to bladder function after spinal cord injury, including inability to control urination. Many people will use catheters and other treatments to control their bladder functions after spinal cord injury, which may predispose them to developing urinary tract infections if not done carefully.

Read our articles about Bladder Health for more information!

Changes in bowel function

Cartoon of the stomach and intestinesBowel problems are also common after spinal cord injury and can include an inability to control bowel functions (bowel incontinence), constipation, and other problems. Many people use a personalized bowel routine, which is a schedule that keeps bowels moving at a regular rate (using special foods or supplements), to maintain healthy bowel function after spinal cord injury.

Read our article about Bowel Changes After SCI for more information!

Changes in control of blood pressure and heart rate

The autonomic nervous system is part of the nervous system that controls the unconscious functions of the internal organs like the heart and circulation (blood vessels). Spinal cord injury can cause changes to how the autonomic nervous system functions, which may alter the body’s ability to control blood pressure, temperature, and heart rate, as well as cause conditions like orthostatic hypotension (a sudden drop in blood pressure when moving into an upright position) and autonomic dysreflexia.

Read our article about Orthostatic Hypotension for more information!

Autonomic dysreflexia

Autonomic dysreflexia is a potentially dangerous, sudden increase in blood pressure that can happen in in people with injuries at T6 and above. It can cause symptoms like headaches, sweating, and flushing. Autonomic dysreflexia is a medical emergency.

Read our article about Autonomic Dysreflexia for more information!

Changes in sexual function

Changes in sexual function are also common after spinal cord injury. This may include difficulties with orgasm, ejaculation, and erection. These changes depend on the individual and their particular injury.

Read our article about Sexual Health After SCI for more information!

What are “complete” and “incomplete” spinal cord injuries?

Complete spinal cord injury

The spinal cord, conus medullaris, and cauda equina.7

A complete spinal cord injury is when there is a total loss of strength and sensation below the spinal cord injury. This must include complete loss of movement or sensation of the anus (S4 and S5).

In some cases, people with complete injuries may still have some areas of strength or sensation below level of injury (but not including S4 and S5). These areas are known as zones of partial preservation. 

Incomplete spinal cord injury

An incomplete spinal cord injury is when some strength and/or sensation remain below the spinal cord injury. This must include some movement or sensation of the anus (S4 and S5).

Incomplete injuries can have very different symptoms depending how much and in what way the injury has affected the spinal cord. These have traditionally been described as different “syndromes”, but more often now are best described by the characteristics of the person’s unique symptoms.

You may hear your healthcare providers use these terms:

SyndromeArea of spinal cord injuryKey Symptoms
Central cord syndromeCentral areas of the cervical spinal cord
  • Greater weakness in the arms than the legs
Brown-Séquard syndromeOne half of the spinal cord (the right or left side)
  • Weakness and the loss of joint position sense on one side of the body
  • Loss of pain and temperature sensation on the other side of the body
Conus medullaris syndromeThe end of the main part of the spinal cord and the start of the ’cauda equina’
  • Loss of bladder and bowel function
  • Variable function in the strength and sensation of the legs
Cauda equina syndromeThe nerves in lowest part of the spinal canal once the “true” spinal cord has ended
  • Loss of bladder, bowel, and reflexes in the legs
  • Variable function in the strength and sensation of the legs

What are "upper" and "lower" motor neuron injuries?

Nerve pathways that send movement commands from the brain to the muscles are made up of two types of neurons: upper motor neurons (UMNs) which start in the brain and go down the spinal cord, and lower motor neurons (LMNs) which connect to the UMN in the spinal and go out to the muscles.

UMN injuries disrupt the neuron connection from the brain to the muscles but keep the spinal reflexes of the LMNs (automatic movement responses to pain or sensation that don’t require signals from the brain), intact. The disruption of brain commands causes muscle weakness/paralysis and leaves the spinal reflexes unmoderated, which presents as spasticity. The uncontrolled activity of spinal reflexes also maintains muscle tone. In contrast, LMN injuries disrupt the neuron connection from both the brain and spinal cord to the muscles. There are no signals going to the muscles at all, which causes muscle paralysis and atrophy (degeneration).

Refer to our article on Spinal Cord Anatomy for more information on motor neurons and spinal reflexes!

The effects of UMN and LMN injuries in SCI can be seen in various systems of the body.

Effects of UMN injury in SCI:

Effects of LMN injury in SCI:

  • Flaccid neurogenic bladder and/or bowel
  • Sexual health – loss of reflex arousal but retain psychogenic arousal

Refer to our articles on Bladder Changes After SCI, Bowel Changes After SCI, Sexual Health After SCI, Spasticity, and Autonomic Dysreflexia for more information!

Mixed UMN and LMN injuries

Depending on their injury, a person with SCI could be more likely to have UMN, LMN, or both injuries at the same time. For example, a cauda equina injury happens at the bottom of the spinal cord where all the nerves are LMNs, while a conus medullaris injury is likely to be a mix of both. Injuries caused by trauma will often injure both the UMNs at the spinal cord and surrounding LMNs.

Relevance to treatment

The advancement of treatments like nerve transfer and functional electrical stimulation that depend on intact LMN function bring attention to the need to distinguish UMN from LMN injury. Determining if one has an UMN or LMN injury is accomplished by diagnostic techniques such as nerve conduction studies and electromyography.

Refer to our articles on Nerve Transfer Surgery and Functional Electrical Stimulation for more information!

What is the “neurological level of injury”?

Neurological level of injury is the lowest level of the spinal cord that has normal function, which is confirmed using strength and sensation tests. Level of injury is an important classification that, together with whether the injury is complete or incomplete, can be used to describe how much physical function a person is likely to have.

What are tetraplegia (quadriplegia) and paraplegia?

A silhouette of a persons arm and handA silhouette of a persons leg and footAlthough not specifically describing level of injury, tetraplegia and paraplegia are terms used to describe the extent of a spinal cord injury’s effects on the body.

Tetraplegia, or Quadriplegia, describes injuries that affect the cervical spinal cord and causes a partial or total loss of strength and sensation of the neck, trunk, arms and legs (all four limbs).

Paraplegia describes injuries that affect the thoracic, lumbar or sacral spinal cord and causes a partial or total loss of strength and sensation of the legs and trunk, without affecting the arms. 

What is the International Standards for Neurological Classification of Spinal Cord Injury exam?

The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) exam (often called the American Spinal Injury Association (ASIA) exam) is a physical exam that is used to classify spinal cord injuries. It determines both the neurological level of injury and the completeness of the injury.

During this exam, a health provider such as a doctor or physiotherapist will carefully test for sensation and strength at specific points on the body and use the exam findings to determine the characteristics of the injury. These tests include:

  • Testing for “light touch” sensation (if you can feel the touch of a cotton swab or tissue and whether it feels normal)
  • Testing for “pin prick” sensation (if you can feel whether the touch of a safety pin is sharp or dull and whether it feels normal)
  • Testing for muscle strength of specific muscles (if you can resist against certain movements applied by the health provider)
  • Testing for movement and sensation of the anus. This is a very important test because it is the only way we can determine if a person’s injury is complete or incomplete). It is testing the last nerves to leave the spinal cord (S4 and S5).

Testing muscle strength as part of the ISCNSCI Exam.10

ASIA Impairment Scale (AIS)

The ASIA Impairment Scale (AIS) describes the completeness of the injury. This scale identifies whether a person has any movement or sensation in the lowest levels of the spinal cord (S4 and 5) and what movement or sensation they have below the neurological level of injury. If you are interested in learning how healthcare providers are trained to do the test, you can visit: scireproject.com/outcome/ais/.

A, CompleteNo sensation or movement below the injury, including around the anus (S4 and 5)
B, Sensory IncompleteThere is sensation, but not movement below the injury, including around the anus (S4 and 5)
C, Motor IncompleteThere is movement, but not sensation below the level of injury and more than half of the muscles below the injury are quite weak
D, Motor IncompleteMovement is present below the injury and at least half of muscles below the injury have close to normal strength
E, NormalSensation and movement are normal

How common is spinal cord injury?

Spinal cord injury is a relatively rare condition. Although estimates vary by country and study, it is estimated 86,000 people were living with SCI in Canada in 2010. New injuries were estimated to be 4,300 per year in 2010.

The bottom line

It is best to discuss all treatment options with your health providers to find out which treatments are suitable for you.

For a review of how we assess evidence at SCIRE Community and advice on making decisions, please see SCIRE Community Evidence.

Reference list

Parts of this page have been adapted from the SCIRE Professional “Rehab: From Bedside to Community” and “Epidemiology of Traumatic SCI” Modules:

Eng JJ (2014). Rehab: From Bedside to Community. In Eng JJ, Teasell RW, Miller WC, Wolfe DL, Townson AF, Hsieh JTC, Connolly SJ, Noonan VK, Loh E, McIntyre A, editors. Spinal Cord Injury Rehabilitation Evidence. Version 5.0. Vancouver: p. 1-48.

Furlan JC, Krassioukov A, Miller WC, Trenaman LM (2014). Epidemiology of Traumatic Spinal cord Injury. In Eng JJ, Teasell RW, Miller WC, Wolfe DL, Townson AF, Hsieh JTC, Connolly SJ, Noonan VK, Loh E, McIntyre A, editors. Spinal Cord Injury Rehabilitation Evidence. Version 5.0. Vancouver: p 1- 121.
Available from: scireproject.com/evidence/epidemiology-of-traumatic-sci/ 

Brodell DW, Jain A, Elfar JC, Mesfin A. National trends in the management of central cord syndrome: an analysis of 16,134 patients. Spine J. 2015 Mar 1;15(3):435-42. doi: 10.1016/j.spinee.2014.09.015. Epub 2014 Sep 28.

Van Middendorp JJ, Goss B, Urquhart S, Atresh S, Williams RP, Schuetz M. Diagnosis and Prognosis of Traumatic Spinal Cord Injury. Global Spine Journal. 2011;1(1):1-8. doi:10.1055/s-0031-1296049.

Kirshblum SC, Burns SP, Biering-Sorensen F, Donovan W, Graves DE, Jha A, Johansen M, Jones L, Krassioukov A, Mulcahey MJ, Schmidt-Read M, Waring W. International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med. 2011 Nov;34(6):535-46. doi: 10.1179/204577211X13207446293695.

American Spinal Injury Association (ASIA) Learning Center. International Standards for Neurological Classification of spinal cord injury (ISNCSCI). Available from: http://lms3.learnshare.com/Images/Brand/120/ASIA/International%20Standards%20Worksheet.pdf. Accessed April 13, 2016.

Noonan VK, Fingas M, Farry A, Baxter D, Singh A, Fehlings MG, Dvorak MF. Incidence and prevalence of spinal cord injury in Canada: a national perspective. Neuroepidemiology. 2012;38(4):219-26.

New PW, Cripps RA, Bonne Lee B.Global maps of non-traumatic spinal cord injury epidemiology: towards a living data repository. Spinal Cord. 2014 Feb;52(2):97-109.

Farry A, Baxter D. The Incidence and Prevalence of Spinal Cord Injury in Canada: Overview and estimates based on current evidence. Rick Hansen Institute and Urban Futures Institute 2010.

McCammon JR, Ethans K. J Spinal Cord Med. 2011;34(1):6-10. Spinal cord injury in Manitoba: a provincial epidemiological study.

Warren S, Moore M, Johnson MS. Traumatic head and spinal cord injuries in Alaska (1991-1993). Alaska Med. 1995 Jan-Mar;37(1):11-9.

Evidence for “What are “upper” and “lower” motor neurons?”

Emos MC, Agarwal S. Neuroanatomy, Upper Motor Neuron Lesion. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.

Javed K, Daly DT. Neuroanatomy, Lower Motor Neuron Lesion. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.

Zayia LC, Tadi P. Neuroanatomy, Motor Neuron. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.

Doherty JG, Burns AS, O’Ferrall DM, Ditunno JF. Prevalence Of Upper Motor Neuron Vs Lower Motor Neuron Lesions In Complete Lower Thoracic And Lumbar Spinal Cord Injuries. J Spinal Cord Med. 2002 Dec;25(4):289–92.

Kingwell SP, Curt A, Dvorak MF. Factors affecting neurological outcome in traumatic conus medullaris and cauda equina injuries. Neurosurg Focus. 2008 Nov;25(5):E7.

Bryden AM, Hoyen HA, Keith MW, Mejia M, Kilgore KL, Nemunaitis GA. Upper Extremity Assessment in Tetraplegia: The Importance of Differentiating Between Upper and Lower Motor Neuron Paralysis. Arch Phys Med Rehabil. 2016 Jun;97(6):S97–104.

Mulcahey MJ, Smith B, Betz R. Evaluation of the lower motor neuron integrity of upper extremity muscles in high level spinal cord injury. Spinal Cord. 1999 Aug 9;37(8):585–91.

Image credits

  1. SCIRE “I” by SCIRE
  2. Image by SCIRE
  3. Blood Pressure ©Alexander Panasovsky, CC BY 3.0 US
  4. Dermatoms © Ralf Stephan, CC0 1.0
  5. Image by SCIRE
  6. Excretory system ©Olena Panasovska, CC BY 3.0 US
  7. Image by SCIRE
  8. Arm ©Jacqueline Fernandes, CC BY 3.0 US
  9. Leg ©Bakunetsu Kaito. CC BY 3.0 US
  10. Image by SCIRE

 

Disclaimer: This document does not provide medical advice. This information is provided for educational purposes only. Consult a qualified health professional for further information or specific medical advice. The SCIRE Project, its partners and collaborators disclaim any liability to any party for any loss or damage by errors or omissions in this publication.