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There are obviously excellent medical references that can explain the different types of spinal cord injury far more helpfully than we can as mere solicitors. But the purpose of this blog is to explore some of the more frequently encountered aspects of different types of spinal cord injury that we see in our work – and to give a flavour of why the classification of different types of spinal cord injury matter to legal representatives and indeed Judges in spinal cord injury compensation claims.
In very broad terms the spinal cord might be considered as the conduit for messages from and to the brain and by which movement and sensation can be managed.
Running from our brain down through the spine to the coccyx the cord is sheathed like wires within an electric cable. The spine’s vertebra are numbered within sections of the spine – cervical, thoracic, lumbar and sacral (C, T, L and S).
The ‘level’ of the injury will correspond to the vertebra closest to where the cord is damaged. C4 would typically imply damage at shoulder level – the point at which the fourth vertebra is situated towards the top of the spine and in the neck. An injury at T10 would suggest the injury would have been caused to the spine around the level of the navel.
The level of the damage or lesion implies that messaging to and from the brain beyond that level is impeded. If the messaging is completely blocked the injury is described as complete. If it is partially blocked the injury is described as incomplete.
Clinicians use letters A, B, C and D to indicate the extent of the motor and or sensory loss below the area of the cord that is damaged . Sometimes the classification is described as Frankel A, B, C or D; but the scale seen most often is the ASIA impairment scale. (The American Spinal Injury Association updated the Frankel classification in the early 1990s).
A spinal cord injury referred to as C4 ASIA A – means a complete injury: no motor or sensory function below the neurological level of the injury (C4).
C4 ASIA B is an incomplete injury and would mean sensory but not motor function is preserved below the level of the injury.
C4 ASIA C is an incomplete injury and would mean motor function is preserved below the level of the injury and more than half of muscles below the level of the injury are compromised by having a muscle grade less than 3.
C4 ASIA D is an incomplete injury and would mean motor function is preserved below the neurological level and at least half of the muscles below the injury level would have a muscle grade of 3 or more.
You would rarely see it written in the notes but ASIA E would infer normal motor and sensory function.
A number of syndromes are also classified depending on where the damage to the cord occurs. Central cord syndrome, Brown-Sequard syndrome, anterior cord syndrome, conus medullaris and cauda equina syndrome are frequently encountered within spinal cord injuries work.
A tetraplegia case (complete or incomplete) would imply damage to all four limbs. A paraplegia case would imply damage to the lower limbs. Hemiplegia is occasionally encountered where for example a stroke causes paralysis to limbs on one side of the body, and triplegia is used to describe damage to both lower limbs and one arm.
The damage to the cord is referred to as a lesion. What causes the damage to the tissue of the cord may be brought on by damage to vertebrae, ligaments or discs in the spinal column. Damage is typically caused by compression of the cord (as a result of contusion, oedema, haematoma, abscess etc) and or by restricted blood supply to the cord (ischaemia).
For those injured above T6 the risk of autonomic dysreflexia is always present. Autonomic dysreflexia is an abnormal autonomic (that is involuntary) nervous system reaction to stimulation or harmful stimulus. A change in heart rate, excessive sweating or headaches in response to stimulation may be a sign of an ‘AD’ attack. Where the uninjured spinal cord might allow the body to react so as to lower blood pressure, the ability to regulate the body in that way is compromised where the spinal cord is damaged. The issue is frequently encountered in connection with bladder and bowel issues in those with complete injuries. To read more use this link https://eput.nhs.uk/PublicationWF/PDF_Output/5580.pdf
Another risk that people with spinal cord injury (and solicitors representing them in compensation cases) is syringomyelia (or “scurrying Amelia” as one cherished former colleague once thought she heard us talking about). Syringomyelia is the development of a syrinx (or fluid filled cyst) within the cord. If it enlarges it can cause further damage above the level of the original injury which can be catastrophic if not treated. Muscle weakness, loss of reflexes, loss of sensitivity to pain and temperature, headaches, stiffness in back, shoulders, arms and legs, pain in neck and back and scoliosis (spinal curvature) are all to be watched for and discussed with medics.
The risk of further catastrophic damage being caused by a syrinx consequential to the original spinal cord injury is small but real and is the reason why spinal cord injury claims should always be pleaded on the basis that any compensation award is ‘provisional’. This means that in the event of further damage being caused later on, the Claimant is able to bring the case back to the Court and seek to recover the further compensation that may well then be indicated and needed.
If you are unsure about how the injury you have or someone close to you has is classified, the discharge letter sent by the rehabilitation clinicians to you/the GP will usually detail exactly what the diagnosis is. The solicitor representing the spinal cord injured patient will certainly want to establish exactly what the nature and extent of the injury is.
To read more about Brethertons Spinal Cord Injuries Team - https://www.brethertons.co.uk/site/individuals/spinal-injury-solicitors/spinal-injury-solicitors-page/
To follow us on Twitter - @neurolawyer