Following on from the recent Spinal Cord Injury Awareness Day on 17th May 2024, which was aimed at raising awareness and understanding of the devastating impact of spinal cord injury, we now embark on a series of articles dealing with spinal cord injury claims. In this first article we look at the anatomy of the spine and provide an overview of the potential conditions as a consequence of a spinal injury.
Basic anatomy
The spinal cord is part of the central nervous system. It is a long column starting at the brainstem at the base of the skull and extending down to the lower back. It consists of nerve tissue and plays a vital role in relaying motor and sensory signals between the brain and the body. It is protected by the vertebral column (which is the protective layer of bone called the vertebrae).
The spinal cord is essentially divided into segments: cervical, thoracic, lumbar, sacral and coccygeal. These segments consist of 31 pairs of spinal nerves which control motor, sensory and autonomic (ie unconscious processes such as breathing and heartbeat) function. Each pair of spinal nerves connects to different parts of the body as follows:
Cervical spinal nerves (C1 – C8) in the neck – the back of the head, the neck and shoulders, the arms and hands, and the diaphragm;
Thoracic spinal nerves (T1 – T12) in the upper mid-back – the chest muscles, some of the muscles in the back, and some organ systems;
Lumbar spinal nerves (L1 – L5) in the low back – the lower parts of the abdomen and the back, the buttocks, some parts of the external genital organs, and parts of the leg;
Sacral spinal nerves (S1 – S5) in the lower back – the thighs and lower parts of the legs, the feet, most of the external genital organs, and the area around the anus;
Coccygeal spinal nerves – the rectum and anus.
Injury to the spinal cord
As a team, we see spinal cord injuries arising from a whole manner of accidents, to include:
- Motor accidents – this is perhaps the most common cause of catastrophic spinal cord injuries
- Injuries involving vulnerable road users e.g. pedestrians, motorcyclists and cyclists
- Falls from height – these can occur in a public or workplace
- Workplace accidents
- Medical negligence
A spinal cord injury occurs when there is any damage to the spinal cord which affects the transmission of communication between the brain and the body. After such an injury a person’s motor, sensory and reflex messages will be affected, and generally speaking the extent of dysfunction that a person experiences will be determined by the level of injury. For example, an injury to the high cervical nerves (C1 – C4) can lead to paralysis from the neck down and the person may not be able to breathe unaided. Conversely an injury to the very lower back (S1 – S5) might result in impaired function in the hips and legs, and bladder/bowel problems, but the injured person will most likely be able to walk.
Injuries to the spinal cord can be complete or incomplete. An incomplete injury means the spinal cord is still able to transmit some messages to/from the brain, and there may be some feeling or movement below the location of the spinal cord injury. A complete injury means that no messages can be transmitted below the injury site, and there is no movement or feeling below this point.
A common classification scale adopted by clinicians to indicate the extent of a spinal cord injury is the ASIA Impairment Scale, developed by the American Spinal Injury Association. This is a standardized neurological examination and leads to an individualised score for the injured person.
The ASIA Impairment Scale is as follows:
ASIA A – Complete: there is no feeling or movement below the level of injury
ASIA B – Incomplete: there is incomplete sensory but no motor function below the level of injury
ASIA C – Incomplete: there is motor function below the level of injury, but more than half of the key muscles have a muscle grade less than 3 (so they are unable to lift against gravity)
ASIA D – Incomplete: there is motor function below the level of injury and at least half of the key muscles have a muscle grade of 3 or more (so are able to move and lift against gravity)
ASIA E – Normal: motor and sensory function is normal
By way of an example, C4 ASIA B denotes an incomplete injury at C4, where sensory but no motor function is preserved below the level of injury.
Impact of a Spinal Cord Injury
A Spinal Cord Injury can have devastating and life-changing consequences for the injured person. The symptoms which will flow from the injury will depend on the level and extent of the injury. Generally speaking, the higher the level of injury, the more areas of the body will be affected.
If an injury occurs at a high level, this could lead to paralysis of all four limbs (this is known as tetraplegia or quadriplegia). An injury at a lower level could lead to paralysis affecting the lower part of the body and legs (known as paraplegia).
In addition to paralysis, a person may experience a whole range of other symptoms to include, but not limited to:
- Sensory changes, numbness and tingling
- Difficulty breathing
- Speech and language difficulties e.g. swallowing and speech
- Generalised weakness
- Neuropathic pain
- Spasms
- Bladder and/or bowel incontinence
- Sexual dysfunction
- Difficulty walking and mobilising
We should not of course forget the psychological sequelae which can be extreme; it can be extraordinarily difficult for a person to come to terms with the life-changing consequences of a spinal cord injury and it is important a person receives appropriate care and treatment for this.
Summary
The above provides a summary of the devastation that can be caused by a Spinal Cord Injury, and as will be anticipated these injuries need to be very carefully managed. Claims flowing from such injuries require expert handling and a holistic approach to the litigation is key. We will be looking at these issues in more detail in further articles to follow.
