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Understanding Lumbar Spine Injuries L1-L5

By Steph Walsh in Spinal Cord Injuries on July 11, 2024

Understanding Lumbar Spine Injuries L1-L5

Sustaining a lumbar spinal cord injury is a serious and often devastating event. This type of injury can cause various degrees of paralysis in the lower body – a condition also known as paraplegia. Some people temporarily lose some movement, while others permanently lose all movement in certain areas of the body. Regardless of the severity, it’s a debilitating situation that leaves injured individuals and their loved ones struggling with a new reality.

Not only is this disruptive to your social, familial, and vocational life, but it can cause significant mental and emotional stress, including symptoms of depression and anxiety. Recovering from a lumbar spinal cord injury is a long process and requires a comprehensive approach, addressing both physical and psychological symptoms and aspects.

Lumbar spinal cord injuries are most often caused by motor vehicle accidents – including car accidents, motorcycle accidents, trucking accidents, pedestrian accidents, and more – falls, violence, or other trauma. There are many types of spinal cord injuries, but those occurring in the lumbar region generally affect the lower body while upper body function remains intact. This poses unique challenges as you learn how your upper body can compensate for loss of function or sensation in your lower body.

Understanding the complexities of a lumbar spinal cord injury is important as you begin your journey to healing and recovery.

The Lumbar Spinal Cord – a Quick Overview

The lumbar spinal cord is a crucial part of the central nervous system, located in the lower back region of the vertebral column. It extends from the thoracic spinal cord above and continues down until it reaches the conus medullaris, the tapered end of the spinal cord. The lumbar spinal cord contains nerve cells and bundles of nerve fibers that transmit signals between the brain and the lower limbs, as well as to and from the pelvic organs and the lower abdomen. It plays a vital role in controlling movements, sensations, and reflexes in the legs, feet, and lower body.

The lumbar spinal cord is protected by the surrounding vertebrae, which are the largest and most load-bearing vertebrae in the spinal column. The spinal cord is covered by protective layers called meninges and surrounded by cerebrospinal fluid, which acts as a cushion and provides additional protection. Nerves branching off from the lumbar spinal cord exit through openings between the vertebrae, called foramina, to innervate specific lower body regions. These nerves, known as lumbar spinal nerves, are responsible for transmitting sensory information from the skin, muscles, and organs in the lower body to the spinal cord and brain, as well as carrying motor commands from the brain to the muscles, enabling movement and maintaining the proper function of the lower limbs and pelvic organs.

What is a Lumbar Spinal Cord Injury?

Lumbar spinal cord injuries are categorized into two main types: traumatic and non-traumatic. Traumatic injuries result from external forces, such as those experienced in car accidents, falls, or acts of violence. Conversely, non-traumatic causes encompass a range of medical conditions, including tumours or cancer, infections, autoimmune diseases, herniated discs or spinal stenosis, and vascular events like spinal strokes.

The extent and location of damage to the lumbar spinal cord determine the impact on an individual’s motor and sensory functions. Injuries at or below the level of damage can lead to impairments in these functions, while abilities controlled by segments above the injured area remain unaffected. Consequently, most people who suffer a lumbar spinal cord injury experience sensory deficits, motor weakness, or paralysis in their lower extremities. However, they typically retain normal function and sensation in their upper body and trunk.

The Effects of A Lumbar Spinal Cord Injury

There are five levels of lumbar spinal cord injuries, corresponding to the five segments of the vertebrae that may be damaged. The level of a lumbar spinal cord injury refers to the lowest level where motor and sensory functions remain.

The level of any given spinal cord injury is usually determined by the International Standards for Neurological Classification. Determining the level of injury requires testing motor functions and sensations throughout different areas of the body.

Each level affects individuals differently and will impair different functions:

L1 Spinal Cord Injury

The L1 spinal nerves affect sensation and movement in the hip and pelvic region. An L1 spinal cord injury may leave sensory and motor functions in this area intact, but the legs can become entirely paralyzed and lose sensation. This injury may also affect bowel and bladder function.

L2 Spinal Cord Injury

L2 spinal nerves are responsible for sensation in the front portion of the upper thighs, including the hip flexors and hip adductors. These nerves facilitate the bending of the hips and bringing the legs together. Those with an L2 spinal cord injury may retain sensation in the upper thighs and mobility in their hips but could lose feeling and mobility in the lower legs.

L3 Spinal Cord Injury

The L3 spinal nerves are responsible for sensation in the knees and front of the lower thighs. They also affect your ability to extend and straighten the knees and rotate the hips outward. Those with an L3 spinal cord injury may retain movement in the knees and hips but may lose movement and sensation in the lower legs and ankles.

L4 Spinal Cord Injury

The L4 spinal nerves affect sensation around the front and inner areas of the lower legs and are connected to many motor functions. Around the hips, they affect the ability to bring the legs back, pull the legs outward, and rotate the hips inward. L4 spinal nerves also affect movement from the knee to the ankle, including bending of the knee, moving the ankle side to side, and straightening the toes.

An L4 spinal injury will affect the motor function and sensation in the foot, while hip, knee, and some ankle functions may remain intact.

L5 Spinal Cord Injury

The L5 spinal nerves affect sensation in the outer areas of the lower leg, including the big, second, and middle toes. These nerves are responsible for bending and straightening the big toe and separating the toes. Those with an L5 spinal cord injury will retain mobility and sensation in their feet but may lose movement and feeling in the ankles and the back of the leg.

Complete vs. Incomplete Lumbar Spinal Cord Injuries

Lumbar spinal cord injuries can be classified as either complete or incomplete, depending on the extent of damage to the spinal cord. A complete injury occurs when there is a complete loss of sensory and motor function below the level of the injury. In this case, the spinal cord cannot transmit signals past the point of damage, resulting in paralysis and lack of sensation in the affected areas. For example, a person with a complete L1 spinal cord injury may experience paraplegia, with no movement or feeling in their legs and lower body.

In contrast, an incomplete lumbar spinal cord injury is characterized by partial preservation of sensory and/or motor function below the level of injury. This means that some signals can still pass through the area of damaged spinal cord, allowing for varying degrees of sensation and movement. For instance, someone with an incomplete L3 spinal cord injury may have some sensation in their legs and feet and the ability to move certain muscle groups, albeit with reduced strength and control.

The prognosis and recovery rates for complete and incomplete lumbar spinal cord injuries differ significantly. Individuals with incomplete injuries generally have a better chance of regaining some function and sensation over time, as the spared neural pathways can adapt and compensate for the damaged ones. Physical therapy, occupational therapy, and rehabilitation can help optimize their recovery and improve their quality of life.

On the other hand, complete lumbar spinal cord injuries have a more limited potential for recovery, as the absence of any intact neural connections makes it challenging to restore function. However, advances in research and technology, such as stem cell therapy and neuromodulation, offer hope for future treatments that may promote regeneration and repair of the damaged spinal cord.

Regardless of the type of injury, a comprehensive, multidisciplinary approach to care is essential to address the physical, emotional, and social needs of individuals with lumbar spinal cord injuries.

Lumbar Spinal Cord Injury Complications

Lumbar spinal cord injuries can come with a wide range of complications, many of which add additional stress, pain, financial complications, and health issues to the individual’s life. These things may also introduce the need for additional treatments, therapies, and support.

Some of the most common and severe complications include:

Bladder and bowel dysfunction – damage to the lumbar spinal cord can disrupt the nerves that control bladder and bowel function, leading to incontinence, retention, or constipation. This can increase the risk of urinary tract infections and other health issues.

Pressure ulcers – also known as bedsores, these can develop when there is prolonged pressure on the skin, particularly in areas with reduced sensation. Those with particularly severe spinal cord injuries can get these from being bedridden for long periods of time as they recover. Loved ones or caregivers helping an individual to change their position periodically can help prevent these. If not treated promptly, these painful sores can become infected and lead to serious complications.

Deep vein thrombosis – reduced mobility and circulation following a lumbar spinal cord injury can increase the risk of developing blood clots in the deep veins of the legs. If these clots manage to travel to the lungs, they can cause a life-threatening condition called pulmonary embolism.

Spasticity – damage to the spinal cord can cause involuntary muscle contractions and spasms, known as spasticity. This can lead to pain, stiffness, and reduced mobility, further affecting an individual’s ability to perform daily activities.

Chronic pain – many individuals with lumbar spinal cord injuries experience chronic pain, which can be neuropathic (caused by damage to the nervous system) or musculoskeletal (due to overuse or strain on certain muscle groups). Living with chronic pain of any sort is extremely exhausting and can be debilitating to quality of life.

Mental health issues – the physical, emotional, and social challenges associated with lumbar spinal cord injuries can take a toll on an individual’s mental well-being, leading to depression, anxiety, and other mental health concerns.

Respiratory complications – although less common than in higher-level spinal cord injuries, lumbar injuries can still impact respiratory function, particularly if the individual has a pre-existing condition or develops pneumonia.

Muscle atrophy – reduced physical activity and a lack of weight-bearing ability can cause muscles in the legs to weaken and eventually shrink. This is one of the many reasons physical therapy is crucial in spinal cord injury recovery, but even with the best treatment and therapists, one’s ability to walk, move, and bear weight is often greatly reduced.

Sexual dysfunction – lumbar spinal cord injuries can impede various reflexes, mobilities, and sensations in the lower body that play a role in sexual functioning. This can, in turn, have a negative effect on relationships.

Lumbar Spinal Cord Injury Recovery and Rehabilitation

The recovery journey looks different for everyone, and the specifics depend on the location and severity of the injury. That said, it’s never quick or easy to re-learn how to do things you’ve taken for granted your whole life, like walking around, stretching, completing chores, and going to work. In some cases, you may not be able to return to your previous career or even work at all.

However, with proper care, treatment, and therapy, many individuals with a lumbar spinal cord injury are able to return to many facets of their lives. Whether the injury is complete or incomplete, individuals will still have normal functioning in their upper body. Many can learn to compensate for a loss of function and re-learn how to do various tasks and activities in a different way.

Full lumbar spinal cord injury rehabilitation has many components:

Rehabilitative Therapies – physical therapy involves targeted exercises to improve strength, mobility, and flexibility. Occupational therapy helps individuals regain independence in their everyday activities and will work on things like dressing, bathing, etc. They often encourage the use of adaptive devices and techniques as necessary.

Medical equipment – there are many things you can introduce to your home and your life that can help make things easier after a lumbar spinal cord injury, such as:

  • Wearable orthotic devices such as special shoes or braces can help promote musculoskeletal alignment, provide support, and keep you comfortable as you move about your daily life.
  • Mobility devices like canes, walkers, or wheelchairs can help you navigate your community with more independence.
  • Adaptive equipment, such as leg lifters, reachers, and transfer benches, can also provide more independence and make your home more accessible.
  • Car adaptations such as wheelchair locking mechanisms and hand controls can help those with a lumbar spinal cord injury learn to drive again, which is extremely important to some.

Emotional support – lumbar spinal cord injuries are devastating, debilitating, and so often life-changing. In addition to physical recovery, many struggle mentally and emotionally with the drastic life change and go through the process of grieving their old life. This can quickly lead to depression and its associated symptoms, so it’s crucial that those with a lumbar spinal cord injury seek the help they need. This can include regular sessions with a therapist and joining support groups.

Medical interventions – for some, surgery may be recommended to help improve their condition. They may be able to decompress the spinal cord, manually lengthen spastic muscles or tendons, stabilize the spinal column, and minimize the hyperactivity of any spastic muscles. Some may also be prescribed medication to help with various secondary issues such as chronic pain, spasticity, constipation, etc.

Should I Hire a Spinal Cord Injury Lawyer?

The financial implications of a lumbar spinal cord injury can be substantial, as many individuals may need to take extended time off work for treatment, rehabilitation, and adaptation to their new circumstances. There will also be a variety of medical expenses to consider.

If your injuries were the result of someone else’s negligence or carelessness, it’s advisable to hire a Hamilton spinal cord injury lawyer to help you seek appropriate compensation or initiate a lawsuit if necessary. Those injured from a car accident, motorcycle accident, pedestrian accident, or something similar also have access to accident benefits in Ontario. These complex benefits provide support for income replacement, rehabilitation, and other medical expenses regardless of who was at fault. However, securing these benefits can be challenging due to the various regulations and coverage levels, and the need for documentation and proof to justify your claim. This is where the help of a Hamilton spinal cord injury lawyer and their experience becomes invaluable.

A lawyer will also work closely with an occupational therapist to develop a comprehensive recovery plan and determine future needs. This plan is designed to help individuals adapt to their new reality and gain confidence in navigating their daily lives. This will help determine what level of financial compensation you should seek, and an experienced spinal cord injury lawyer can help ensure that you get the maximum compensation possible for your circumstances.

Call Our Hamilton Spinal Cord Injury Lawyers for a Free Consultation

Our firm has extensive experience with lumbar spinal cord injury claims and will help you secure the support and compensation you deserve. We’ll guide you through the entire process, help gather the necessary medical evidence, and work closely with you and a qualified occupational therapist to ensure you’re recovering and adapting well.

We’ll also represent you when necessary and negotiate with insurance companies on your behalf. Nothing can reverse the pain, loss, and devastation you’ve experienced as a result of a spinal cord injury, but proper financial compensation can relieve much of the financial stress associated with lost wages, medical expenses, and the uncertainty of the future. We’ll navigate the legal complexities of your case so you can focus all your time and energy on healing, recovering, and getting your life back on track.

Our consultations are always free. We’ll thoroughly review your case, listen to your concerns, and provide advice on how to proceed.

Call our Hamilton Spinal Cord Injury Lawyers today, no matter where you are in Ontario, at 1-844-LALANDE or local throughout Southern Ontario at 905-333-8888. Alternatively, you can contact us online, confidentially, by filling out a contact form. You may also have a social worker or nurse practitioner reach out to us on your behalf if you can’t.



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