By Matt Lalande in Spinal Cord Injuries on May 01, 2021
Spinal cord injury, or SCI, is no doubt a traumatic, life-altering experience that affects not only the individual suffering the injury but his or her family and friends as well. Spinal cord injuries can happen to anyone-young or old, male or female, of any race, religion, or socioeconomic status. SCI’s are often caused by trauma – for example – in motor vehicle accidents, pedestrian accidents, bicycle accidents or diving accidents – but they can also result from non-traumatic medical conditions such as tumors or infections.
Depending on the location of an spinal cord injury, movement and sensation may be lost in both the arms and the legs (tetraplegia, formerly known as quadriplegia), or just in the legs (paraplegia). In other words, the parts of the body affected depend on the section of the spinal cord involved.
In the most general terms, cervical spinal cord injuries, or the higher up in the cord (higher up in the neck) an injury occurs, the more parts of the body may be paralyzed and subsequently, the greater the potential loss of function. Injuries to the higher neck area, as discussed below, are often the worst spinal cord injuries one could sustain, and often have the worst outcomes.
The spinal cord is a soft, rope-like structure that is made up of millions of nerves. It runs from the base of the brain to the lower part of the back. Its purpose is to carry information between the brain and, by way of the peripheral nerves, to other parts of the body, such as the arms, legs, and all of the organs in the body. Some of the nerves in the spinal cord send messages telling a particular body part to move in a certain way. Other nerve fibers send messages about heat, cold, or pain.
Some verve fibers tell your bladder or bowel to “hold on a little longer,” or “it’s OK to go now.” Others control your body’s involuntary (autonomic) activities, such as your blood pressure, body temperature, and sweating. In addition, information from various parts of your body travels back to the brain by way of the spinal cord.
Your spinal cord is surrounded and protected by 29 vertebrae which are the bones that make up the spinal column. The bones are stacked one on top of another and each has a hole, creating a canal through which the spinal cord passes. Your vertebrae are cushioned from one another by spongy material called disks. Ligaments (very tough and strong ropes) hold the vertebrae in the proper alignment.
Your spinal cord emerges from the base of your skull and ends at the lower part of the back. The peripheral nerves (also called spinal nerves) are paired and travel to various parts of the body. There are 31 pairs of spinal nerves, which are numbered according to sections of the spinal column.
Your cervical or neck section (C1 to C8), which includes 8 nerves and 7 vertebrae in the neck area. Your thoracic or chest section (T1 to T12), which includes 12 nerves and 12 vertebrae in the chest and abdomen (belly) area. Your lumbar or low back section (L1 to L5), which includes 5 nerves and 5 vertebrae in the lower back.
The spinal cord ends at the L2 level. Beyond this point, a collection of many nerves form the cauda equina, or “horse’s tail,” which is just what the bundle of nerves looks like. Your sacral section (S1 to S5) includes the lowest nerves exiting the spinal cord in the pelvic area (area of the buttocks). The sacrum is actually several vertebral bones that are fused, or attached, to form one large bone with 5 nerves emerging from holes in each side of the bone.
As mentioned above, the cervical spine is your neck area – and it consists of the C-1 to C-8 vertebrae in the neck and at the bottom of the skull. This section of the spinal cord is responsible for making a connection between the brain and the rest of the spinal cord, sending nerve signals and communications to their appropriate destination.
Each level of the cervical spine controls a different bodily function. Here is a quick breakdown of which areas of the body each level of the cervical spine is connected to:
Spinal Cord Injuries can arise from many causes, both traumatic and non-traumatic (disease-related) issues. Trauma to the spinal cord usually causes significant shifting of the vertebrae, which then pinch or crush the spinal cord within. This is what typically results when bones in the back are broken or ligaments are torn in a car crash, for example. Torn fragments of bone or disc may then enter the bony canal where the spinal cord sits and also directly injure by bruising, tearing, or cutting-its ting-its nervous tissue.
Motor vehicle accidents account for a large amount of traumatic spinal cord injury cases in Canada. Sports-related injuries to the spinal cord occur largely with sports such as diving, football, gymnastics, and surfing and cause quadriplegia, because these types of injuries most often affect the cervical spine, and often penetrate the spinal cord.
Non-traumatic spinal cord injuries can be caused by such disorders as multiple sclerosis, blood vessel disorders leading to bleeding around the spinal cord or a lack of blood supply to the spinal cord tumors (benign or cancerous), infections, developmental disorders and arthritis.
A cervical spinal cord injury occurs when the C-1 to C-8 vertebrae suffer damage from trauma such as a forceful blow to the neck, or from a non-traumatic cause such as osteoporosis or inflammation. When this trauma occurs, the nerve signals and transmitters in the cervical spine become compromised, and as a result they are unable to send signals from the brain to the body.
There are two types of spinal cord injury: complete spinal cord injury and incomplete spinal cord injury. A complete spinal cord injury is an injury that leads to complete loss of motor and sensory function below the level of injury (in this case, below the neck). Likewise, individuals with an incomplete spinal cord injury may retain some or limited function below the level of injury. The prognosis is usually better for those with incomplete spinal cord injuries because all functions have not been impaired, which can indicate the possibility for recovery.
A cervical spinal cord injury occurs when the spinal cord in the C1 to C8 vertebral levels is injured. Cervical spinal cord injuries are the most severe types of spinal cord injuries and often results in complete and permanent sensory loss and may result in quadriplegia. Trauma is the most common cause of cervical injuries in Canada.
Cervical spinal cord injuries are devastating because the higher on the spinal cord your injury occurs, the greater the effect on movement, sensation, and other body functions. Tetraplegia (formerly called quadriplegia) refers to an injury to the cervical (neck) section of the spinal cord.
It can involve either partial or complete loss of movement and/or feeling in the head, neck, shoulders, upper chest, arms, and legs. Paraplegia refers to an injury in the thoracic, lumbar, or sacral sections of the spinal cord. It can involve either partial or complete loss of movement or feeling in the chest, stomach, hips, legs, and feet. Tetraplegia is slightly more common than paraplegia.
In addition to being described according to the level of injury, SCI is described according to the severity of the injury. A complete injury is one that results in no voluntary movement and no measurable feeling below the level of injury. An important point is the term “voluntary” movement or movement that you are able to start, stop and completely control. Often after a spinal cord injury you will experience spasms, or parts of your body moving or “jumping” without your controlling this movement. This is called “involuntary” movement. Similarly, “feeling” is defined as some sensation found by your doctor during neurologic testing.
Many people have involuntary movements or experience “feelings” in their legs or other body parts, yet the injury is still called “complete.” The fact that you have a complete injury doesn’t mean these movements or feelings don’t exist; they just can’t be measured accurately during neurologic testing. An incomplete injury is one in which there is some measurable feeling and/or voluntary movement below the level of the injury. A doctor or health care professional who specializes in treating people with SCI can help you determine if your injury is complete or incomplete.
A complete cervical spinal cord injury is typically the most severe type of spinal cord injury a victim could suffer. C-1 to C-3 level cervical spine injuries occur at the bottom of the head and the top of the neck, which is the closest part of the spinal cord to the brain. Therefore, injuries at this level are the most likely to lead to tetraplegia, a type of paralysis wherein all four of the body’s limbs and the torso are paralyzed. Injuries to the spinal cord in the C1-C2 are rare, and account for less than 1% of spinal injuries in Canada each year, but are considered the worst SCI that it is possible to sustain, and often fatal.
The image below helps in understanding the various outcomes of a spinal cord injury, particularly at the c1 to c7 levels.
According to Dr. Stevem Kirshblum, in the book Spinal Cord Injury Medicine, individuals who suffer C1 to C3 tetraplegia may be ventilator dependent, and require total assistance with chest percussion and assistive cough, bladder management, catheter management, bowel management, require total assistance for dressing, eating, bathing, grooming and brushing teeth. Individuals with C1 to C3 tetraplegia also require total assistance for all housework and kitchen work, bed mobility, transportation, wheelchair and bed transfers, hydraulic lift transfers etc.
Individuals with C4 tetraplegia may breathe on their own, maybe require total assistance for catheter use, bowel routine, dressing, eating, bathing, grooming and teeth brushing. Dr. Thomas Bryce notes in his book “Spinal Cord Injury” (as part of the Rehabilitation Medicine Quick Reference series) that individuals with C4 tetraplegia with some elbow flexion and deltoid strength may use a mobile arm to support with feeding, grooming and bathing. Individuals with C4 tetraplegia may be independent to total assistance needed for communication telephoning, depending on adaptive devices. With respect to mobility, total assistance is needed for transportation, bed mobility, we’ll chair in bed transfers, hydraulic lift transfers but are independent with power wheelchair propulsion with the appropriate controls.
Dr. Bryce also notes that individuals with C-5 tetraplegia require total assistance for upper and lower body dressing, minimal assistance and set up needed for teeth brushing and grooming with adaptive equipment, total assistance needed for the setup of meals but can be independent and feeding with adaptive equipment such as a wrist splint and utensil holder or universal cuff, bed fork or spoon, nonslip mat, plate garden possibly a mobile arm support. Total assistance is needed with all housework and kitchen work. Mobility is improved with lower-level injuries. Individuals with C-5 tetraplegia may be independent and driving a van with a wheelchair lift and hand controls from a secured wheelchair, and independent with power wheelchair propulsion with an arm drive control.
Individuals with C6 tetraplegia are independent for pressure reliefs in a manual or power wheelchair. Some to total assistance is needed for lower body dressing with adaptive devices. Individuals with C6 tetraplegia are independent for toothbrushing with a universal cuff or electric toothbrush, upper extremity bathing, eating with or without adaptive equipment but total assistance is still needed for all housework and kitchen work.
Individuals with C7 tetraplegia may be independent with eating, teeth cleaning, upper and lower body dressing (with adaptive equipment) independent for light meal preparation and very light housework, independent with driving a car or van with hand controls, minimum assistance is needed transfers, power wheelchair mobility and bed mobility.
Life after a cervical spinal cord injury can be difficult and disabling, preventing a victim from enjoying the activities they once loved or from being able to return to work. A basic action such as brushing one’s hair may become impossible for someone living with a cervical spine injury, making it incredibly difficult to adjust to any type of lifestyle when returning home from rehabilitation.
Victims with the highest level of cervical spine injury may suffer a complete loss of independence, requiring 24-hour assistance with daily activities such as managing bowel and bladder functions, getting dressed, brushing their teeth, housekeeping, communication, and movement.
In addition to the physical impairment and pain, individuals with tetraplegia are often at significantly high risk for other medical complications or conditions in the future that could potentially have fatal consequences. These complications include conditions such as deep vein thrombosis, pressure ulcers, pneumonia, urinary tract infections, blood clots, and/or cardiovascular disease.
Further, the psychological impact of a cervical spine injury can be just as devastating as the physical impact. Severe depression and anxiety are very common in spinal cord injury victims. In fact, a study published by the Mayo Clinic found that 19.3% of adults with spinal cord injury had anxiety disorder (compared to 14.1% of the non-injured population). Further, the study also showed that 29.3% of spinal cord injury victims had severe depression (compared to 9.3% of the non-injured population) and 37.4% of those victims reported more than one mental health condition. The loss of independence and mourning for the life you once lived can lead to feelings of low self-worth, paranoia, sadness, and even suicidal thoughts or substance abuse.
In addition, there is the costs of care that will require consideration. The economic burden of a spinal cord injury, throughout a victim’s lifetime, depending on the age in the location of injury on the spinal cord, can range anywhere from five to $15 million. Tetraplegia victims will require such direct costs as prescription drugs, nonprescription items, adaptive equipment, home modifications, vehicle modifications, long-term institutional care, attendant care, mobility equipment etc.
Depending on who causes the accident, which causes the injury, insurance availability may be limited. For example, most automobile policies in Ontario carry limits of $1 to $2 million. Accident benefit recovery is limited to $1 million. In most scenarios, paraplegic or tetraplegia victims are left with no more than $3 million, less lawyer fees, to cover their estimated lifetime economic burden.
However, the accident is caused by the commercial vehicle, those limits may be higher. We have been cases where limits on transport trucks ranged from two to $10 million.
That being said, insurance companies simply don’t hand over money. or your loved one still is the onus of proving that you will require the costs of care that you’re seeking. Typically, our firm retains occupational therapists and professional life care planners to implement a life care and future care costs plan. Although estimating acute care costs is different for every accident victim, the professionals that we hire are able to propose a reasonable trajectory of estimated lifetime costs.
It’s important that you speak to a spinal cord injury lawyer at our firm sooner rather than later so that we may help put insurance issues and your spinal cord injury team together sooner rather than later.
Spinal Cord Injuries no doubt have a debilitating and lifelong impact on the injured victim and his or her family. Besides the physical impact of your injuries, many aspects of your daily functions will be affected, including the ability to care for yourself, the ability to work or take part in social community activities. Over the past several decades there has been rapidly increasing knowledge of the medical, physical and emotional social impact of a spinal cord injury, and although advances in treatment have led to a better quality of life and reduction in mortality, however, there are still very serious consequences and costs that need to be addressed for spinal cord injury victims in Ontario to live with an acceptable and enjoyable quality of life.
It’s important that you speak to a spinal cord injury lawyer sooner rather than later. It’s important that your spinal cord injury lawyer retain the appropriate life care planner professionals and occupational therapists to assist in obtaining the maximum amount of compensation possible in your case. Again, insurance company simply won’t hand over money because you suffer spinal cord injury. You still have to prove your losses in that you will require compensation for the rest of your life – and you cannot do this alone.
Our Hamilton spinal cord injury law firm represents spinal cord injury victims all over the Province. If you or your loved one has been suffered a spinal cord injury, call us no matter where you are in Ontario at 1-844-LALANDE or local in them Hamilton/GTA/Niagara area at 905-333-8888. We would be happy to speak with you any time, seven days a week.