The Devastation of a Cervical Spinal Cord Injury

Critical Cervical Concerns: the Severity of Cervical Spinal Cord Injuries

Spinal cord injury, or SCI, is a traumatic, life-altering experience that affects not only the individual suffering the injury but all those who surround the victim. Spinal cord injuries can happen to anyone old, male or female, of any race, religion, or socioeconomic status.

Spinal cord injuries are typically classified as traumatic or non-traumatic. Traumatic spinal cord injuries result from a sudden, external impact like car accidents or bicycle accidents, causing immediate damage to the spinal cord. Non-traumatic spinal cord injuries, however, arise from internal factors such as disease, degeneration, or compression of the spinal cord over time, without an abrupt external force.

Depending on the location of a 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.

Spinal cord injuries are particularly severe when the lesion is higher up on the neck because this region, known as the cervical spine, controls vital functions like breathing, as well as movements of the arms and, to some extent, the trunk. Damage here can result in a greater loss of mobility and sensory function, including quadriplegia, where all four limbs are affected. The higher the injury on the spinal cord, the more critical and widespread the impact tends to be, affecting a larger portion of the body and potentially leading to life-threatening complications.

A Review of Spinal Cord Anatomy

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 nerve 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), includes 12 nerves and 12 vertebrae in the chest and abdomen (belly) area.

Your lumbar or lower back section (L1 to L5), which includes 5 nerves and 5 vertebrae in the lower back.

The bottom of the spine, where the lumbar area ends, is at the lumbosacral junction, marking the transition from the lower back’s lumbar spine into the sacral region. This junction, featuring the last of the lumbar vertebrae (L1-L5) and the sacrum, is critical for support and movement, bearing significant weight and facilitating mobility. It’s also a common site for back pain due to its heavy load-bearing and high mobility.

The cauda equina, or “horse’s tail,” is a bundle of nerves located at the lower end of the spinal cord, extending from the L2 to S5 nerve roots. These nerves provide sensory and motor functions to the legs and pelvic organs. Cauda equina syndrome, a severe compression of these nerves, is a medical emergency characterized by back pain, motor weakness, and potential bladder or bowel dysfunction. Prompt treatment is vital to prevent lasting damage.

What is the Cervical Spine?

The cervical spine refers to the uppermost section of the vertebral column, comprising the first seven vertebrae (C1 to C7) located in the neck.

This delicate yet vital structure supports the head’s weight, enables a wide range of head movements, and protects the spinal cord, which transmits neural messages between the brain and the body.

The cervical spine’s distinctive features include the unique atlas (C1) and axis (C2) vertebrae, which allow for nodding and rotation, and its gentle lordotic curve, which helps absorb shock and maintain balance.

This region is both highly flexible and susceptible to injury, playing a crucial role in overall spinal health and function. 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, a breakdown of which is provided below:

• C1 to C3: These nerves primarily control the head and neck movements. C1 (also known as the Atlas) and C2 (Axis) are crucial for neck flexion, extension, and rotation. However, they don’t directly control facial muscles; those are innervated by cranial nerves. The phrenic nerve, which arises from C3 to C5, plays a role in controlling the diaphragm, not C1 to C3.
•  C4: This level does contribute to diaphragm control via the phrenic nerve (C3-C5) and shoulder movements. However, it’s not typically associated with upper arm control; that’s more C5 and C6.
•  C5: Controls the deltoids (shoulder muscles) and biceps, allowing for shoulder and elbow flexion. It also plays a role in diaphragm control along with C3 and C4.
•  C6: Primarily controls wrist extension and is important for the control of the biceps and wrist extensors. It also contributes to thumb extension.
•  C7: Controls the triceps (allowing for elbow extension) and also contributes to wrist flexion. It does play a role in finger extension and the control of some hand muscles.
•  C8: Controls some hand muscles, particularly those involved in finger grip and fine motor skills. It’s also involved in forearm muscles.

It’s important to note that while specific spinal cord segments are generally responsible for certain areas, there’s a significant overlap in innervation, and individual variation can occur. Also, the muscles and movements mentioned are typically the primary ones affected by the corresponding nerve root, but they aren’t the only ones influenced. For the most accurate and detailed information, consulting anatomical texts or a medical professional is recommended.

What is a Cervical Spinal Cord Injury?

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 in an accident, 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.

Why are Cervical Spinal Cord Injuries so Devastating?

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.

Cervical spinal cord injuries are often more serious than injuries in other areas of the spine for several key reasons:

1. Location and Functionality: The cervical spine is located in the neck and is responsible for supporting the head and connecting the brain to the rest of the body. This region contains the uppermost part of the spinal cord, which controls functions for almost the entire body below the neck.
2.  Vital Nerve Pathways: The cervical region houses pathways that control essential functions such as breathing, and arm and hand movement. An injury here can disrupt these critical pathways, potentially leading to paralysis of the arms, trunk, and legs (quadriplegia) and may even affect the ability to breathe independently.
3.  Limited Regeneration: The spinal cord has a limited ability to heal itself after injury. Damage to the nerve fibers in the cervical area can have widespread effects, impacting numerous bodily functions and leading to complex, multi-system challenges.
4.  Severity of Impact: Because of its position and range of motion, the cervical spine is more vulnerable to certain types of injuries, such as hyperextension or hyperflexion, especially during traumatic incidents like falls or car accidents. These injuries can be more severe due to the higher mobility and lesser stability of the cervical spine compared to the thoracic or lumbar regions.
5.  Complications: Injuries to the cervical spinal cord can lead to a range of severe complications, including chronic pain, loss of fine motor skills, respiratory issues, and susceptibility to secondary conditions like infections due to reduced mobility and sensation.
6.  Quality of Life Changes: The high level of paralysis and loss of independence associated with cervical injuries often requires significant lifestyle adjustments. Victims may need lifelong assistance with daily activities, experience changes in employment and social involvement, and require extensive rehabilitation and medical care.

Which Cervical Spinal Cord Injuries is the Worst?

The worst cervical spinal cord injury is typically considered to be a complete injury at the C1 or C2 level, often referred to as a high-cervical injury. Consider the following:

1. Location (C1 and C2 Vertebrae): The C1 vertebra, known as the atlas, and the C2 vertebra, known as the axis, are at the top of the cervical spine and are crucial for head and neck movement. An injury at this level affects not only the neck and head but also potentially all bodily functions below the neck.
2.  Complete Injury: A complete spinal cord injury means there is no sensory or motor function preserved in the spinal segments below the level of injury. When this occurs at the C1 or C2 level, it often results in the loss of almost all voluntary movement and sensation below the neck.
3.  Breathing Dependency: These high-cervical nerves control the diaphragm, which is essential for breathing. Damage at this level typically requires the injured person to rely on ventilatory support, such as a mechanical ventilator or diaphragmatic pacemaker, for the rest of their life.
4.  Quadriplegia: An injury at this level usually results in quadriplegia (also known as tetraplegia), which is the paralysis of all limbs. This means the individual will likely need full-time care and assistance with all daily activities.
5.  Life-Threatening Complications: High-cervical injuries come with a high risk of life-threatening complications, such as respiratory failure, pneumonia, or other infections. The body’s reduced ability to control blood pressure, heart rate, and body temperature can also lead to additional serious health issues.
6.  Prognosis and Rehabilitation: Recovery prospects are generally limited for high-cervical injuries, and extensive rehabilitation is required to adapt to new ways of performing daily tasks. Technological aids like voice-activated systems, adaptive devices, and powered wheelchairs become necessary for any level of independence.

C2 to C7 Cervical Spinal Cord Injuries

Due to the comprehensive loss of function and the life-altering impact on both the individual and their caregivers, a complete C1 or C2 injury is typically considered the most severe and devastating type of cervical spinal cord injury.

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 and may 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 of total assistance needed for communication telephoning, depending on adaptive devices. Concerning mobility, total assistance is needed for transportation and bed mobility, we’ll chair in bed transfers, and 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 setup 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 of 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, and 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.

The Long-Term Financial Complications of a Spinal Cord Injury

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. Although some home care is covered by provincial health plans, many individuals require additional support beyond what is provided. Hiring PSWs for daily activities and care can be one of the largest ongoing expenses.

Modified vehicles, which can include lifts and hand controls, are necessary for transportation and can be a significant expense.

Another significant expense includes modifying homes to make them wheelchair accessible. This can involve installing ramps, stairlifts, wider doors, accessible bathrooms, and specialized furniture, all of which can be costly.

Wheelchairs, particularly motorized ones, are costly and typically need replacement or repairs every few years. Other necessary equipment might include electronic beds, pressure-relieving mattresses, and respiratory aids.

Prescription costs for pain management, spasticity, bladder and bowel care, and other secondary conditions can also add up. While some costs may be covered, there are often out-of-pocket expenses for over-the-counter medications and ongoing medical supplies.

In addition to the physical impairment and pain, individuals with high cervical cord injuries such as 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. 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 are 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.

Financial Recovery for Spinal Cord Injury Victims – Was Someone at Fault?

If your injury is deemed a traumatic spinal cord injury that was caused by someone careless, then you may have a legal recourse to recover damages – but remember, you only have one chance at recovering compensation, so it’s vital to hire a personal injury lawyer with experience in spinal cord injuries.

If you were hurt by any type of vehicle, you will be entitled to access no-fault insurance benefits to assist with your medical, rehabilitation, and attendant care requirements throughout your life. Typically, unless “extra” benefits were purchased, the limit of recovery is one million ($1,000,000), in addition to certain other benefits that may assist you with visitors and replace your income.

You also have the right to pursue legal compensation against a motorist who hurt you. You will be able to recover both non-economic and economic damages, normally with limits of up to $2,000,000.00, unless you were involved in an accident with a commercial vehicle – where limits on transport trucks range from $2,000,000 to $10 million.

That being said, insurance companies simply don’t hand over money. You still have the onus of proving that you are entitled to damages and that it will be possible 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 can propose a reasonable trajectory of estimated lifetime costs.

You must 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.

Do I need a Spinal Cord Injury Lawyer?

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, and the ability to work or take part in social community activities.

Although advances in treatment have led to a better quality of life and reduction in mortality for spinal cord injury victims, there are still very serious consequences and costs that need to be addressed for spinal cord injury victims in Ontario to help them go on living an acceptable and comfortable quality of life.

You must speak to a spinal cord injury lawyer sooner rather than later. Your spinal cord injury lawyer must retain the appropriate life care planner professionals and occupational therapists to assist in obtaining the maximum amount of compensation possible in your case. Again, the insurance company simply won’t hand over money because you suffer a 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.

Determining your next steps after a Car Accident, Motorcycle Accident, Truck Accident, Pedestrian, or Bicycle Accident that caused your cervical spinal cord injury can be unclear – but we can help. Our Hamilton lawyers have recovered millions for spinal cord injury victims across Ontario since 2003 – and have the knowledge and experience to help you and your family in a time of need.

For immediate assistance anywhere in Ontario, contact us at 1-844-LALANDE. If you’re in the Southern Ontario area, reach out at 905-333-8888. Alternatively, you can send a confidential email through our website to set up a consultation and learn your legal options. Our team is ready to help you understand your rights and the legal pathways available for seeking justice and compensation.