Levels of Injury

Vertebrae are grouped into sections. The higher the injury on the spinal cord, the more dysfunction can occur.

High-Cervical Nerves (C1 – C4)

  • Most severe of the spinal cord injury levels
  • Paralysis in arms, hands, trunk and legs
  • Patient may not be able to breathe on his or her own, cough, or control bowel or bladder movements.
  • Ability to speak is sometimes impaired or reduced.
  • When all four limbs are affected, this is called tetraplegia or quadriplegia.
  • Requires complete assistance with activities of daily living, such as eating, dressing, bathing, and getting in or out of bed
  • May be able to use powered wheelchairs with special controls to move around on their own
  • Will not be able to drive a car on their own
  • Requires 24-hour-a-day personal care

Low-Cervical Nerves (C5 – C8)

  • Corresponding nerves control arms and hands.
  • A person with this level of injury may be able to breathe on their own and speak normally.
  • C5 injury
    • Person can raise his or her arms and bend elbows.
    • Likely to have some or total paralysis of wrists, hands, trunk and legs
    • Can speak and use diaphragm, but breathing will be weakened
    • Will need assistance with most activities of daily living, but once in a power wheelchair, can move from one place to another independently
  • C6 injury
    • Nerves affect wrist extension.
    • Paralysis in hands, trunk and legs, typically
    • Should be able to bend wrists back
    • Can speak and use diaphragm, but breathing will be weakened
    • Can move in and out of wheelchair and bed with assistive equipment
    • May also be able to drive an adapted vehicle
    • Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment
  • C7 injury
    • Nerves control elbow extension and some finger extension.
    • Most can straighten their arm and have normal movement of their shoulders.
    • Can do most activities of daily living by themselves, but may need assistance with more difficult tasks
    • May also be able to drive an adapted vehicle
    • Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment
  • C8 injury
    • Nerves control some hand movement.
    • Should be able to grasp and release objects
    • Can do most activities of daily living by themselves, but may need assistance with more difficult tasks
    • May also be able to drive an adapted vehicle
    • Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment

Thoracic vertebrae are located in the mid-back.

Thoracic Nerves (T1 – T5)

  • Corresponding nerves affect muscles, upper chest, mid-back and abdominal muscles.
  • Arm and hand function is usually normal.
  • Injuries usually affect the trunk and legs(also known as paraplegia).
  • Most likely use a manual wheelchair
  • Can learn to drive a modified car
  • Can stand in a standing frame, while others may walk with braces

Thoracic Nerves (T6 – T12)

  • Nerves affect muscles of the trunk (abdominal and back muscles) depending on the level of injury.
  • Usually results in paraplegia
  • Normal upper-body movement
  • Fair to good ability to control and balance trunk while in the seated position
  • Should be able to cough productively (if abdominal muscles are intact)
  • Little or no voluntary control of bowel or bladder but can manage on their own with special equipment
  • Most likely use a manual wheelchair
  • Can learn to drive a modified car
  • Some can stand in a standing frame, while others may walk with braces.

Lumbar Nerves (L1 – L5)

  • Injuries generally result in some loss of function in the hips and legs.
  • Little or no voluntary control of bowel or bladder, but can manage on their own with special equipment
  • Depending on strength in the legs, may need a wheelchair and may also walk with braces

Sacral Nerves (S1 – S5)

  • Injuries generally result in some loss of functionin the hips and legs.
  • Little or no voluntary control of bowel or bladder, but can manage on their own with special equipment
  • Most likely will be able to walk