Wondering what to expect after a complete vs incomplete spinal cord injury?
Completeness of injury refers to the amount of sensorimotor function you have following spinal cord injury.
It greatly impacts your recovery outlook and chances of experiencing secondary complications.
This article will clear up some common misconceptions about complete vs incomplete spinal cord injuries.
Complete Spinal Cord Injury
A complete spinal cord injury means that you have no feeling and no control below your level of injury.
Why? The damage to the spinal cord prevents messages from traveling between your brain and body.
Because the nerves from the spinal cord are unable to receive messages from the brain, the body becomes completely paralyzed below the level of injury.
Complete spinal cord injuries can occur due to a large, single lesion or multiple smaller lesions that block off neural connectivity in the spinal cord.
Incomplete Spinal Cord Injury
Incomplete spinal cord injury is when a person has some feeling or movement below the level of injury.
This means that the spinal cord can still send some messages between the brain and body, and that the pathway is not completely compromised.
You can think of incomplete spinal cord injury as partial paralysis.
Unlike complete spinal cord injuries, there’s a lot of room for functional variations between patients with incomplete spinal cord injuries.
ASIA Impairment Scale
Based on how much sensorimotor control you have, you will fall under one of five categories.
AIS A is when one is unable to feel anything below the injury level. Sound familiar? That’s because AIS A is a complete injury.
In contrast, AIS B, C, and D all describe incomplete spinal cord injuries.
AIS B is when you can feel some sensation below the injury but cannot control muscle movement.
AIS C is when you can feel and have some motor control. This means that more than half of your key muscles below the level of injury have a muscle grade less than 3.
AIS D is when you can feel and have strong muscle movement (when more than half your key muscles below your level of injury have a muscle grade of 3 or more).
Lastly, AIS E is when sensorimotor functions are normal.
Can a Complete Spinal Cord Injury Become Incomplete?
Immediately after a spinal cord injury, a process called spinal shock occurs.
Spinal shock is the result of biochemical processes that occur after a spinal cord injury in an attempt to heal the spinal cord.
However, this process is also very harmful to the spinal cord and results in a lot of oxidation, reduced blood flow, swelling, inflammation, and cell deaths.
Spinal shock is caused when there’s too much swelling in the spinal cord, which cuts off blood flow. When the spinal cord (or any part of the body) doesn’t receive enough blood, it starts to dysfunction.
Swelling of the spinal cord cuts off functions below the lesion, which is why people in spinal shock will experience hyporeflexia below the level of injury.
Hyporeflexia is when the muscles stay floppy and loose. They become like this because they don’t receive any signals from the brain.
Once the swelling starts to die down and blood starts flowing through the spinal cord again, reflexes will gradually start to return.
The spinal lesion itself has not recovered, the amount of blocked neural pathways due to swelling has.
It’s only after spinal shock that you can get an accurate idea of what functions you really can and can’t control.
Therefore, diagnosing complete or incomplete spinal cord injuries requires spinal shock to subside, which can last anywhere between a few days to a few months.
Seeking immediate medical treatment after spinal cord injury will help minimize swelling.
Complete vs Incomplete Spinal Cord Injury Recovery
One of the greatest barriers of spinal cord regeneration is that scarring forms around the lesion.
This helps prevent inflammation from traveling to other parts of the spinal cord, but also blocks the rest of the spinal cord from passing through the lesion site.
With incomplete spinal cord injuries, there are still active connections between the brain and body.
Through neuroplasticity (the central nervous system’s ability to adapt and rewire itself), your spinal cord can work around the lesion to promote axonal sprouting and synaptic plasticity in those active connections.
The best way to activate neuroplasticity is through lots of repetition. Essentially, you have to reteach your body how to move again and strengthen the new neural pathways by constantly using them.
Recovery from a complete spinal cord injury is definitely more complex because it involves more damage and because there are no active connections to work with.
But don’t lose hope just yet! Next, we’ll go over some promising research for spinal cord injury recovery.
Treatments for Complete and Incomplete Spinal Cord Injuries
Currently, there is no cure to reverse the damage caused by spinal cord injury.
Medical intervention after spinal cord injury generally consists of stabilizing the spinal cord through surgery and corticosteroids.
There are some very promising treatments in progress for both complete and incomplete spinal cord injuries.
Although incomplete spinal cord injury patients have a better recovery outlook, the following treatments are even getting people with complete spinal cord injuries back on their feet.
Epidural stimulation involves implanting a stimulator onto the spinal column that transmits small electric currents below the level of injury.
The electric currents mimic brain signals and excite neurons that stimulate your muscles to move.
A critical part of epidural stimulation is that you have to retrain your body how to move through intensive locomotor training because the spinal cord is reconnecting to the brain with a new pathway.
The more you repeat, the stronger the neural pathways in the central nervous system become and over time, the easier it will become to perform the movement.
Stem Cell Transplants
Stem cells are extremely versatile because they can differentiate into various cell types depending on the type of environment they’re placed in.
There are a lot of different sources of stem cells in the body. The idea is that if you use your own cells, the chances of your body rejecting them are much lower than if you were to get cells from another person.
Stem cells can also divide infinitely, which makes them ideal for damaged tissue regeneration.
Some complications that still need to be worked out include figuring out what type of stem cell to use, how much to use, getting FDA approval, randomizing and controlling the studies for consistent results, and accounting for the high cost of treatment.
Just like epidural stimulation, stem cell transplants require intensive locomotor training to reteach the body how to move again after spinal cord injury.
Complete vs Incomplete Spinal Cord Injury: Summary
Complete and incomplete spinal cord injuries are both traumatic events that can drastically affect your life.
Generally, incomplete spinal cord injuries have a better recovery outlook because they have neural connections that are still intact.
Many times, people mistake spinal shock for complete spinal cord injury and are pleasantly surprised to find some functions return.
Currently, there is no cure for spinal cord injury, but there are ways to manage its complications and still live a very fulfilling life.
Research for potential treatments is proving very promising and suggests a very hopeful future for spinal cord injury patients.
In the meantime, working around the injury and promoting neuroplasticity through intensive, repetitive exercise will help strengthen and recover functions.
Hopefully, this article helped you better understand the differences between complete and incomplete spinal cord injuries and inspires you to continue working hard toward recovery. Good luck!