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C3 Spinal Cord Injury: What to Expect and How to Recover

c3 spinal cord injury illustration

A C3 spinal cord injury (SCI) can affect movement and sensation from the neck down.

Fortunately, by participating in rehabilitative therapies and effectively managing secondary complications, individuals can learn to become as functional as possible and maybe even recover movement.

To help you understand what to expect after a C3 SCI, this article will discuss potential outcomes and how to manage them.

Complete vs. Incomplete C3 Spinal Cord Injury

complete vs incomplete c3 spinal cord injury

The severity of a C3 spinal cord injury significantly affects one’s functional outcomes and recovery outlook. One way to measure the severity of an SCI is to determine whether it is complete or incomplete through a CT scan or MRI.

A complete spinal cord injury refers to damage that cuts all the way across the spinal cord, leaving no spared neural pathways. As a result, no motor control or sensation will exist below the level of injury.  

In contrast, an incomplete spinal cord injury refers to partial spinal cord damage. Some neural pathways will be spared and consequently, some motor and/or sensory functions below the level of injury may be unaffected.                                             

Spared neural pathways are essential for recovery because they’re capable of using neuroplasticity. Neuroplasticity is the central nervous system’s ability to adapt and reorganize itself so that functions weakened by SCI can be relearned. The less severe a spinal cord injury is, the more spared neural pathways exist, and the better the recovery outlook.

In the next section, we’ll discuss what to expect after a C3 spinal cord injury.

What to Expect After C3 Spinal Cord Injury

The C3 level of the spinal cord is the third uppermost segment (out of 31 segments) of the spinal cord. This means that individuals with complete C3 injuries only have 3 segments of the spinal cord where sensory and motor functions are intact and unaffected.

The C1 and C2 segments of the spinal cord generally control the muscles that allow you to nod your head up and down as well as sensations at the upper neck and head. The C3 spinal nerves are responsible for neck side flexion, which is the ability to tilt your neck to the side.

As a result, individuals with C3 spinal cord injuries should be able to move their heads and necks normally. Depending on the severity of the injury, functions below the neck may or may not be affected. Functional outcomes and the onset of secondary complications can vary significantly.

Below, we’ll discuss 7 common outcomes of C3 SCI:

1. Breathing Difficulties

c3 spinal cord injury patient with ventilator

The C3-C5 spinal nerves innervate an important muscle for breathing called the diaphragm. Damage at the C3 spinal cord can affect your diaphragm which, without immediate medical attention, can be fatal.

Individuals with C3 spinal cord injuries often require ventilator assistance to restore breathing, at least initially. Depending on the severity of the injury and the effectiveness of rehabilitative interventions, it is possible for individuals to strengthen breathing functions and gradually wean off ventilator dependence.

2. Paralysis from the Neck Down

A C3 spinal cord injury results in quadriplegia, which refers to paralysis of the arms, trunk, and legs.

Depending on the severity of your spinal cord injury, you may be able to move and/or feel sensation below your level of injury.

However, in the case of a complete C3 SCI, individuals experience paralysis from the neck down and require full-time caregiver assistance.

3. Changes in Body Composition

Because spinal cord injuries at the C3 level can significantly affect most body movements, individuals often experience physical changes to the body as a result of limited active movement

Consequences of reduced physical activity include:

  • Reduced bone density
  • Muscle atrophy
  • Poor circulation
  • Lowered resting metabolic rate

Likewise, individuals may initially lose a substantial amount of weight due to reduced bone density and muscle mass. However, they may also gain weight because they continue to consume the same amount of food as they did when they were more physically active.

4. Bowel and Bladder Dysfunction

If messages from the bowel and bladder cannot pass through the damage in the spinal cord to reach the brain, then individuals with C3 spinal cord injuries may experience changes to their bowel and bladder functions. As a result, they will not be able to sense when their bladder or bowels are full and are susceptible to leaking and accidents.

Complications of bladder and bowel dysfunction include urinary retention, kidney damage, infection, and constipation.

To prevent bowel and bladder-related accidents from occurring, it’s essential for individuals with C3 SCIs to follow a bowel and bladder program.

5. Pressure Sores

pressure sores after c3 spinal cord injury

If individuals lose sensation after a C3 spinal cord injury, they likely won’t feel antsy when sitting or lying in the same position for prolonged periods. However, failure to frequently change positions places too much pressure on certain parts of the skin, which can cut off blood flow and cause the skin to break down. Areas of skin breakdown due to prolonged periods of sitting or lying down are known as pressure sores.

Pressure sores most commonly develop in bony areas like the hip bones, heels, knees, tailbone, and elbows.

To prevent pressure sores from developing, change positions every two hours when lying in bed or every 30 minutes when sitting in your wheelchair. Additionally, inspecting your skin daily can help identify and treat pressure sores early before they become problematic.

6. Autonomic Dysreflexia

The autonomic nervous system regulates involuntary body functions like body temperature, blood pressure, and heart rate. After a C3 spinal cord injury, individuals may experience autonomic dysreflexia, which occurs when these functions become hyperactive due to the disrupted transmission of messages between the brain and body.

Generally, any stimulation (wearing tight clothes, extreme temperatures, pressure sores, etc.) below the level of injury can trigger autonomic dysreflexia. As a result, individuals may experience a spike in blood pressure, feelings of panic, and flushed skin.

Because signals from the brain may not be able to reach areas below the level of injury, individuals may experience contrasting symptoms above and below their level of injury.

Generally, autonomic dysreflexia can be resolved by identifying what is triggering the episode and removing it. It’s essential for individuals with C3 spinal cord injuries and their caregivers to be alert and mindful of their surroundings.  If symptoms persist, seek immediate medical attention.

7. Spasticity

Following a C3 spinal cord injury, individuals may experience spasticity. Spasticity describes involuntary muscle contractions that can worsen with movement.

Because messages between the brain and areas below the level of injury are disrupted by SCI, spastic muscles are unable to receive signals from the brain to relax and therefore, remain tightened. This can cause stiff movements, jerks, and chronic pain.

Up next, we’ll discuss rehabilitation for C3 spinal cord injuries.

C3 Spinal Cord Injury Recovery

rehabilitation therapy for c3 spinal cord injury

Every C3 spinal cord injury is unique, so a personalized rehabilitation plan that addresses your specific needs is essential.

Rehabilitation for C3 spinal cord injuries can consist of:

  • Physical therapy. At physical therapy, a physical therapist will assess your functional abilities and guide you through targeted exercises that can help you improve your mobility. Consistently practicing these exercises will help promote neuroadaptive changes in the spinal cord.
  • Occupational therapy. Occupational therapy will help individuals prepare for everyday life with a C3 SCI. This can involve practicing activities of daily living, learning adaptive techniques, and preparing to return to work.
  • Speech therapy. Individuals with weakened respiratory functions after a C3 SCI should work with a speech therapist for a voice assessment and related impairments.
  • Psychotherapy. Adjusting to life after a C3 SCI can be difficult and take a toll on your mental health. Working with a psychotherapist can help you learn effective ways to cope.
  • Medications. Medications may be prescribed to help manage secondary complications like pain, spasticity, and depression.
  • Orthotics. Orthotic devices like braces and splints will help promote correct musculoskeletal alignment.
  • Bowel and bladder programs. Following a bowel and bladder program will help prevent bowel and bladder-related accidents. This can involve following a schedule, catheterization, and using suppositories.
  • Adjusting one’s diet. Modifying your diet can help prevent excess weight gain, promote bowel and bladder movements, and improve energy levels to participate in rehabilitative therapies.

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C3 Spinal Cord Injury: Key Points

A C3 spinal cord injury can affect movement and sensation below the neck. However, depending on the severity of their injury, individuals may be able to move or feel areas below the level of injury.

By participating in rehabilitative therapies and effectively managing secondary complications, individuals can become as functional as possible and improve their quality of life.

Hopefully, this article helped you better understand the effects of a C3 spinal cord injury. Good luck!

Photo credits: iStock/demaerre/LSOphoto

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