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Cervical Spinal Cord Injury: What to Expect At Each Level of Injury

understanding cervical spinal cord injury

Cervical spinal cord injury is a serious, life-threatening emergency that can cause paralysis throughout the entire body.

Depending on the level and severity of a cervical spinal cord injury, it can affect major body functions like breathing and mobility from your neck down.

This article will help you understand what to expect after a cervical SCI by guiding you through the functions affected at each level of injury.

Understanding Cervical Spinal Cord Injury

The cervical spine consists of the first 7 vertebrae that primarily make up your neck.

Encased within the spine is the spinal cord, which has 8 cervical nerve segments.

Because it bears less weight and has a greater range of motion, the cervical region is less stable than lower regions of the spine. As a result, almost 60% of all spinal cord injuries are cervical and often result in the loss of motor function and sensation in both the arms and legs.

Depending on your level of injury, upper body mobility and sensation can significantly vary.

Now that you have a basic overview of what a cervical spinal cord injury is, let’s discuss how it can affect different functions in the body.

Effects of Cervical Spinal Cord Injury

cervical spinal cord injury and quadriplegia

Depending on the severity and level of your injury, cervical spinal cord injuries can affect a wide variety of functions including:

After a complete spinal cord injury, signals from the brain can’t get past the spinal cord damage. In an incomplete spinal cord injury, some (but not all) signals can be transmitted past the level of injury. As a result, control of functions innervated below your level of injury will be impaired.

The higher your spinal cord injury is located, the more areas of your body can potentially be affected. This is why the road to recovery is often longer for cervical spinal cord injury patients. There are more functions that need rehabilitation.

In the following section, we’ll explain what functions are innervated at each level of injury.

What to Expect at Each Level of Cervical Spinal Cord Injury

Dermatomes for cervical spinal cord injury

Each level of cervical spinal cord injury will directly affect a different set of muscles and area of skin. Level of injury is determined by the lowest area where sensory and motor functions are unaffected.

Below, you can find information on your specific level of injury based on the international standards for neurological classification.

C1 Spinal Cord Injury

C1 spinal cord injury is the most severe type of cervical spinal injury.

Often, it is fatal. Luckily, it is rare and only makes up about 1.2% of all SCIs.

The C1 vertebra is also called the atlas. It connects the skull to the spine and helps support the head, allowing it to make up-and-down nodding motions.

After a C1 spinal cord injury, the following can occur:

  • Paralysis from the neck down
  • Loss of independent breathing (will require ventilator assistance)
  • Full caregiver assistance due to extremely limited mobility
  • Communication difficulties (ability to talk can be affected)

Learn more about C1 spinal cord injury »

C2 Spinal Cord Injury

Because the C1 and C2 spinal nerves are closely aligned, C2 spinal cord injuries often result in similar outcomes.

The C2 vertebra is also known as the axis and it allows you to rotate your head side-to-side as if signaling ‘no’.

Along with the atlas, the axis helps support the head and provide the neck with a greater range of motion than the rest of the spine.

After a C2 spinal cord injury, the following can occur:

  • Paralysis from the neck down
  • Loss of independent breathing (will require ventilator assistance)
  • Full assistance of a caregiver needed
  • Limited speaking ability

Read more about C2 spinal cord injury »

C3 Spinal Cord Injury

The C3-C5 spinal nerves innervate the diaphragm, which is the main muscle involved in breathing.

Additionally, individuals with C3 spinal cord injuries will generally have sensation at their neck.

Common results of a C3 spinal cord injury include:

  • Improved head and neck control (after spinal cord damage has stabilized)
  • Intact neck side flexion (the ability to tilt your head to the side)
  • Loss of independent breathing (will require ventilator assistance)
  • Paralysis of the arms, legs and trunk

Discover more about C3 spinal cord injury »

C4 Spinal Cord Injury

C4 spinal cord injury patients may only require temporary ventilator assistance because the C3 spinal nerves are unaffected.

With the help of breathing and coughing exercises, many C4 patients can wean off the ventilator and achieve independent breathing.

Other outcomes of C4 spinal cord injury include:

  • Full head and neck mobility
  • Partial shoulder mobility
  • Breathing difficulties/ weakness

Learn more about C4 spinal cord injuries »

C5 Spinal Cord Injury

A C5 spinal cord injury directly affects sensation around the outer area of the upper arm.

Additionally, the C5 spinal nerves connect to the deltoids (which are responsible for shoulder movement), biceps, and brachioradialis (which are responsible for elbow flexion and upward rotation of the forearm).

Individuals with C5 spinal cord injuries may experience the following:

  • Normal head, neck, and shoulder movements
  • Full sensation at head, neck, shoulders, and outer upper arms
  • Ability to raise the arms and bend the elbows
  • Breathing weakness (but usually no need for ventilator assistance)

Read more about C5 spinal cord injuries »

C6 Spinal Cord Injury

After a C6 spinal cord injury, patients usually retain more arm mobility.

With the help of specialized adaptive tools like grip attachments, C6 spinal cord injury patients should be able to perform everyday tasks like eating, grooming, and getting dressed on their own.

Some positive effects of C6 spinal cord injury include:

  • Full head, neck, and shoulder mobility
  • Ability to raise the arms, bend the elbows, flip hand palm up and palm down, and extend the wrists
  • Normal sensation in the head, neck, shoulders, and outer areas of the arms
  • Ability to use tenodesis grasp patterns

Find out more about C6 spinal cord injuries »

C7 Spinal Cord Injury

Due to increased mobility of the upper extremities, C7 spinal cord injury patients generally have a great deal of independence. With a C7 level of injury, individuals gain more motor control of their arm and hand, but still are unable to fully bend the fingers.

C7 spinal cord injury should be able to:

  • feel sensations at the head, neck, shoulder, arms, index fingers, and thumbs
  • demonstrate full range of motion in the shoulders and neck
  • raise the arms
  • bend and straighten the elbows
  • bend and straighten the wrists
  • extend the fingers

Learn more about C7 spinal cord injuries »

C8 Spinal Cord Injury

Lastly, we’ll discuss what to expect after a C8 spinal cord injury.

Generally, C8 SCI patients can carry out activities of daily living on their own because the majority of their upper body functions are normal.

After a C8 spinal cord injury, patients can expect:

  • Full range of motion in the wrists, elbows, shoulders, and neck
  • Hand weakness
  • Normal sensation in the fingers, arms, shoulders, neck, and head

C8 patients should practice hand exercises to help recover strength and dexterity in their fingers.

Discover more about C8 spinal cord injuries»

Cervical Spinal Cord Injury: Key Points

Cervical spinal cord injuries are the most common type of spinal cord injuries. 

Depending on the level of injury, cervical SCIs can directly affect mobility in the neck, arms, and fingers. They often can result in trunk and lower body paralysis, depending on the severity of injury.

As you’ve just learned, higher-level cervical SCIs have very different functional and sensory outcomes than lower-level injuries.

However, it’s also important to understand that less severe spinal cord lesions will result in fewer impairments. As a result, you may still be able to feel and control areas of your body that are innervated below your level of injury.

Keep in mind that recovery after incomplete spinal cord injuries is possible. Typically, after the spinal cord stabilizes, some functions may start to return. With intensive therapy, most spinal cord injury patients recover at least some mobility and sensation over time.  

Hopefully, this article helped you better understand what to expect after a cervical spinal cord injury. Good luck!

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