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Cervical Spine Injury: What to Expect At Each Level of Injury

Cervical spine 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 spine injury by guiding you through the functions affected at each level of injury.

Understanding Cervical Spine 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 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 Spine Injury

cervical spinal cord injury and quadriplegia

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

After a spinal cord injury, signals from the brain can’t get past the spinal cord damage. As a result, control of functions innervated at and 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 spine injury

Each level of cervical spine injury will directly affect a different set of muscles and area of skin.

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 spine 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 side effects 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 side effects can occur:

  • Paralysis from the neck down
  • Loss of independent breathing (will require ventilator assistance)
  • Full assistance of a caregiver
  • 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 breathing muscle.

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

Common side effects of a C3 spinal cord injury include:

  • Partial head and neck control (after spinal cord damage has stabilized)
  • Difficulties with neck side flexion (the ability to tilt your head to the side)
  • Loss of independent breathing (will require ventilator assistance)

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 exercising, 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
  • Full sensation at the neck

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 forearm rotation).

Individuals with C5 spinal cord injuries can sustain the following side effects:

  • Normal head, neck, and shoulder movements
  • Full sensation from the shoulders up
  • 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 some 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.

Additionally, the muscles that innervate the diaphragm are not affected by spinal cord injuries at the C6 level or below. As a result, all injuries below C6 will result in normal breathing.

Some positive effects of C6 spinal cord injury include:

  • Full head, neck, and shoulder mobility
  • Ability to raise their arms
  • Ability to bend the elbows
  • Normal sensation in the head, neck, shoulders, and upper arms

Find out more about C6 spinal cord injuries »

C7 Spinal Cord Injury

Generally, C7 spinal cord injury patients can control their upper extremities.

However, the wrist flexors and finger extensors are affected at this level of injury. As a result, C7 SCI patients may struggle to bend their wrists and spread out their fingers.

Potential outcomes of a C7 spinal cord injury include:

  • Normal sensation at the head, neck, shoulder, arms, index fingers, and thumbs
  • Full shoulder and neck range of motion
  • Partial elbow and wrist control

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.

Due to the injury occurring lower on the spinal column, C8 SCI patients tend to have the most independence right after the injury.

After a C8 spinal cord injury, patients can expect:

  • Full range of motion in the wrists, elbows, shoulders, and necks
  • Hand weakness
  • Partial sensation in fingers (thumbs, index, and middle should be normal while ring fingers and pinkies may lack sensation)
  • Normal sensation at arms, shoulders, neck, and head

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

Discover more about C8 spinal cord injuries»

Cervical Spine Injury: Key Points

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

They directly affect mobility in the neck, arms, and fingers but also can indirectly result in trunk and lower body paralysis.

As you’ve just learned, higher-level cervical spine injuries 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 physical 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 spine injury. Good luck!

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