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Spinal cord anatomy

The Spinal Cord

The spinal cord runs from the base of the head to around the waist. It carries the nerves up and down our bodies to allow us to function. The cord is housed by rings of bone called vertebra which make up the “spinal column”. The spinal column is divided into sections relating to their location in the spine; the cervical spine (neck), thoracic spine (chest), lumbar and sacral (waist). Each section has a series of vertebra numbered “1” at the top, counting downwards, so for example the top vertebra in the cervical spine is C1 counting down, C2, C3 etc. and T1 is the top vertebra in the thoracic spine.

The spinal cord carries messages back and forth from the brain via nerves upper motor neurons (UMNs). Nerves called lower motor neurons (LMNs) branch out from the spinal column to carry messages to the outer parts of our bodies, for example telling us to move our legs to walk and sending messages back to the brain, for example the feel of an object when we touch it.

Spinal Cord Injury (“SCI”)

An injury to the spinal cord is damage to the cord itself, rather than to the vertebra, and typically results in paralysis. A ruptured disc or pinched nerve is a back injury, not a spinal cord injury and may not result in paralysis, so a “broken back” may not be a SCI.

The level at which the spinal cord is injured is likely to dictate the extent of the injury to the affected person.

Cervical spine – there are 7 vertebra and injury to the cervical SCI usually results in quadriplegia (affecting both arms and legs).

  • C1 to C3 injuries – this is the most severe and can affect the ability to breathe/respiratory function.
  • C4 and C5 – there may be some remaining capacity in the shoulders and biceps, but probably no control in the wrist or hands and from the chest downwards.
  • C6 – this may allow use of the wrist, but not the hands.
  • C7 / T1 – often results in full arm use, but with some restrictions in the
  • hand and fingers.

Thoracic SCI – this will usually result in paraplegia (lower limbs) and impact on the chest and legs.

  • T1 to T8 – may result in some limited trunk control, e.g. difficulty sitting/supporting the body.
  • T9 to T12 – the paraplegia is lower down and the affected person should retain control of the trunk, e.g. ability to sit/balance the upper body.

Lumbar/sacral nerve injury – injuries at this level and below may affect the nerves emerging from the end of the spinal cord and may result in problems affecting the legs, bladder and bowel function and maybe sexual function. Spinal cord injuries can be “complete” or “incomplete”. Complete injuries result in a total loss of function, whereas incomplete injuries may result in some partial function, or regain of function over time as swelling in the spinal cord injury reduces (typically over the days or weeks after the injury, but rarely is there much regain of function after 18 months). Incomplete injuries may affect one side of the body more than the other.

Spinal cord injuries can affect other aspects of physical capacity, for example bowel and bladder control, or sexual function/fertility.

There is no cure for spinal cord injury, but advances in medical science are allowing better treatments and greater technological input to equipment is assisting SCI victims in everyday life.  Rehabilitation facilities are crucial in enabling an SCI victim to have a decent quality of life, and there is also some evidence that good rehab promotes life expectancy. This underlines the need for specialist facilities and using appropriate medical experts.

Many SCI people use a wheelchair as a mobility tool and even those that are able to use a manual chair, sometimes have electric powered chairs for ease/comfort. However, no-one is considered “wheelchair bound” and everyday activities (ranging from gardening to flying a plane) are not always carried out from the seat of a chair!

Recent advances in technology have seen powered exoskeletons which allow SCI individuals to walk again with a motorised bionic suit.

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