I just wrote a new article on spinal cord injury levels and classification

[Wise Young]

Several postings on the forums suggest that people are confused by the levels of injury and the concepts of complete and incomplete spinal cord injury, as well as the ASIA Impairment Scale. I therefore wrote an article about this and put it on the carecure site: http://carecure.rutgers.edu/spinewire/Articles/SpinalLevels.html

I hope that it explains things for people. I would be glad to answer any questions, etc.

Wise.

[SCI-Nurse]

Thanks, Dr. Young for a complete yet concise summary. Unfortunately the pictures do not load for me. This will be a good article to book-mark for many.

(KLD)

[antiquity]

ARRGGGHHHH!

Now I'm confused. I was diagnosed by a physiatrist as C8/T1 but the article states that C8 controls the finger flexors, and T1 the little finger abductor. I can extend my fingers but can't curl or ball them and I can only move my little finger up, but not down so I can't be a C8/T1, maybe I'm really a C7.

It also says that "T2 to T12. The thoracic covers the axillary and chest region. T3 to T12 covers the chest and back to the hip girdle. The nipples are situated in the middle of T4." I have full sensation right at T4 and spotty sensation below. Does that mean that I'm a T4 sensory and C7 motor?

[Wise Young]

KLD, I am sorry. Which figures did not load or all of them? I had taken one figure from the Emory site and the rest from the ASIA classification system. I just took a look and realized that the netscape browser will not load the pictures for some reason. I will try to fix that soon. Wise.

[Wise Young]

Seneca,

Thanks for your comments. Unfortunately, I had to simplify the details of the motor innervation for the article. The motor innervation of muscles are sometimes spread over several segments. In the coming days, based on the comments of people here on the forum, I will try to improve the article to make it more understandable and usable.

You should keep in mind that there are two kinds of damage to the spinal cord. An injury at the C7 vertebral level will damage the C8 spinal cord, interrupting the spinal tracts and damaging the neurons at the C8. Since the C8 spinal cord innervates the finger flexors, damage to the neurons will compromise finger flexion. T1 neurons innervate the abductor muscles of the fifth finger (pinky), allowing it to move out and up.

Combined with the fact that your sensory line is at T4, this suggests that your sensory tracts have recovered to T4 and that your motor level is at least T1 and perhaps lower (the T2 to T4 muscles are represented by the intercostal muscles of the second through fourth intercostal muscles of your ribs). Your finger flexors may be weak because the neurons at C8 have been damaged.

In summary, your description suggests that you are now a T4 but with some C8 damage to gray mater. Was your vertebral injury level at C7?

Wise.

[Carl R]

the article helps out a lot Dr. Young. I use a Microsoft Internet explorer browser and cannot get the pictures to load either. I have a few more questions, but I will wait until the pictures come up since they might help to explain better.

Dr. Young, do you have any problem if I print the article and share it with others? Thanks again for your help. Believe it or not, some of this stuff is finally starting to come together and become understandable.

[antiquity]

Thanks for your response Dr. Young.

Twentytwo years ago I was diagnosed as C6/7. I didn't notice the difference between level and functional ability until 6 years ago when a PT at Jackson Memorial told me I was C8. I was most recently diagnosed as C8/T1.

[Scorpion]

Dr. Young, it looks as though the URLs for the images point to a local file on your computer instead of the actual web location. This can be annoying and can happen often depending on the program uzed to create the web page. It looks like you used Adobe GoLive to create the page, and GoLive's automation sometimes does weird stuff. Actually, most web creation programs will. Anyway, let me know if you need help fixing the image problem.

~Rus

"Because you're not promised tomorrow." ~ Stuck Mojo

[Webber]

I had a C6-7 fracture and have no motor problems with hands/arms. Have bowel/bladder control. Move toes and can swing lower leg back and forth (very weakly) Sensory level to hot/cold diminishes at about mid-chest area. Alot of burning pain in legs and feet and plenty of spasms. Are there any other C6-7 para's with this amount of function??

[Scorpion]

Normally, a C-6/7 fracture would result in quadriplegia...you got lucky. http://sci.rutgers.edu/forum/images/smilies/smile.gif I'm sure there are others with similar stories, but it's rare.

~Rus

"Because you're not promised tomorrow." ~ Stuck Mojo

[Wise Young]

Scorpion, thanks. You are right. I am using GoLive (trying to save time by directly setting up the article in html). I checked all the links but it turned out to be an error in the html coding. The problem went away when I rewrote the code. Wise.

[Scorpion]

Programs like GoLive and Dreamweaver are great until they do something screwy with the code and you have to go back to old-fashioned text-based editing. Luckily, HTML isn't too complicated.

~Rus

"Because you're not promised tomorrow." ~ Stuck Mojo

[Wise Young]

The article and the pictures should be loading appropriately right now. I am not happy about the pictures and am trying to make better ones and will update them when they are done. Wise.

[Scorpion]

I checked it out--very informative, and the pictures/diagrams do help.

~Rus

"Because you're not promised tomorrow." ~ Stuck Mojo

[David Berg]

Wise,

Great article. I have one question, though. I know very little about marginal cells, but I understand that they are sort of "odd beasts" in the cord that might fall outside of the guidelines that you lay down for sensory nerves. For instance, I've heard of an experiment where stimulating a single marginal cell caused pain on both sides of the body. Do you have any additional thoughts on where marginal cells fit in, or can you at least point me to a source where I can learn a little more?

David Berg

[Wise Young]

Hmm, marginal cells... I must admit that I don't know about this. Let me look it up and see what I find. Wise.

[Wise Young]

David, after some searching, I finally found what the marginal cells that I think you were referring to. They must be the cells in the marginal layer (layer 1) of the substantia gelatinosa, mentioned in Gray's Anatomy http://www.bartleby.com/107/185.html, and in the following studies:

• Galhardo V & Lima D (1999). Structural characterization of marginal (lamina I) spinal cord neurons in the cat. A Golgi study. Journal of Comparative Neurology, 414, 315-333.

• Lima D, Galhardo V & Coimbra A (1995) Morphological classification of marginal (lamina I) neurons in the cat spinal cord: a golgi study. Soc. Neurosci. Abstr., 21, 378.

and other references ... I posted them in the Pain Forum with comments.

Wise.