SCI Regeneration MapWhat the world knows about repairing the injured spinal cord

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4

How clinicians describe an injury

The words clinicians use: complete and incomplete, the level, the AIS scale, the syndromes. This is educational context, and it is not self-diagnosis.

This is educational context. It is not a diagnosis, not a prognosis, not a treatment plan and not advice about any individual person. For anything urgent, seek professional help rather than an answer from a website.

12of 19How clinicians describe an injury

Complete, incomplete, and the five grades

Open this plate

Two sections above two drawings of the lowest segments. On the left the cord is cut across and both marks in the pelvis are negative; on the right the damage is central, the sacral segments are spared and both marks are positive — pressure felt, and a squeeze on request. Below, the five grades as a rising stair with an arrow along it.
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Plate 12Atlas of a spinal cord injury12of 19Complete, incomplete,and the five gradesComplete injuryIncomplete injuryComplete injury — Two sections above two drawings of the lowest segments. On the left the cord is cut across and both marks in the pelvis are negative; on the right the damage is central, the sacral segments are spared and both marks are positive — pressure felt, and a squeeze on request. Below, the five grades as a rising stair with an arrow along it.Incomplete injury — Two sections above two drawings of the lowest segments. On the left the cord is cut across and both marks in the pelvis are negative; on the right the damage is central, the sacral segments are spared and both marks are positive — pressure felt, and a squeeze on request. Below, the five grades as a rising stair with an arrow along it.Sacral sparing — Two sections above two drawings of the lowest segments. On the left the cord is cut across and both marks in the pelvis are negative; on the right the damage is central, the sacral segments are spared and both marks are positive — pressure felt, and a squeeze on request. Below, the five grades as a rising stair with an arrow along it.Sacral sparingSacral sparingDeep anal pressureDeep anal pressureVoluntary anal contractionVoluntary anal contractionABCDEThe AIS scaleThe AIS scale

  1. Complete injury

    A clinical term with an exact meaning: no motor and no sensory function is preserved in the lowest sacral segments. It does not mean the cord has been cut through.

  2. Incomplete injury

    Some function is preserved in the lowest sacral segments — sensory, motor or both. How much is preserved varies widely.

  3. Sacral sparing

    What is checked in the lowest segments, S4–S5: sensation around the anus, deep pressure, or a voluntary contraction of the anal sphincter. The presence or absence of exactly this is what separates complete from incomplete.

  4. The AIS scale

    Five grades from A to E describing severity, from no function in the sacral segments to a normal neurological examination. The grade is determined by a trained clinician from an examination — not by a website and not by the person themselves.

  5. The grade is not stated in the record

    A state of our data, not a state of a body. The great majority of records in this corpus do not state the AIS grade in a field this map reads — so the "complete" and "incomplete" cells are empty not because no such studies exist but because the records do not say. That is a gap, and this is where it is visible.

Also on this plate

  • Deep anal pressure

    Whether the person feels pressure in the lowest sacral segments. It is one of the two findings that make an injury incomplete.

  • Voluntary anal contraction

    Whether the person can squeeze the muscle deliberately on request. It is the motor sign that the lowest segments are spared.

Where this goes in the corpus

AIS not reported28studies
Not applicable27studies
Complete2studies

13of 19How clinicians describe an injury

Five different pictures on one section

Open this plate

Five rows. Each carries the section with its own territory involved — the centre, one half, the front two thirds, the cone at the end of the cord, and the roots below it — and beside it a body with the pattern of loss that territory leaves, which is different in all five.
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Plate 13Atlas of a spinal cord injury13of 19Five differentpictures on one sectionCentral cord syndromeCentral cord syndrome — Five rows. Each carries the section with its own territory involved — the centre, one half, the front two thirds, the cone at the end of the cord, and the roots below it — and beside it a body with the pattern of loss that territory leaves, which is different in all five.1Central cord syndromeMovementThe arms are weaker than the legs — and the hand weaker than the shoulder.SensationSensation is often unevenly altered, more so in the arms.Autonomic functionsThe bladder is often affected; to a varying degree.SideBoth sides, symmetricalBrown-Séquard syndromeBrown-Séquard syndrome — Five rows. Each carries the section with its own territory involved — the centre, one half, the front two thirds, the cone at the end of the cord, and the roots below it — and beside it a body with the pattern of loss that territory leaves, which is different in all five.2Brown-Séquard syndromeMovementWeakness is on the same side as the damage.SensationTouch and position sense are lost on the side of the damage; pain andtemperature on the opposite side.Autonomic functionsLess affected than in the other syndromes.SideOne side — and different losses on each sideAnterior cord syndromeAnterior cord syndrome — Five rows. Each carries the section with its own territory involved — the centre, one half, the front two thirds, the cone at the end of the cord, and the roots below it — and beside it a body with the pattern of loss that territory leaves, which is different in all five.3Anterior cord syndromeMovementMarked weakness below the level, on both sides.SensationPain and temperature are lost; touch and position sense are largely kept — andit is that combination that names the syndrome.Autonomic functionsBladder and bowel are affected.SideBoth sides, symmetricalConus medullaris syndromeConus medullaris syndrome — Five rows. Each carries the section with its own territory involved — the centre, one half, the front two thirds, the cone at the end of the cord, and the roots below it — and beside it a body with the pattern of loss that territory leaves, which is different in all five.4Conus medullaris syndromeMovementWeakness in the legs is moderate or slight.SensationLoss of sensation in the perineum — "saddle", symmetrical.Autonomic functionsBladder, bowel and sexual function are affected early and markedly.SideBoth sides, symmetricalCauda equina syndromeCauda equina syndrome — Five rows. Each carries the section with its own territory involved — the centre, one half, the front two thirds, the cone at the end of the cord, and the roots below it — and beside it a body with the pattern of loss that territory leaves, which is different in all five.5Cauda equina syndromeMovementWeakness is flaccid and often unequal between the legs: individual roots aredamaged.SensationLoss of sensation is "saddle", often asymmetrical, with marked pain.Autonomic functionsUrinary retention and disturbed bowel function — a sign that needs urgent help.SideOften different on each side

  1. Central cord syndrome

    Damage mainly to the central part of the cord, most often in the neck. Its characteristic sign is that the arms are affected more than the legs.

  2. Brown-Séquard syndrome

    Damage to one half of the cross-section. Because different paths cross to the other side in different places, weakness appears on one side and the loss of pain and temperature on the other.

  3. Anterior cord syndrome

    Damage to the anterior two thirds of the cross-section, often related to blood supply. Movement and the sense of pain and temperature are changed, while the sense of position is largely preserved.

  4. Conus medullaris syndrome

    Damage to the very end of the cord. Bladder and bowel function change early, while the legs may be affected much less.

  5. Cauda equina syndrome

    Damage to the bundle of roots below the end of the cord. This is a peripheral nerve injury and it differs from an injury to the cord itself.

Where this goes in the corpus

Motor function31measurements
Sensory function6measurements

14of 19How clinicians describe an injury

The examination

Open this plate

Two bodies with the sensory points marked on front and back, each point drawn twice because two things are tested there and scored apart: a ring for touch, a filled point for the pin. A third body carries the ten key muscles. Beside them the muscles listed by segment, the five steps of the examination in order, the five grades, and the notice that this is not something to do to yourself.
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Plate 14Atlas of a spinal cord injury14of 19TheexaminationFrontBackThe ten key musclesC4C5C6C7C8T1T2T4T6T8T10T12L1L2L3L4L5S1C2C3C4T2T6T10L1S3S2S4-5Neurological level — Two bodies with the sensory points marked on front and back, each point drawn twice because two things are tested there and scored apart: a ring for touch, a filled point for the pin. A third body carries the ten key muscles. Beside them the muscles listed by segment, the five steps of the examination in order, the five grades, and the notice that this is not something to do to yourself.C5C6C7C8T1L2L3L4L5S1Elbow flexors · C5Wrist extensors · C6Elbow extensors · C7Finger flexors · C8Finger abductors · T1Hip flexors · L2Knee extensors · L3Ankle dorsiflexors · L4Long toe extensors · L5Ankle plantar flexors · S1Light touchLight touchPin prickPin prickThe ISNCSCI examinationThe ISNCSCI examinationThe ten key musclesElbow flexors · C5C5Elbow flexors · C5Wrist extensors · C6C6Wrist extensors · C6Elbow extensors · C7C7Elbow extensors · C7Finger flexors · C8C8Finger flexors · C8Finger abductors · T1T1Finger abductors · T1Hip flexors · L2L2Hip flexors · L2Knee extensors · L3L3Knee extensors · L3Ankle dorsiflexors · L4L4Ankle dorsiflexors · L4Long toe extensors · L5L5Long toe extensors · L5Ankle plantar flexors · S1S1Ankle plantar flexors · S1In this orderSensation1SensationMovement2MovementNeurological level3Neurological levelSacral sparing4Sacral sparingThe AIS scale5The AIS scaleABCDEThis is not self-diagnosis

  1. The ISNCSCI examination

    The international standard for neurological classification of spinal cord injury: an ordered examination of sensation at key points and strength in key muscles, from which the level, the completeness and the grade are derived. It is a procedure performed by a trained clinician.

  2. Sensation

    Touch, temperature, pain and the sense of where a limb is. Losing sensation is not only about not feeling: it is also a wound noticed late.

    What may change after an injuryDifferent kinds of sensation travel by different paths, so they can change unevenly — and that unevenness is what gives a clinician the pattern.

  3. Movement

    Voluntary movement: strength, control, the ability to hold a position. It is the function most studies measure, and it is only one of several.

    What may change after an injuryStrength can change; control can change while strength is preserved; tone can increase. These are different changes and different scales measure them.

  4. Neurological level

    The lowest segment where sensation and strength are still preserved on both sides. It is not the same as the broken vertebra: the level in the bone and the level in the nervous system are often different.

  5. This is not self-diagnosis

    This section explains the words clinicians use, and nothing more. A person cannot determine their own AIS grade through a website: the classification is performed by a trained clinician during an examination. And a classification is not an individual prognosis of recovery — it describes a state at the time of the examination.

Also on this plate

  • Light touch

    A light touch with a wisp of cotton at every key point. It is scored in three states: absent, altered, normal.

  • Pin prick

    The sharp and the blunt end of a single-use pin at the same point. It tests a different pathway from touch, which is why it is scored separately.

  • Elbow flexors · C5

    Bending the elbow. The first of the ten key muscles and the top of the motor examination of the arm.

  • Wrist extensors · C6

    Lifting the hand at the wrist. This movement is what gives part of a grip after a cervical injury.

  • Elbow extensors · C7

    Straightening the elbow. Pushing up with the arm depends on it.

  • Finger flexors · C8

    Bending the middle finger at its end joint. The key muscle of the eighth cervical segment.

  • Finger abductors · T1

    Spreading the fingers apart. The key muscle of the first thoracic segment.

  • Hip flexors · L2

    Drawing the knee up while lying down. The first key muscle of the leg.

  • Knee extensors · L3

    Straightening the knee. Standing depends on it to a large degree.

  • Ankle dorsiflexors · L4

    Pulling the foot upwards. Without it the foot drops and catches when walking.

  • Long toe extensors · L5

    Lifting the big toe upwards. The key muscle of the fifth lumbar segment.

  • Ankle plantar flexors · S1

    Pushing the foot downwards. The last of the ten key muscles.

Where this goes in the corpus

Sensory function6measurements

What is missing at this step

This layer names the axes the corpus is indexed by. Where an axis holds no records, the panel says so and says what would change it — the gap is part of the answer.

What is still missing → · What is covered →

Where to look next

The same corpus, entered a different way: by question, by place, by connection, and by what changed recently. Every one of these reads the records this step has been pointing at.

124 medical statements · 6 authorities · 124 stand on an address that answered · 0 have been read against the source by a person

The last of those numbers is nought, and it is printed rather than left to be assumed. These explanations are ordinary anatomy and ordinary clinical vocabulary, written for this product, and each one names the authority it stands on; nobody has yet sat down and compared them, sentence by sentence, with the text at those addresses.