Complete vs. Incomplete Spinal Cord Injury: Understanding Your Injury

A spinal cord injury (SCI) diagnosis can cause feelings of uncertainty and worry. There are new terms to learn, all while adjusting to a new season of life. Our team understands how overwhelming this sudden influx of information can feel, and we want to help ease the burden. Likely, you were told whether you have a complete or incomplete spinal cord injury. Learning the difference between these two SCI categories can help you understand your injury and give you confidence as you navigate the medical complexity of spinal cord injuries.

Spinal Cord Injuries: Incomplete vs. Complete

When your doctor diagnoses you with a spinal cord injury, they will tell you whether it is complete or incomplete. These terms describe the severity of your injury, influence the impact on your functional ability, and help shape your rehabilitation plan.

What Is a Complete Spinal Cord Injury?

A complete spinal cord injury means all motor and sensory function is disrupted below the injury. The nerves from the spinal cord to the muscles cannot communicate with each other, so there is no feeling or movement in parts of the body below the spinal cord injury.

What Is an Incomplete Spinal Cord Injury?

An incomplete spinal cord injury occurs when some of the spinal cord remains intact and can still receive and relay signals to and from the rest of the body. This may mean there is still some movement or some sensation—the degree of preserved movement and sensation will depend on the severity of the damage and the type of incomplete injury sustained.

Types of Incomplete Spinal Cord Injury

Incomplete spinal cord injuries can be categorized under the following types:

Anterior Cord Syndrome: Injury affects the front of the spinal cord, typically due to blocked blood flow from the anterior spinal artery. This can impact both motor and sensory function—particularly the ability to feel touch, pain, and temperature—but rehabilitation can often help recover some movement.
Brown-Sequard Syndrome: A rarer form of incomplete spinal cord injuries. Brown-Sequard Syndrome causes asymmetrical motor and sensory impacts on the body because it occurs when the right or left side of the spinal cord is damaged.
Cauda Equina Syndrome: Often an outcome of spinal compression, Cauda Equina is the result of damage to the lumbar and sacral nerve roots. It can affect certain motor skills and functions—causing loss of feeling, muscle weakness, and incontinence—but may not fully affect movement.
Central Cord Syndrome: This is the most common incomplete spinal cord injury. As the name implies, this type of injury occurs when the inner most part of the spinal cord is damaged. Sensation loss is common. People with this injury may have more movement in their legs and less refined movement in their arms or hands.
Conus Medullaris Syndrome: This presents very similar to Cauda Equina Syndrome and also affects the lumbar and sacral nerves. The main differences are that Conus Medullaris will occur most instantaneously and may allow for better motor movement, but cause more incontinence.
Posterior Cord Syndrome: This occurs when the injury damages the back of the spinal cord. Movement usually remains fairly unaffected; however, it may cause a loss of proprioception and coordination.

The ASIA Impairment Scale

The American Spinal Injury Association (ASIA) impairment scale (also known as AIS Grade) is used to grade the functional impact of a spinal cord injury and determine if it’s complete or incomplete. It’s measured by testing sensation and motion at different parts of the body. There are five grades on the ASIA impairment scale:

Grade A: Complete spinal cord injury. There are no motor or sensory abilities below the injury.
Grade B: Incomplete spinal cord injury where at least some sensory function remains below the injury; however, there’s no motor function.
Grade C: Incomplete spinal cord injury where motor function remains below the injury; however, over half of the muscles are weakened below a muscle grade 3 and cannot move against gravity.
Grade D: Incomplete spinal cord injury where motor function remains below the injury, and at least half of muscles are a grade 3 or higher and can move against gravity.
Grade E: Motor and sensory function are normal.

Often, you’ll receive your grade shortly after injury, but when swelling/spinal shock subsides, sometimes your grade can change. You should be re-assessed periodically to ensure your ASIA grade is accurate.

What Causes a Spinal Cord Injury?

Unlike some other forms of paralysis, a spinal cord injury commonly results from a traumatic event. The WHO estimates traumatic events account for around 90% of spinal cord injuries; however, some evidence suggests that non-traumatic spinal cord injuries may actually be more prevalent. An injury of this type can happen in a variety of ways, but some incidents result in an SCI more frequently. The most common causes of spinal cord injury are motor vehicle accidents and falls. Some other traumatic injury causes include:

Violence (firearms or physical assault)
Sports injuries
Work-related accidents
Conditions that affect the bones (cancer, osteoporosis, arthritis, etc.)
Medical injury or malpractice

Non-traumatic spinal cord injury causes include:

Tumors and cancers such as lymphoma
Stroke to the spinal cord
Infections
Arthritis
Disk deterioration
Multiple sclerosis

Any of the causes listed above can result in an incomplete or complete spinal cord injury—it is the severity of the injury, not the cause, that will determine whether it’s complete or incomplete.

Symptoms

Spinal cord injuries are complex and will vary from person to person. While it’s impossible to say exactly what symptoms a person will experience from their injury, some common symptoms occur in both complete and incomplete spinal cord injuries:

Loss of movement and/or motor function
Loss of sensation
Spasms and spasticity
Pain
Sexual dysfunction
Bladder and bowel incontinence
Breathing problems
Numbness or tingling sensation
Muscle weakness and/or atrophy
Respiratory issues
Lack of circulation

Complete SCI

As previously mentioned, a complete SCI means there is no communication between the spinal cord and muscles below the level of the injury. For this reason, the fundamental symptom of a complete spinal cord injury is a total lack of movement, feeling, and sensation below the injury.

Incomplete SCI

The symptoms of an incomplete SCI will depend on the type of injury and degree of damage. A commonality between all the types is retaining either some movement and/or feeling below the injury. Chronic pain below the injury is more commonly associated with incomplete SCIs.

Treatment Options

There’s such a wide range of spinal cord injuries, and how it affects a person will vary just as much. Because of this range, medical management should be personalized to each injury. A spinal cord injury treatment plan can include the following:

Surgery
Medication to manage symptoms and/or pain
Support devices such as splints and braces
Spinal traction
Physical, occupational, and speech (if cervical-level injuries cause difficulty with speech, swallowing, and/or breathing) therapy
Mental health therapy

While incomplete spinal cord injuries tend to recover faster, patients with complete spinal injuries can also see improvements in their well-being through rehabilitation. Patience, dedication, and a positive outlook are key to spinal cord injury recovery.

Can FES Be Used for Complete and Incomplete Spinal Cord Injuries?

Functional electrical stimulation (FES) can stimulate paralyzed muscles, facilitating muscle contractions to enable functional movement. For spinal cord injury rehabilitation, FES can provide exercise to paralyzed limbs—increasing muscle mass, reducing the risk of atrophy, improving mental health, and easing spasticity.

At MYOLYN, we’ve seen FES cycling assist both people with complete SCIs and people with incomplete SCIs. Helen, a MyoCycle user with an incomplete spinal cord injury, had this to say about her experience with FES cycling, “In the short time I’ve had my MyoCycle, I have noticed increased strength in my lower and upper legs, increased sensation throughout, more functional abilities in my feet, and an overall better feeling of health. I feel like I am gaining more independence and a better quality of life due to my workouts with my MyoCycle.”

Todd, a MyoCycle user with a complete spinal cord injury, was very active before his injury. Since his injury, he’s been able to exercise again with his MyoCycle. He had this to say about his experience with FES cycling, “Since using the MyoCycle, I have seen a marked increase in the size of my leg muscles as well as an increase in density. My waistline has stabilized with some decrease. It’s not just noticeable to me but also my wife, extended family, and friends. When used regularly, my spasticity is decreased.” When discussing his mobility, he told us, “I have readjusted my expectations to be sure but the reversal of atrophy has benefits beyond vanity. There’s a cause/effect correlation between FES cycling and overall vigor and GI management…[The MyoCycle is] now an essential part of my activity.”

Improve Your Spinal Cord Injury Rehabilitation with the MyoCycle

As you recover from a spinal cord injury, you do not have to do so alone. Our MyoCycle Home allows you to continue your rehabilitation outside of the clinic and reach your goals from the comfort of your own home—you can even connect with users just like you with our new virtual cycling!

Whether you need help fighting insurance, setting up, or optimizing your workouts, our team provides continued support with every MyoCycle. Talk to your doctor about how FES cycling can improve your recovery, and reach out to our team for more information about the MyoCycle.