How is SCI diagnosed?

SCIs are not always immediately recognizable. The following injuries should be assessed for possible damage to the spinal cord¹:

• Head injuries, particularly those with trauma to the face
• Pelvic fractures
• Penetrating injuries in the area of the spine
• Injuries from falling from heights

If any of these injuries occur together with any of the symptoms mentioned above (acute head, neck, or back pain; decline of feeling in the extremities; loss of control over part of the body; urinary or bowel problems; walking difficulty; pain or pressure bands in the chest area; difficulty breathing; head or spine lumps), then SCI may be implicated.²

A person suspected of having an SCI must be carefully transported—to prevent further injury the spine should be kept immobile—to an emergency room or trauma center. A doctor will question the person to determine the nature of the accident, and the medical staff may test the patient for sensory function and movement. If the injured person complains of neck pain, is not fully awake, or has obvious signs of weakness or neurological injury, diagnostic tests will be performed.

These tests may include³:

• A CT ("cat") scan. This approach uses computers to form a series of cross-sectional images that may show the location and extent of the damage and reveal problems such as blood clots (hematomas).
• An MRI (magnetic resonance imaging) scan. An MRI machine "takes a picture" of the injured area using a strong magnetic field and radio waves. A computer creates an image of the spine to reveal herniated disks and other abnormalities.
• A myelogram. This is an X-ray of the spine taken after a dye is injected.
• Somatosensory evoked potential (SSEP) testing or magnetic stimulation. Performing these tests may show if nerve signals can pass through the spinal cord.
• Spine X-rays. These may show fracture or damage to the bones of the spine.

On about the third day after the injury, doctors give patients a complete neurological examination to diagnose the severity of the injury and predict the likely extent of recovery. This involves testing the patient's muscle strength and ability to sense light touch and a pinprick. Doctors use the standard ASIA (American Spinal Injury Association) Impairment Scale for this diagnosis. X-rays, MRIs, or more advanced imaging techniques are also used to visualize the entire length of the spine.

The ASIA Impairment Scale has five classification levels, ranging from complete loss of neural function in the affected area to completely normal⁴:

• A: The impairment is complete. There is no motor or sensory function left below the level of injury.
• B: The impairment is incomplete. Sensory function, but not motor function, is preserved below the neurologic level (the first normal level above the level of injury) and some sensation is preserved in the sacral segments S4 and S5.
• C: The impairment is incomplete. Motor function is preserved below the neurologic level, but more than half of the key muscles below the neurologic level have a muscle grade less than 3 (i.e., they are not strong enough to move against gravity).
• D: The impairment is incomplete. Motor function is preserved below the neurologic level, and at least half of the key muscles below the neurologic level have a muscle grade of 3 or more (i.e., the joints can be moved against gravity).
• E: The patient's functions are normal. All motor and sensory functions are unhindered.

To illustrate, a person classified as C-level on the ASIA scale functions better than a person at the B level. Time was, a patient might have been labeled a C4 quadriplegic. Today, however, using the ASIA scale, the classification might be C4 ASIA A tetraplegic. Regarding muscle-strength grades, zero is the lowest, corresponding to complete absence of muscle movement. Five is the highest, representing full, normal strength.^5,6