Spinal Cord Injury
Medical Author: Jason C. Eck, DO, MS
Medical Editor: Jay W. Marks, MD
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The Waiting Game Spinal Cord Injury:
C4 Is a Crucial Level
Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD
 There are seven cervical
vertebrae, twelve thoracic and five lumbar. Each level gained or lost is a
victory in rehabilitation, but C4 is the big one.
Nerves run from the brain through the spinal cord to the body. They connect
to the muscles and tissues of the body, allowing them to function. Some
functions are within our control, like moving an arm, making a facial expression
or walking. Others are part of our unconscious system, things we take for
granted, like breathing or swallowing saliva.
The fourth cervical vertebra is the level where nerves run to the diaphragm,
the main muscle that allows us to breathe. It separates the chest from the
abdomen, and when it contracts, air is sucked into the lungs like a bellows. No
contraction, no sucking, no breathing. People who survive spinal cord injuries
above this level need ventilators or machines to breathe.
In front of a national audience on September 9, 2007, Kevin Everett, a pro football
player, broke his neck at the level of C4. The bones surrounding his spinal cord
had been damaged, and the ligaments holding everything stable were torn. The
spinal canal - the space where the cord is supposed to have room to sit - was
narrowed, and the cord stopped working. While he lay paralyzed on the field, the
trainers, doctors and paramedics at his side began doing the work that is
practiced time and again.
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What is the spinal cord?
The spinal cord is a collection of nerves that travels from the bottom of the
brain down your back. There are 31 pairs of nerves that leave the spinal cord
and go to your arms, legs, chest and abdomen. These nerves allow your brain to
give commands to your muscles and cause movements of your arms and legs. The
nerves that control your arms exit from the upper portion of the spinal cord,
while the nerves to your legs exit from the lower portion of the spinal cord.
The nerves also control the function of your organs including your heart, lungs,
bowels, and bladder. For example, signals from the spinal cord control how fast
your heart beats and your rate of breathing.
Other nerves travel from your arms and legs back to the spinal cord. These
nerves bring back information from your body to your brain including the senses
of touch, pain, temperature, and position. The spinal cord runs through the
spinal canal. This canal is surrounded by the bones in your neck and back called
vertebrae which make up your back bone. The vertebrae are divided into 7 neck
(cervical) vertebrae, 12 chest (thoracic) vertebrae and 5 lower back (lumbar)
vertebrae. The vertebrae help protect the spinal cord from injury.
What is a spinal cord injury?
The spinal cord is very sensitive to injury. Unlike other parts of your body,
the spinal cord does not have the ability to repair itself if it is damaged. A
spinal cord injury occurs when there is damage to the spinal cord either from
trauma, loss of its normal blood supply, or compression from tumor or infection.
There are approximately 10,000 new cases of spinal cord injury each year in the
United States. They are most common in white males. Specifically, 80% of spinal
cord injuries occur in males, and 2/3 occur in whites. Most injuries occur in
patients 16-30 years of age.
Spinal cord injuries are described as either complete or incomplete. In a
complete spinal cord injury there is complete loss of sensation and muscle
function in the body below the level of the injury. In an incomplete spinal cord
injury there is some remaining function below the level of the injury. In most
cases both sides of the body are affected equally.
An injury to the upper portion of the spinal cord in the neck can cause
quadriplegia-paralysis of both arms and both legs. If the injury to the spinal
cord occurs lower in the back it can cause paraplegia-paralysis of both legs
only.
Next: What are the causes of spinal cord injury? »
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