San Francisco Accident Attorneys

The spinal cord is that portion of the central nervous system (CNS) that travels down the neck and back. (The CNS is made up of the brain and spinal cord.) The nerves connect to the muscles and tissues of the body, allowing them to function. The bones surrounding and protecting the spinal cord are known as vertebrae. Starting at the top of the spine (the base of the brain), there are seven cervical vertebrae that make up the neck (C-1 to C-7, in descending order), twelve thoracic vertebrae (T-1 to T-12) that are at chest level, five lumbar vertebrae (L-1 to L-5) that are in the lower back, and below that the five sacral (tail) vertebra (S-1 to S-6). If the spinal cord injury (SCI) is to the person’s cervical vertebrae, this has traditionally been called quadriplegia but is being replaced by the term tetraplegia (“quadra” comes from Latin and means four; plegia comes from Greek and means paralysis; tetra also comes from Greek and means four). In quadriplegia, or tetraplegia, the injury to the spinal cord is in the cervical region with associated loss of muscle strength in all four extremities.

The cervical spinal nerves control signals to the back of the head the neck and shoulders, the arms and hands, and the diaphragm. The thoracic spinal nerves control signals to the chest muscles, some muscles of the back, and parts of the abdomen. The lumbar spinal nerves control signals to the lower part of the abdomen and the back, the buttocks, some parts of the external sex organs, and parts of the leg. Sacral spinal nerves control signals to the thighs and lower parts of the legs, the feet, most of the external sex organs, and the area around the anus. As you can see, the higher the SCI to the spine, the more disabling—and potentially fatal—the injury. For instance, a spinal cord injury at the neck level may cause paralysis in both arms and legs and make it impossible for the victim to breathe without a respirator, while a lower injury may affect only the legs and lower parts of the body.

A spinal cord injury begins with a sudden traumatic blow to the spine that fractures, dislocates, crushes, or compresses one or more vertebrae. The damage starts the moment displaced bone fragments, disc material, or ligaments bruise or tear into the spinal cord. Additional damage usually occurs over days or weeks because of bleeding, swelling, inflammation, and fluid accumulation in and around the spinal cord. The spinal cord does not have to be severed in order for a loss of functioning to occur. In fact, in most people with SCI, the spinal cord is intact, but the damage to it results in loss of functioning.

The vertebrae do not need to be broken to cause nerve damage. For example, in “whiplash” injuries, a person can suffer severe, even disabling pain emanating from the spinal cord and surrounding tissue even though no vertebrae have broken. On the other hand, it is possible to suffer a broken vertebra in the neck or back without causing nerve damage. A person can literally break his or her neck or back but not sustain an SCI if the bones around spinal cord (the vertebrae) are damaged, but the spinal cord is not affected. In such situations, the victim may not experience paralysis after the bones are stabilized.

Rather than severing the spinal cord, a traumatic injury is more likely to cause fractures or compression of the vertebrae, which then crush and destroy the “axons”—extensions of nerve cells that carry signals up and down the spinal cord between the brain and the rest of the body. An injury to the spinal cord can damage a few, many, or almost all of these axons. Some injuries will allow almost complete recovery, while others will result in complete paralysis.

SCIs involving the cervical vertebrae usually cause loss of function in the arms and legs, known as quadriplegia. If the SCI is at or below the C-3 level, then the ability to breathe on one’s own is affected and it may be necessary to have a mechanical ventilator for the person to breathe, such as the actor Christopher Reeve was required to use after his accident until his death. Many people with SCI above C-3 die before receiving medical treatment because of their inability to breathe. C-4 is a critical level; the fourth cervical vertebra is the level where nerves to the diaphragm—the main muscle that allows us to breathe—exit the spinal cord and go to the breathing center. C-4 separates the chest from the abdomen, and when it contracts, air is sucked into the lungs like a bellows. If there is no contracting and no sucking, there is no breathing.

People who survive SCIs above C-4 need ventilators or machines to breathe for them. Besides regulating the breathing process, injuries at C-4 may give the person some use of biceps and shoulders, but it is fairly weak. Injuries at the C-5 level often result in shoulder and biceps control, but no control of the wrist or hand. If the SCI is at the C-6 level, the victim usually has wrist control, but no hand function. Victims with SCI at the C-7 level can usually straighten their arms, but may still have dexterity problems with the hand and fingers. Injury at the C-7 level is generally the level for functional independence.

If the SCI is at the T-1 to T-8 levels, the victim usually has control of his or her hands, but poor trunk control resulting from a lack of abdominal muscle control. Lower thoracic vertebra injuries (L-9 to L-12) allow good trunk control and good abdominal muscle control, and the victim’s sitting balance is very good. SCI to the lumbar and sacral regions result in decreasing control of the legs and hips, urinary system, and anus.

SCI is not always obvious and does not always occur at the moment of trauma. Numbness or paralysis may result gradually as bleeding or swelling occurs in and around the spinal cord. Anyone who has suffered significant trauma to the head (especially trauma to the front of the face) or neck requires immediate medical evaluation for the possibility of SCI. Other instances in which damage to the spinal cord may not be readily apparent include pelvic fractures, penetrating injuries in the area of the spine and injuries that involve falling from heights. In fact, it is best to assume that trauma victims have SCI until proved otherwise after a comprehensive medical exam and evaluation.

If you suffer a head or neck injury, paramedics or other emergency workers will attend to three immediate concerns: (1) maintaining your ability to breathe; (2) keeping you from going into shock; and (3) immobilizing your neck with a rigid neck collar and carrying board to prevent further spinal cord damage. 50% of all SCI cases have other injuries associated with the SCI.

SCI may be diagnosed in the emergency room by a doctor carefully examining a injured person, testing for sensory function and movement, and asking the victim some questions about the accident. If the injured person complains of neck pain, is not fully awake, or has obvious signs of weakness or neurological injury, emergency diagnostic tests may be necessary. These tests include X-rays, computed tomography (CT) scan, magnetic resonance imaging (MRI), and myelogram, a special type of X-ray in which a dye is injected around the spinal cord. A few days after the injury, the doctor will conduct a neurological examination to determine the severity of the injury and to predict the likely extent of recovery.

Besides a loss of motor functioning and feeling below the level of injury, depending upon the level of the SCI, persons with SCI may experience other difficulties, such as:

• Pain or an intense stinging sensation caused by damage to the nerve fibers in the spinal cord

• Loss of movement

• Loss of sensation, including the ability to feel heat, cold, and touch

• Difficulty breathing, coughing, or clearing secretions from the lungs

• Loss of bladder or bowel control

• Pressure sores from sitting of lying in the same position for a long period of time (bedsores or “decubitus ulcers”)

• Inability or reduced ability to regulate heart rate, arrhythmias (irregular heart beats), blood pressure, sweating and hence body temperature

• Exaggerated reflex activities or spasms (spasticity)

• Atrophy of the muscles

• Changes in sexual function (e.g., a male’s inability to ejaculate), sexual sensitivity, and fertility (men’s sperm have a decrease in motility; a woman’s fertility is not affected, although if a woman with SCI becomes pregnant, it is treated as a high-risk pregnancy)

• Autonomic dysreflexia or abnormal increases in blood pressure, sweating and other autonomic responses to pain or sensory disturbances

• Blood clots, especially in the lower limbs (Deep Vein Thrombosis) and in the lungs (pulmonary embolism)

• Osteoporosis (loss of calcium) and bone degeneration

• Mental depression, often resulting in suicide or attempted suicide

The damage to the nerve may be complete or incomplete. If the damage is complete, then there is a total loss of sensory and motor function below the level of the SCI; there is no movement and no feeling below the level of injury, and both sides of the body are equally affected. If the damage is incomplete, there is some functioning and/or sensation below the site of the SCI. For instance, a person with incomplete damage may be able to move one leg more than the other, may be able to feel parts of the body that cannot be moved, or may have more functioning on one side of the body than the other. The extent of an incomplete injury is generally determined after spinal shock has subsided, approximately six to eight weeks after the injury is sustained. With the advances in acute treatment of SCI, incomplete injuries are becoming more common than complete SCI injuries.

To alleviate the confusion surrounding the terminology associated with spinal cord injury levels, severity, and classification, the American Spinal Injury Association (ASIA) has tried to sort some of these issues by standardizing the language that is used to describe spinal cord injury. The ASIA classifies a SCI as A, B, C, D, or E. An ASIA A classification means there is a complete injury, with no motor or sensory function below the level of injury or in the sacral segments S-4 to S-5. A B classification is an incomplete injury with sensory but not motor function preserved below the level of the injury and some sensation in the sacral segments S-4 to S-5. A C classification designates an incomplete injury with motor function preserved below the level of SCI and more than half of key muscles below the injury site have a muscle grade less than 3 (i.e., not strong enough to move against gravity). A D classification is an incomplete injury with motor function preserved below the level of injury, and at least half of the key muscles below the level of SCI have a muscle grade of 3 or more (i.e., joints can move against gravity). A classification of E is normal, with full motor and sensory function.

There are 10,000 to 13,000 new SCIs every year, with the vast majority of them involving males between the ages of 16 to 30. The average age of a person at the time of suffering an SCI is 39.5 years. Men sustain about 80% of SCIs, while women sustain only about 20%. Almost two-thirds of this population is white males (63%), followed by African-Americans (22.7%), Hispanics (11.8%) and the remaining 2.4% are from other racial and ethnic groups.

SCI from automobile and motorcycle accidents, especially Sport Utility Vehicles (SUVs) and 15-passenger vans rolling over, are the most frequent occurrence. Sport Utility Vehicles (SUVs) rollover accidents seriously injured or kill about 10,000 people in the United States each year, more than side and rear crashes combined. SUV and 15-passenger vans are much more likely to rollover or flip over than standard passenger vans and automobiles. Rollover accidents are responsible for 51% of all deaths in SUVs; 36% of deaths in trucks (mainly pickup trucks); and 19% of deaths in passenger automobiles. SUVs were originally designed as off-road vehicles, and their high center of gravity makes them top heavy. An SUV traveling at freeway speeds or above is most likely to rollover when the driver performs a simple driving maneuver like turning to avoid an object in the road or over-steering when passing another vehicle. 

One of the main reasons for this high rate of death and SCI due to rollover is caused by crushed roofs. The more the roof is crushed, the more severe the injuries and the risk of death. The current roof strength standard is some 35 years old, and many serious injuries or deaths could be averted by higher strength standards. A study by the National Highway Traffic Safety Administration revealed a clear statistical correlation between the amount a roof collapsed into the passenger compartment and the severity of injury. In cases where the vehicle’s occupants were not injured, the vehicles averaged 16 centimeters of lost headroom due to roof intrusion. In accidents with the most serious injuries, the vehicles lost an average of 24 centimeters of headroom in the rollover crashes. 

SCI due to violent acts—such as being shot or stabbed—are the second-most common type of SCI, and are the leading type of SCI in some urban settings in the United States. SCI due to falls are the third-most common type of SCI, occurring most frequently in persons aged 65 years or older. Recreational sports injuries are the fourth-most common cause of SCI, with diving in shallow water the sport that causes most SCI of all recreational sports, followed by impact or high-risk sports such as football, rugby, wrestling, gymnastics, surfing, ice hockey, and downhill skiing. 92% of all sports injuries result in quadriplegia.

Since 2000, the most frequent neurologic category at discharge for patients suffering from SCI is incomplete tetraplegia, followed by complete paraplegia, complete tetraplegia, and incomplete paraplegia. Over time, the percentage of persons with incomplete tetraplegia has increased slightly, while both complete paraplegia and complete tetraplegia have decreased slightly. 88.1% of all persons with SCI who are discharged alive from the system are sent to a private, noninstitutional residence, in most cases their homes before they were injured. Only 5.4% are discharged to nursing homes. The remainder are discharged to hospitals, group living situations, and other destinations.

There is no cure for an SCI, but the sooner the intervention, the better the chances of minimizing the damage. For example, a corticosteroid drug (methylprednisolone) administered within 8 hours of the time of injury may reduce swelling, which is a common cause of secondary damage. An experimental drug appears to reduce loss of function, but its mechanism is not completely understood.

It is often impossible for the doctor to make a precise prognosis right away, and emergency doctors are advised not to make prognoses. On about the third day of hospitalization, the doctors give the victim a complete neurological examination to determine the severity of the injury and predict the likely extent of recovery. The ASIA Impairment Scale is the standard diagnostic tool used by doctors. X-rays, MRIs, or more advanced imaging techniques are also used to visualize the entire length of the spine. Recovery, if it occurs, typically starts between a week and six months after the injury is sustained, especially as the swelling goes down. The majority of recovery occurs within the first six months after injury. Impairment remaining after 12 to 24 months is usually permanent, although with incomplete SCIs, the person may recover some functioning as late as 18 months after the injury. However, some people experience small improvements for up to two years or longer. For instance, Christopher Reeve regained the ability to move his fingers and wrists and feel sensations more than five years after he sustained a SCI in a horse-riding accident. But the fact remains that only a very small fraction of persons who sustain an SCI will recover all functioning.

Victims with a complete SCI have a less than 5% chance of recovery; if complete paralysis persists at 72 hours after the injury, recovery is essentially zero. The prognosis is much better for incomplete SCIs. If some sensory function is preserved, the chance that the victim will eventually will be able to walk again is greater than 50%. Ultimately, 90% of victims with SCI are able to return to their homes and regain independence. Currently, the five-year survival rate for patients with traumatic quadriplegia is over 90%.

There is the risk of an earlier death for a person who suffers a SCI than one who doesn’t. 85% of SCI patients who survive the first 24 hours are still alive 10 years later, compared with 98% of the non-SCI population given similar age and sex. The most common cause of death of SCI victims is due to diseases of the respiratory system, especially pneumonia. In fact, pneumonia is the leading cause of death for the 15-year period following SCI for all age groups, both males and females, whites and non-whites, and persons with quadriplegia. The second leading cause of death is non-ischemic heart disease, which are most always unexplained heart attacks often occurring among young persons who have no previous history of underlying heart disease. Suicide is the cause of death in a substantial number of persons who sustained a SCI. Other leading causes of death are pulmonary emboli and septicemia. Mortality rates are significantly higher during the first year after injury than during subsequent years, particularly for severely injured persons.

The costs associated with paraplegic and tetraplegia are enormous. The length of initial hospitalization following injury in acute care units is 15 days. The average stay in a rehabilitation unit is 44 days. The victim of a serious SCI will often have to go through extensive and exhaustive rehabilitation and physical therapy. Persons suffering from a serious SCI are generally treated at a regional SCI spine center, such as Rancho Los Amigos or Craig Hospital. The initial hospitalization costs following an SCI is in the range of several hundred thousand dollars for paraplegics and over half a million dollars for tetraplegics. The average lifetime costs for victims becoming paraplegics at the age of 25 can easily top $1 million. The average lifetime costs for victims who become quadriplegics at age 25 easily reaches into the area of several million dollars.

If you or a loved one has suffered a traumatic SCI due to another person’s carelessness, a defective or dangerous product, or other third party’s wrongful conduct, it is vital that you contact an experienced personal injury law firm as soon as possible. An experienced personal injury attorney can help to see to it that you obtain proper and thorough medical care for your physical and emotional injuries suffered as a result of the SCI. An experienced personal injury law firm can see to it that you obtain full compensation for your medical expenses, pain and suffering, mental anguish, property damage, lost wages, and all of your other injuries and damages. Serious spinal cord injuries require serious attention by an experienced personal law lawyer who understands both the physical and psychological injuries and disabilities caused by a serious SCI.

It is also important to contact an experienced personal injury law firm as soon as possible after the accident that causes the SCI, as the attorney may want to send his or her investigator to the scene of the accident to inspect and take pictures of the accident site and any dangerous condition that caused of contributed to the accident. The attorney or his or her investigator will also want to talk to any witnesses to the accident while the facts are still fresh in their minds. If the employee worked for the state, city, county or other public entity, you need to be aware that it is generally necessary to file a claim for damages with the proper governmental agency within six months of the date of the incident. An experienced personal injury attorney will know how and where to file this claim on your behalf.

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