Lumbosacral Spinal Cord Injury
Written by Andrew Sarski on July 30, 2013
Lumbosacral Spinal Cord Segments and Function
In general, the lumbar vertebrae of the spine protect the lower portion of the spinal cord and the cauda equina, which controls signals to the legs, hips, bladder and bowel. The sacral vertebrae protect the section of the cauda equina that controls signals to the groin, toes and certain parts of the legs. The individual function of each lumbar and sacral spinal cord segment is as follows:
- T7-L1: Controls abdominal muscles
- L1, L2, L3, L4: Thigh flexion
- L2, L3, L4: Thigh adduction
- L4, L5, S1: Thigh abduction
- L5, S1, S2: Extension of the leg at the hip (gluteus maximus)
- L2, L3, L4: Extension of the leg at the knee (quadriceps)
- L4, L5, S1, S2: Flexion of the leg at the knee (hamstrings)
- L4, L5, S1: Dorsiflexion of foot
- L4, L5, S1: Extension of toes
- L5, S1, S2: Plantar flexion of foot
- L5, S1, S2: Flexion of toes
Lumbosacral Injury Symptoms
The adverse effects of injuries to the lumbar or sacral areas of the spinal cord are decreased control of the urinary system, anus, and legs and hips. Because bladder and bowel function is controlled by the sacral region of the spine, it is very common for traumatic injury to result in dysfunction of the bowel and bladder, sometimes including anal incontinence and bladder infections. Sexual function may also be affected by an injury to the sacral section of the spinal cord, particularly if trauma is inflicted on levels S2-S4.
Common Causes of Lumbosacral Spinal Cord Injuries
Lumbosacral spinal cord injuries are typically the result of direct trauma, especially trauma involving forcible flexion and rotation of the lower portion of the spine. Some of the most common causes of lumbosacral spinal cord injuries include car accidents (45%), fall accidents (18%), violence (17%) and sports injuries (13%). Research shows that an estimated 9-15% of sports-related injuries result in spinal cord injury, 3-7% of which involve the lumbar spine. Also, in some cases, injury to the lumbosacral spine may be the result of an indirect injury associated with compression from swelling or fractured bone fragments.
Lumbosacral Injury Treatment
Treatment for spinal cord injuries is typically initiated within eight hours of the injury, and consists of administering drug therapy, relieving cord compression, and stabilizing the spine (surgically or non-surgically). Once the spine is stabilized, spinal cord injury treatment is typically focused on physical and occupational therapy, injury management and emotional care. Long-term care for a lumbosacral spinal cord injury may include specialized medication regimens and other therapies. In injured individuals with compressive nerve deficit, unstable fractures, or partial cord injury, surgical intervention may be necessary for treatment.
Long-Term Consequences of Lumbosacral Injuries
Injuries to the lumbosacral spinal cord are diagnosed as either complete or incomplete. A complete spinal cord injury is characterized by the total loss of sensory and motor function below the level of the injury, while an incomplete spinal cord injury is associated with partial loss of sensory and/or motor function below the level of the injury. A severe lumbosacral fracture accompanied by spinal cord injury can irreversibly interrupt the transmission of sensory and motor impulses, causing paralysis in the lower extremities – a condition called paraplegia. The American Spinal Injury Association (ASIA) scale is the tool most commonly used to measure impairment resulting from a spinal cord injury. The ASIA Impairment Scale is as follows:
- A: Complete – No motor or sensory function is preserved in the sacral segments S4-S5.
- B: Incomplete – Sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5.
- C: Incomplete – Motor function is preserved below the neurological level, and more than half of key muscles below the neurological level have a muscle grade less than 3.
- D: Incomplete – Motor function is preserved below the neurological level, and at least half of key muscles below the neurological level have a muscle grade of 3 or more.
- E: Normal – Motor and sensory function is normal.
Prognosis for Lumbosacral Spinal Cord Injury
The prognosis for a lumbosacral spinal cord injury depends largely on the severity of the injury. There is currently no cure for the complications associated with spinal cord injuries, although rehabilitation can be effective in helping to alleviate some long-term effects of the injury. A lumbosacral spinal cord injury can significantly affect many aspects of a victim’s life, and rehabilitation must address his or her functional status at home, at work, and in the community. For example, depending on the level of the injury, the victim may require job retraining to return to work, and the work facility will need to be wheelchair accessible. In many cases of a lumbosacral spinal cord injury, some function is restored between one week and 24 weeks after the initial injury occurs. Unfortunately, once 24 weeks have passed, the chances of spontaneous recovery is significantly reduced. If you have suffered a lumbosacral spinal cord injury and you believe you may be entitled to compensation, contact an experienced spinal cord injury lawyer immediately. You may have grounds to file a personal injury lawsuit against the at-fault party, in order to seek fair and timely reimbursement for your injuries, medical expenses and long-term care.