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What is Spinal Cord Injury (SCI)? Understanding the Basics

Learn about spinal cord injury (SCI): causes, classification, effects, treatments, and recent advances. Understand how damage to the spinal cord affects body functions and daily life.

What Is a Spinal Cord Injury?

If you think of the body as a network of telephone lines, the spinal cord is the main trunk line. Every signal the brain sends to a muscle, and every signal the body sends back about touch, temperature, position, or pain, runs along that trunk line. When the spinal cord is injured, some of those signals slow down, are weakened, or fail to get through at all. The pattern of what changes after an injury depends on where the damage is and how much of the cord is affected.1

SCI is the medical abbreviation you will see throughout this article. The two clinical terms used to describe paralysis after SCI, paraplegia (paralysis affecting the trunk, legs, and pelvic organs) and tetraplegia (paralysis affecting the arms, trunk, legs, and pelvic organs), refer to the body regions where function is lost. These terms are defined in detail later in the article.2

To understand why a single injury at one place along the spinal cord can change so much about how a body works, the next section explains briefly what the healthy spinal cord does.

The Spinal Cord, Briefly

The spinal cord is a long bundle of nerves that runs from the base of the brain down through a protective tunnel of vertebrae called the spinal canal. In an adult, the cord itself is about 18 inches long and roughly the width of a thumb. It is surrounded by three layers of membrane called the meninges, bathed in cerebrospinal fluid, and protected by the bony vertebrae of the spinal column.1

The cord carries three main types of traffic. Motor pathways carry signals from the brain out to muscles, allowing voluntary movement. Sensory pathways carry information from the skin, joints, and internal organs back to the brain, allowing sensation. Autonomic pathways manage the involuntary background work of the body, including blood pressure, heart rate, breathing, body temperature, digestion, bladder, bowel, and sexual function.1

The four regions of the spinal cord

The spinal cord is divided into four regions, each connected to a specific part of the body through 31 pairs of spinal nerves that branch off the cord between the vertebrae.2

One detail worth knowing before reading further: the spinal cord itself does not extend all the way down the spinal column. It typically ends near the L1 or L2 vertebra, where it gives way to a downward fan of nerve roots called the cauda equina (Latin for "horse's tail"). This is why an injury to the lumbar spine bones may damage nerve roots rather than the cord itself, and why the medical picture can look different from a higher-level injury.1

Why damage radiates beyond the injury site

Because every signal traveling between the brain and the body has to pass through the cord, an injury at any point interrupts everything that depends on the pathways crossing that point. A cervical injury, near the neck, affects more of the body than a lumbar injury, near the lower back, because more pathways still need to pass through. This is why the level of injury, described in detail in a later section, matters so much for what changes afterward.1

With the geography of the spinal cord in place, the next question is how injuries actually happen. That is where the article turns next.

How Spinal Cord Injuries Happen

Spinal cord injuries fall into two broad groups. Traumatic SCI is caused by a sudden physical event such as a vehicle crash or a fall. Non-traumatic SCI is caused by an internal medical process such as a tumor pressing on the cord, an interruption in blood flow, or an infection. Each group has different typical causes and recovery patterns, so clinicians treat them as distinct categories from the very first assessment.1

Traumatic causes

In the United States, traumatic injuries account for the majority of new SCI cases each year. The National Spinal Cord Injury Statistical Center tracks the leading causes from data collected at SCI Model System rehabilitation centers across the country.3

Falls are now the leading cause of traumatic SCI in adults 65 and older, and as the average age at injury has shifted upward, falls have grown as a share of new injuries overall. Diving and contact sports continue to account for a disproportionate share of cervical injuries in younger adults.3

Non-traumatic causes

Non-traumatic SCI develops without an obvious physical injury. The most common causes include spinal cord tumors, vascular events such as a spinal stroke (an interruption in blood flow to the cord), spinal stenosis (narrowing of the spinal canal that compresses the cord over time), infection such as an epidural abscess or transverse myelitis, and certain inflammatory or degenerative conditions. Non-traumatic causes account for a meaningful and growing share of SCI across North America. Canadian registry data reports an average age at injury of about 60 years for non-traumatic SCI, compared with 55 years for traumatic SCI.1548

A common misconception worth clearing up

Myth check

Spinal cord injury is not contagious. SCI is mechanical or medical damage to the spinal cord itself. It cannot be transmitted from one person to another by contact, fluids, or any other route. People living with SCI present no infection risk to family, friends, coworkers, or healthcare staff.1

Knowing how an injury happened is only one half of the picture. The damage that follows in the hours and days afterward is the other half, and it is often where the most ground can be gained or lost. The next section explains what unfolds inside the body after the moment of injury.

Primary and Secondary Injury: Two Phases of Damage

One of the most important things to understand about SCI is that the damage happens in two stages. The first stage is the physical event itself. The second stage is a wave of biological reactions that begins minutes after impact and continues for hours, days, and even weeks. The two stages are different in nature, and the second one is where modern acute care focuses much of its attention.67

Primary injury: the moment of impact

Primary injury refers to the immediate physical damage to the spinal cord at the moment of trauma. It can take several forms: contusion (bruising of the cord), compression (the cord being squeezed by displaced bone, disc material, or a mass), laceration (cutting of cord tissue, often by a bone fragment or projectile), or transection (the cord being cut across, fully or partially). Primary injury happens in the first few seconds. By the time the patient reaches a hospital, the primary injury is, in most cases, already complete.7

Secondary injury: the hours and days that follow

Secondary injury is the cascade of biological events that the primary injury sets off. It is not a single thing. It is a chain of reactions that can spread the zone of damage well beyond the original site if it is not interrupted.67

This cascade explains why the medical picture in the first 72 hours after an injury can change. A person who arrives at the emergency department with some sensation or movement may lose function as the cascade plays out. The opposite is also possible: with rapid surgical decompression and careful blood pressure management, some function preserved at the time of arrival can be protected.610

Why early treatment focuses on limiting secondary injury

The primary injury cannot be undone. The secondary injury is the part that modern care can influence. Surgical decompression to relieve pressure on the cord, careful management of blood pressure to keep blood flowing through the cord (a process called perfusion), and protection of the airway and breathing are all aimed at the same target: limiting how far the secondary cascade is allowed to run.1011

Once the acute storm has passed, the picture shifts. The next section covers the broader clinical timeline and what each phase is focused on.

The Clinical Phases After Injury

Clinicians describe SCI care in three phases that follow the trajectory of healing. The boundaries between them are not strict, but each phase has a distinct focus and a distinct set of goals. The phases described here apply primarily to traumatic SCI; non-traumatic injuries follow a similar arc but with timing tied to the underlying medical cause.1

First 7 days

Acute

Stabilizing breathing and circulation, surgical decompression of the cord when indicated, blood pressure management to limit secondary injury, prevention of immediate complications such as blood clots and pressure injuries.113

1 week to 6 months

Subacute

Inpatient rehabilitation: rebuilding strength, learning new ways of moving, training in bladder, bowel, and skin care, education for patients and families, transition planning for the move home.114

6 months and beyond

Chronic

Long-term health management at home and in the community, ongoing rehabilitation as needed, vigilance for late-emerging complications, support for participation in work, school, family, and social life.1

The bulk of measurable neurological recovery happens in the first six months, with continued, smaller gains often seen up to two years and sometimes longer in incomplete injuries.33 Recovery is covered in more detail later in the article.

Whether a person ends up with a cervical, thoracic, lumbar, or sacral injury determines a great deal about what life after injury looks like. The next section translates the four spinal cord regions into specific functional implications, level by level.

Levels of Injury: From High Cervical to Sacral

The neurological level of injury is the lowest segment of the spinal cord with normal sensation and at least anti-gravity muscle strength on both sides of the body. It is the single most useful starting point for predicting which functions will be affected after the injury.2

The descriptions below are general patterns. Two people with the same neurological level can have very different functional pictures because of differences in completeness, age, body type, and rehabilitation. They are best read as a guide to where to focus, not a forecast of what any one person will be able to do.117

High cervical
C1 – C4

Tetraplegia with limited or no movement of arms, legs, or trunk. Breathing is often affected because the diaphragm is controlled at C3 to C5; some people require ventilator support, especially with injuries at C1 to C3. Injuries at this level also carry a risk of autonomic dysreflexia, a sudden surge in blood pressure that can be triggered by stimuli below the injury (described in detail later in the article).117

Mid and lower cervical (mid-level cervical)
C5 – C8

Tetraplegia with progressively more arm and hand function as the level moves down. C5 typically allows shoulder and elbow flexion; C6 adds wrist extension; C7 adds elbow extension and most hand function; C8 adds finer finger movement. Independent breathing is usually preserved. Autonomic dysreflexia remains a risk at this level.117

Thoracic (often called mid-level injuries)
T1 – T12

Paraplegia with normal arm and hand function. Trunk control improves as the level moves lower along the thoracic spine, which makes a meaningful difference for sitting balance and transfers. Injuries at T6 and above (which includes the upper thoracic levels and all cervical levels) affect blood pressure regulation and carry a risk of autonomic dysreflexia.117

Lumbar
L1 – L5

Paraplegia affecting the hips and legs to varying degrees, with hip flexion often preserved at L2 to L3 and progressively more leg function as the level moves lower. Bladder, bowel, and sexual function are commonly affected.117

Sacral
S1 – S5

Effects on the lower legs and feet, with bladder, bowel, and sexual function typically the most affected. Many people at this level walk independently, though they may use bracing or assistive devices.117

"Mid-level injury" is a phrase patients and families often use, and it usually refers to thoracic injuries or sometimes mid-cervical injuries (C5 to C8). It is not a formal clinical category; the formal categories are the four regions and the specific neurological level within them.2

The level tells you which body regions are involved. The next set of terms tells you what is happening in those regions.

Paraplegia, Tetraplegia, and Paralysis: What These Terms Mean

Three terms come up over and over in any conversation about SCI. Used loosely, they overlap. Used clinically, they have specific definitions tied to which body regions are affected.2

Paraplegia

Paraplegia describes loss of motor or sensory function in the trunk, legs, and pelvic organs while arm function is preserved. It results from injury at the thoracic, lumbar, or sacral levels. The exact pattern varies with the level of injury and how complete the injury is, so paraplegia ranges from full leg paralysis with intact trunk control to partial weakness in only the lower legs.2

Tetraplegia

Tetraplegia describes loss of motor or sensory function in the arms, trunk, legs, and pelvic organs and results from injury to the cervical region of the spinal cord. Quadriplegia means the same thing and is still in widespread everyday use, but tetraplegia is the clinical term currently preferred. Both words describe the same condition.2

Paralysis

Paralysis is the broader umbrella term for the loss of voluntary muscle function. Paraplegia and tetraplegia are specific kinds of paralysis. Paralysis from SCI can be partial or complete and can affect movement, sensation, or both. It often comes with autonomic changes such as loss of bladder control. Paralysis can also have causes other than SCI, such as stroke, peripheral nerve injury, or multiple sclerosis.1

The level of injury and the body-region terminology together describe where SCI affects the body. The next layer of detail describes how much function is affected, which is the difference between a complete and an incomplete injury.

Complete and Incomplete Injuries: Why the Difference Matters

Every SCI is described as either complete or incomplete. The distinction is decided by a specific clinical exam at the lowest sacral segments of the cord, S4 and S5, and it carries significant weight for prognosis.2

Complete injuries

A complete injury means there is no preserved sensation or voluntary motor function in the lowest sacral segments. In practical terms, the brain is no longer receiving any signal from, or sending any signal to, the bottom of the cord. About one third of new traumatic SCIs are complete at the time of admission to a rehabilitation center.3

Incomplete injuries and sacral sparing

An incomplete injury means at least some sensation or voluntary motor function is preserved in the lowest sacral segments. The preserved signal at S4 and S5 is called sacral sparing, and it is the marker clinicians use to confirm that some pathways are still passing through the injury. Incomplete injuries vary widely in how much function is preserved, and they generally have a better recovery trajectory than complete injuries.233

How clinicians grade severity

The most widely used grading system is the ASIA Impairment Scale, which sorts injuries into five grades from A (complete) through E (normal function). The scale is a way of describing severity in a standard format that any SCI clinician anywhere will understand.218 Because it is a substantial topic in its own right, NASCIC covers the ASIA scale in detail in a dedicated article.

Read next

The ASIA Impairment Scale: Understanding How Spinal Cord Injuries Are Classified covers each grade, the neurological exam used to assign a grade, and what each grade implies for recovery.

Severity sets one part of the picture. The other part is what changes for the body beyond the obvious effects on movement and sensation. The next section addresses the systems that often catch families off guard.

Effects Beyond Movement: The Autonomic Story

The first effects of SCI most people notice are the visible ones: the inability to move a limb, the loss of feeling in a region of the body. The effects that are often more disruptive over the long run are the invisible ones, because the spinal cord also carries the signals that run the body's background machinery. These signals travel through the autonomic nervous system, and they are often disrupted by SCI in ways that touch nearly every organ system.21

Cardiovascular

Blood pressure regulation can be impaired, especially at injuries above T6. Low resting blood pressure, lightheadedness on sitting up, and a higher long-term risk of cardiovascular disease are all common.21

Respiratory

Higher cervical injuries can weaken the diaphragm and accessory breathing muscles, raising the risk of pneumonia, atelectasis (partial collapse of a lung), and sleep-disordered breathing. Respiratory complications remain the leading cause of death after SCI in the modern era.427

Bladder and bowel

Neurogenic bladder and neurogenic bowel are nearly universal after SCI. Routines, medications, and equipment vary by injury level and personal preference, and choices made early often have long-term consequences for kidney health and quality of life.25

Read NASCIC's neurogenic bladder article for a full breakdown of bladder management strategies and long-term considerations.

Thermoregulation

Sweating and shivering may be reduced or absent below the injury, which makes the body slower to respond to heat and cold. Careful clothing and environmental control become part of routine care.22

Sexual function and fertility

Changes affect arousal, sensation, erection, ejaculation, and lubrication. Most people retain the ability to have a satisfying sexual life with adapted approaches, and fertility options exist for both men and women after SCI.1

Autonomic dysreflexia: the medical emergency to know

Autonomic dysreflexia is a sudden, sharp rise in blood pressure that can occur in people with SCI at or above the T6 level. It is set off by a stimulus below the level of injury, most often a full bladder, a blocked catheter, a bowel impaction, or a pressure sore, but sometimes by something as small as a tight piece of clothing. The surge can be life-threatening if not treated quickly. Hallmarks include a pounding headache, sweating above the injury, flushing or goosebumps, and blurred vision. Treatment starts with sitting upright, removing the trigger, and giving fast-acting blood pressure medication if the trigger cannot be found and resolved within minutes.20

The autonomic effects above are the ones most directly tied to nervous system disruption. Over the months and years after an injury, a separate group of conditions tends to emerge from the combination of immobility, equipment use, and altered physiology. The next section covers those.

Secondary Health Conditions Across the Lifespan

SCI changes how the body works, and over time those changes raise the risk of a specific set of secondary conditions. Most are preventable or manageable with proactive care, but they require ongoing attention from the person and their healthcare team.1

Pressure injuries

Skin breakdown over bony areas remains one of the most common reasons people with SCI are readmitted to the hospital. Regular pressure relief, equipment fit, nutrition, and skin checks are the cornerstones of prevention.31

Urinary tract infections

Bladder management methods and catheter use raise UTI risk. Distinguishing symptomatic infection from asymptomatic bacteriuria is important; not every positive urine culture needs treatment.26

Spasticity

Involuntary muscle contractions and stiffness develop in the weeks to months after injury and can range from mildly useful for transfers to disabling. Treatments span stretching, medication, focal injections, and intrathecal therapy.32

Neuropathic pain

Pain caused by changes in nerve signaling itself, often described as burning or electric, affects most people with SCI to some degree. It responds to a different set of medications than musculoskeletal pain.239

Bone loss and fractures

Rapid bone loss below the level of injury starts in the first months after SCI and continues for years. Most fractures occur at the distal femur and proximal tibia and can result from low-energy events such as a transfer.2829

NASCIC's bone health article covers screening and treatment.

Cardiovascular disease

Reduced activity, altered lipid profiles, and blood pressure disruption combine to raise long-term cardiovascular risk. Regular screening and lifestyle adjustments are now standard parts of long-term SCI care.21

Mental health

Depression and anxiety affect a significant share of people with SCI, especially in the first year after injury. They are treatable. Screening, peer support, and access to mental health professionals familiar with SCI improve outcomes.30

Knowing these risks exist is the first step. The second step is the care system that addresses them, from the first hours after injury through the years that follow.

From Emergency Room to Home: Acute Care, Surgery, and Rehabilitation

Care for SCI begins at the scene and evolves through several environments. Each step has a specific job, and modern outcomes depend on each step doing its job in sequence.13

Pre-hospital and emergency stabilization

At the scene, paramedics protect the spine with rigid immobilization, support the airway and breathing, and transport the person to a hospital with surgical and neurological expertise. In the emergency department, imaging confirms the location and severity of injury, blood pressure is supported with fluids and medications to keep the cord perfused, and a neurological exam establishes the baseline that all later assessments are measured against.13

Surgical decompression and the "time is spine" principle

If a bone fragment, displaced disc, or hematoma is pressing on the cord, surgery to remove that pressure is recommended within 24 hours of injury. Multiple studies and the most recent AOSpine clinical practice guideline support early decompression as a way to improve neurological outcomes.101112 The phrase "time is spine" reflects the same urgency that "time is brain" carries for stroke care.

Inpatient rehabilitation

Once medically stable, most people transition to an inpatient rehabilitation unit at a specialty SCI center. In the United States, these are often designated SCI Model System centers funded through the National Institute on Disability, Independent Living, and Rehabilitation Research. In Canada, specialty rehabilitation programs at institutions such as Toronto Rehabilitation Institute (KITE), GF Strong Rehabilitation Centre, Lyndhurst Centre, and other regional centers fill the same role, and the Rick Hansen Spinal Cord Injury Registry coordinates national outcomes data across them. The team is multidisciplinary by design: physiatrists, physical therapists, occupational therapists, speech-language pathologists for higher cervical injuries, rehabilitation nurses, dietitians, psychologists, social workers, and peer mentors. The goal of this phase is to translate the body's new physiology into daily life skills, equipment choices, and a plan for returning home.144748

Returning home and outpatient care

The transition home is often the hardest phase emotionally, and in modern care it is treated as a deliberate clinical milestone, not an endpoint. Outpatient therapy, primary care familiar with SCI, regular urological and rehabilitation follow-up, and connection to peer and advocacy networks all play a role in long-term health. NASCIC and its partner organizations are part of that long-term support system.4344

With the care timeline in place, the natural next question is what recovery actually looks like across that timeline.

Recovery, Prognosis, and Aging With SCI

Patterns of neurological recovery

Most measurable neurological recovery happens in the first six months after injury. Smaller continued gains often occur up to two years, and people with incomplete injuries can see useful changes for longer. Recovery generally moves outward from the level of injury, with sensation often returning before motor function. The pattern is highly variable from person to person, and statistics are best understood as group averages, not individual predictions.33

Life expectancy and leading causes of death

Life expectancy after SCI has improved substantially over the past several decades. People with paraplegia now have life expectancies that approach those of the general population, while people with high cervical injuries, particularly those who require ventilator support, still face a meaningful gap. The leading causes of death have shifted away from kidney failure (which dominated in earlier decades thanks to better bladder management) toward respiratory disease, heart disease, cancer, septicemia, and unintentional injuries. Pneumonia and septicemia together account for a disproportionate share of the remaining gap and are both targets of proactive care.4

Aging with SCI

The first decades after injury and the decades that follow are different. As people with SCI age, the typical wear-and-tear conditions that affect everyone, such as arthritis, cardiovascular disease, and diabetes, layer on top of SCI-specific risks like pressure injuries, spasticity, and bone loss. Shoulder problems from years of wheelchair use are common. Sleep-disordered breathing and respiratory health need ongoing attention. Mental health and social participation matter as much as any other system. Aging with SCI is a research area that has grown substantially as the population aging with SCI has grown, and care models are evolving with it.3534

Day-to-day life with SCI is shaped by the care that exists today. Tomorrow's care is the focus of the next, and final, section.

Where the Research Is Heading

SCI research has changed considerably in the past decade. Several lines of work have moved from animal studies into early human trials, and a handful have produced results that would have been hard to imagine even ten years ago. None of the approaches below is yet a standard treatment. All of them are real, with named investigators, named institutions, and published outcomes.

Neuromodulation

Spinal cord stimulation for movement

At the University of Louisville's Kentucky Spinal Cord Injury Research Center, Susan Harkema and Claudia Angeli reported in the New England Journal of Medicine that participants with chronic motor complete SCI regained the ability to stand and walk over ground using epidural spinal cord stimulation paired with intensive activity-based training.39 A separate group at NeuroRestore in Switzerland subsequently published a brain-spine interface that translated cortical signals into spinal stimulation, allowing a participant with chronic tetraplegia to walk in community settings.40

Brain-computer interfaces

Decoding intent for movement and communication

The BrainGate consortium, led from Brown University, Massachusetts General Hospital, and Stanford, has demonstrated that people with tetraplegia can use implanted intracortical electrodes to control robotic arms, computer cursors, and high-speed text communication.3637 At the University of Pittsburgh, the Schwartz, Boninger, and Gaunt labs have shown that adding artificial sensory feedback through cortical stimulation improves the speed and reliability of BCI-controlled robotic arms.38

Cell therapy

Stem cell and Schwann cell transplantation

At UC San Diego, Curtis and colleagues completed a first-in-human phase I trial of neural stem cell transplantation for chronic SCI, establishing safety in a small group of participants.41 The Miami Project to Cure Paralysis at the University of Miami has reported clinical outcomes from multi-center neural stem cell transplantation in chronic cervical injury, building on a long history of cell-therapy work at that center.42

Neuroprotection

Limiting the secondary cascade

Targeting the secondary injury cascade described earlier in this article remains a priority. Several drug candidates aimed at inflammation, excitotoxicity, and vascular preservation are in clinical trials, and the broader strategy is to combine medical neuroprotection with rapid surgical decompression to protect as much cord tissue as possible.7

Rehabilitation technology

Activity-based therapy and assistive devices

Activity-based therapy programs, robotic gait training, exoskeletons, and functional electrical stimulation are now standard offerings at many SCI rehabilitation centers. Research has moved past the question of whether these tools work. The current focus is on identifying who benefits most and how to make these therapies available at scale.14

Research moves in years, not headlines, and the people who work in this field are careful not to overpromise. What has changed is that several lines of work that once existed only in animal models now have clinical results in humans, and the question has shifted from whether neurological recovery after chronic SCI is possible to who can reach it, by what means, and how soon.

Continue at NASCIC

This article is the starting point. The articles below go deeper on specific topics that come up often in conversations about SCI.

Clinical disclaimer

This article is intended for educational purposes. Decisions about your own care or the care of someone you support should be made with your healthcare team, who can apply the information here to your specific situation. This content does not replace professional medical advice, diagnosis, or treatment.

References

The following citations provide the scientific foundation for information presented in this article. Sources include peer-reviewed medical journals, clinical practice guidelines, registry data, and authoritative North American medical institutions.

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How to cite this article

North American Spinal Cord Injury Consortium (NASCIC). What Is a Spinal Cord Injury? A Plain Guide. NASCIC Knowledge Base. Published 2026. Available at: https://nascic.org/what-is-sci/

Clinical disclaimer: This article is intended for educational purposes. Decisions about your own care or the care of someone you support should be made with your healthcare team, who can apply the information here to your specific situation. This content does not replace professional medical advice, diagnosis, or treatment.

Uniting North American SCI Organizations

The North American SCI Consortium (NASCIC) convenes organizations across the continent that advocate, represent, and communicate with people living with spinal cord injury.

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