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Last Modified: December 29, 2022

4 levels of spinal cord injury

Published on June 27, 2014 • Last updated December 29, 2022 by Ken Christensen
Topics: Uncategorized

"Spine"There are four levels of spinal cord injury: The first level is Cervical (neck), the second level is Thoracic (middle back), the third level is Lumbar (lower back), and the fourth level is Sacral (tailbone). There are also two types of spinal cord injuries that determine the amount of physical return to the body, if any, while recovering. These types of injuries are “complete” and “incomplete.” Complete injuries occur when the spinal cord has been severed (cut) during injury. These injuries mean that there is no chance of physical return to the areas of the body that have been affected and that the connection from the brain to the body and the body to the brain has been cut off. Incomplete injuries occur when the spinal cord has not been severed (not cut) during one’s injury, meaning that there are still some connections from the brain to the body and the body to the brain allowing some physical return during recovery.  This classification system has been designed and used to help doctors, physical therapists, and those with spinal cord injuries understand these injuries better and what their abilities and inabilities will be.

1. Cervical Injuries

The cervical level is located at the base of the skull starting at C-1 and the top of the shoulders ending in C-7. This is the type of injury that quadriplegics and tetraplegics are classified as having. The injuries under this classification are neck injuries and cause the most severe loss of physical function.

Loss of physical function

Depending on how high in the neck the injury is and what kind of break it is, (i.e. a break from C-1–C-3 and complete), the affected person could lose various levels of functionality in their body. It is possible that they will lose the ability to breathe on their own and the ability to move their hands, arms, legs, and trunk muscles. They may also experience loss of voluntary muscle control of the bladder and bowel, and may not be able to function sexually.

These individuals will require the help of a home health aide from a home health agency to help with the everyday living activities, including: dressing and undressing, showering, using the restroom, eating, and moving from pieces of furniture like chairs and beds.

If the break happens lower down the neck, (i.e. a break from C-4–C-6 and is incomplete), the individual will have the ability to breathe on their own and have some limited use of their arms but no use of their hands. They will not have use of their legs and trunk muscles, and they will not have voluntary muscle control of bladder, bowel, or sexual function.


Even though the loss can be severe, there are ways to overcome the loss of one’s physical ability. For instance, a person with a C-1 through C-3 complete break can be given the ability to breathe again through the use of a ventilator and hopefully one day be able to breathe on their own, depending on their physical return. A person with a C-4 through C-7 will have the ability to go to the bathroom with the use of medical aides and catheters.  These individuals can also be given the opportunity to get around their own home or community through the use of a manual or power wheelchair adapted to their physical ability.

2. Thoracic Injuries

The thoracic injury level is the level for paraplegics. This level of break is located below the shoulders starting at T-1 and ending at T-12, which is at the lumbar location of the spine. These kind of injuries are back injuries.

Loss of function

Individuals with these types of injuries will have no use of their legs or trunk muscles. Depending on how complete the break is, they will not have voluntary muscle control of bladder, bowel, or sexual function.

Those affected by thoracic injuries have the use of their hands and arms and can breathe on their own without the use of a ventilator. They will not need the help of home health care around the clock. These individuals can be totally independent and not need the help of anyone. A person with this kind of injury can be assured that they will be independent and be able to push a manual wheelchair instead of the use of a power wheelchair. In time, they can also drive their own vehicle that has been adapted with hand controls.

3. Lumbar Injuries

The lumbar level is also an injury level that affects paraplegics as well. This level is located lower in the spine and begins at L-1 and ends at L-5.

Loss of function

Individuals suffering from lumbar injuries will be limited in their walking abilities (if the break is incomplete) due to the minimal strength in their legs.  They also will have the of loss voluntary muscle control of bladder, bowel, and sexual function, but these can often be managed with special equipment.


These individuals will have more strength in their upper physical extremities and be more physically independent than those with other spinal cord injuries.

4. Sacral Injuries

The sacral level is less severe than all the other spinal cord injuries combined. This level is located right below L-5. It starts at S-1 and ends at S-5 five. This type of break is right at the very bottom of the spine.

Loss of function

Individuals with these injuries will experience some loss in hips and legs. There will be little or no voluntary muscle control of bladder or bowel.


Many individuals with these injuries will be able to manage their own bowel care with special equipment. If the injury is not a complete break, they will also have the ability to their legs again with the help of assisted walking aids like crutches or leg braces.

There are many types of spinal cord injuries that determine different physical abilities and outcomes. Depending on the type of break, one will have different limitations and a different way of living. It has been shown that the higher the break, the more severe the physical loss. Likewise, the lower the break, the more physical return and independence will be given to the person with the injury. Not every break is the same, and many injuries are very different from each other. Paralysis does not mean the end of life—there are many resources that can restore one’s independence and help ensure a healthy way of living and longer life.


Shepherd Center

Royal Adelaide Hospital

Photo “crushed” copyright to Warren Rohner

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