Incomplete spinal cord injury: what it means and what chances of recovery there are

A diagnosis that is not always explained well

When someone is diagnosed with a spinal cord injury, one of the first terms they hear is whether the injury is complete or incomplete. The difference is enormous in terms of prognosis and prospects for recovery, but it is rarely explained clearly enough in a hospital setting.

This article sets out to do exactly that: to explain what each category means, what it implies for recovery, and what treatment options exist when the injury is incomplete.

Complete vs. incomplete spinal cord injury: the fundamental difference

The spinal cord is the main communication cable between the brain and the rest of the body. When it is damaged, the transmission of signals —both those travelling from the brain to the muscles (motor signals) and those travelling from the body to the brain (sensory signals)— can be interrupted completely or partially.

• Complete injury: there is no motor or sensory function below the level of the injury. The nerve pathways are entirely interrupted. The prognosis for recovery is more limited, although it does not rule out functional improvement with treatment.
• Incomplete injury: some motor or sensory function is preserved below the level of the injury. This indicates that some nerve pathways are partly intact. The presence of those pathways is the basis for functional recovery.

The practical difference is crucial: in an incomplete injury, the nervous system has pathways that can be strengthened and extended with the right treatment. Recovery is not guaranteed, but the potential is real and in many cases significant.

The ASIA scale: how spinal cord injury is classified

The most widely used classification system internationally is the ASIA scale (American Spinal Injury Association Impairment Scale), which divides spinal cord injuries into five grades:

• ASIA A (complete): no motor or sensory function in the sacral segments S4-S5. This is the most severe injury.
• ASIA B (sensory incomplete): sensory but not motor function is preserved below the level of the injury, including the sacral segments S4-S5.
• ASIA C (motor incomplete, weak): motor function is preserved below the neurological level, but more than half of the key muscles have a strength of less than 3/5.
• ASIA D (motor incomplete, functional): motor function is preserved below the neurological level, and at least half of the key muscles have a strength of 3/5 or more. This is the grade with the best prognosis for recovering the ability to walk.
• ASIA E (normal): normal motor and sensory function. It is assigned when there was an injury but full recovery has taken place.

Grades B, C and D are incomplete injuries. Grade D in particular carries a 75-95% probability of recovering functional walking with the right treatment.

What realistic chances of recovery are there with an incomplete injury?

The prognosis depends on many factors: the level of the injury (cervical, thoracic, lumbar or sacral), the ASIA grade, the time since the injury, and the intensity of the treatment received. Without resorting to generalisations that can mislead, what the evidence shows is:

• Incomplete injuries have significantly more recovery potential than complete ones.
• Recovery is faster and more pronounced in the first 6-12 months, but it can continue years later with the right treatment.
• The intensity of rehabilitation is one of the most decisive factors: more hours of specific treatment translate into better results.
• Incomplete cervical injuries can regain hand and arm function to a degree that restores significant independence.
• Incomplete thoracic and lumbar injuries have a good prognosis for recovering walking when the ASIA grade is C or D.

The role of neurostimulation in recovery from an incomplete spinal cord injury

In recent years, neurostimulation techniques have significantly widened the treatment options for incomplete spinal cord injury. Functional electrical stimulation (FES), epidural spinal cord stimulation and transcranial magnetic stimulation (TMS) act on the excitability of the preserved nerve pathways, making them easier to activate and strengthening the connections that underpin motor function.

Combined with intensive rehabilitation, these techniques have been shown in clinical studies to improve motor recovery, sensation and, in some cases, bladder and bowel function in patients with an incomplete injury.

When to look for a centre specialising in incomplete spinal cord injury

The public health system provides rehabilitation in the acute and subacute phases, but it often lacks the intensity and the specialisation needed to make the most of an incomplete injury's potential. It makes sense to look for a specialist neurorehabilitation centre when:

• The treatment received so far has been low in intensity (few sessions a week).
• There has been no access to neurostimulation techniques.
• Months have passed since the injury and improvement has stalled before the potential was exhausted.
• The goal is to recover walking or upper-limb function and nothing is being done specifically to work towards it.

Spinal cord injury treatment at Foltra

At Centro Sanitario Foltra we work with patients with incomplete spinal cord injury at every phase of recovery. Our protocol combines intensive neurological physiotherapy, neurostimulation, occupational therapy and speech therapy in a personalised plan built around specific functional goals.

You can find out more about our approach in the section on spinal cord injury rehabilitation, or request an initial assessment directly so that our team can evaluate your case.