Spinal Cord Injury Levels

Here is a clear, structured guide to spinal cord injury (SCI) levels and the functions typically affected.
This applies to traumatic SCI, but patterns are similar in other causes.

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🔵 Spinal Cord Injury Levels & Functions

The spinal cord is divided into 4 major regions:

1. Cervical (C1–C8) – neck

2. Thoracic (T1–T12) – upper/mid back

3. Lumbar (L1–L5) – lower back

4. Sacral (S1–S5) – pelvis, legs, bowel/bladder

The higher the injury, the more of the body is affected.

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🟣 1. CERVICAL LEVELS (C1–C8)

These control the neck, arms, breathing, and upper body.
Injuries here usually cause tetraplegia/quadriplegia (arms + legs affected).

C1–C4 (High Cervical)

C1–C3

• • Full paralysis below the neck

  • May require a ventilator for breathing

  • No arm/leg movement

C4

• • Shoulders and the diaphragm partially work

  • Breathing is often possible without a ventilator

  • No arm/hand function

C5

• Can lift arms and bend elbows

• No wrist/hand function

• Can use a powered wheelchair with modifications

C6

• Wrist extension possible

• Improves independence (tenodesis grasp helps with hand grip)

• Can perform some self-care with aids

C7

• Elbow extension (triceps)

• Better push ability, transfers, and wheelchair propulsion

C8

• Partial hand/finger movement

• Better grip strength

• Greater independence in daily tasks

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🔵 2. THORACIC LEVELS (T1–T12)

Controls chest, abdominal muscles, and trunk.
Injuries here cause paraplegia (legs affected, arms normal).

T1–T5

• Normal arm/hand function

• Weak chest muscles

• Difficulty with trunk balance

• Wheelchair use is necessary for mobility

T6–T12

• Better trunk control

• Stronger abdominal muscles

• Sitting balance improves

• Some may be able to stand or walk with braces

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🟢 3. LUMBAR LEVELS (L1–L5)

Controls the hips, legs, and part of the bowel/bladder.

L1–L2

• Weak hip flexion

• Walking is often possible with orthoses or crutches

L3

• Stronger hip flexion, some knee extension

• Walking with braces is common

L4

• Knee extension improves

• Some independent walking with minimal aids

L5

• Toe and ankle movement

• Walking is often possible with an ankle–foot orthosis (AFO)

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🟡 4. SACRAL LEVELS (S1–S5)

Controls pelvic organs, sexual function, and parts of the legs.

S1

• Good leg strength

• Near-normal walking with minor support

S2–S4

• Controls:

  • Bowel

  • Bladder

  • Sexual function

• Function varies from mild loss to almost normal mobility.