Different injury segments have different symptoms and signs, we can distinguish the segment of injured spine from the injury features.
1. Upper cervical spinal ( C1-4 ) fracture consist 10% of spinal fracture, however, cervical spinal injury particularly the higher cervical spinal injury supervene brainstem injury has a very high mortality, rates 60% of spinal injury mortality. Limbs may spastic paralyzed. C2-4 has a phrenic nerve centre, direct injury or bruise of the lower cervical spine nearby could cause diaphragm paralysis, dyspnea and sound low and deep.
2. Lower cervical spinal ( C5-8 ) injury cause limbs paralyzed. In details, far-end of upper limbs numb, weakness, and atrophy, reduce or even disappear of tendon reflex , lower motor neuron paralysis. Lower limbs get upper motor neuron paralysis, muscle tension intensified, knees and ankles hyperreflexia, pathological reflex is positive. Patient has no feeling beneath injured segment, meanwhile ,has disturbance of sphincter, reflexive bladder will be established 7 or 8 weeks after injury, reflections are obvious generally.
3. Thoracic spine ( T1-12 ) injury. Due to the narrowness of thoracic spinal canal ,the spinal cord injury could be complete, lower limbs spastic paraplegia, sensation disappear beneath the injury. Upper and middle thoracic spine sprain cause intercostal muscular paralysis, dyspnea. Lower thoracic spine injury, abdominal wall reflection with a hook at the end or disappear. If the middle thoracic spine got horizontal injured, the upper abdominal wall reflection ( T7-8 ) can maintain, yet, middle and lower abdominal wall reflection disappear, those could distinguish the segment of injured spine. On the spinal cord shock stage, sympathetic nerve block symptom, lose of vessel angisotasis, fall of blood pressure, slow down of pulse, body temperature change with surrounding could caused by injury of segments above T6. After shock stage, mass reflection, bladder reflection, ejaculation and erection will occur.
4. Intumescentia lumbar ( L1-S2 ) injury. The thoracic/lumbar spine could easily fractured, knees and ankles reflections, cremasteric reflex will disappear, yet, abdominal wall reflection won't be effected. Due to spinal cord centre lost control of anal sphincter, defecation and micturition disorder are very obvious.
5. Conus medullaries ( S3-5 ) injury won't cause body paralysis, but gluteus atrophy, anal reflex disappear, the sense of perineum saddle disappear as well. Conus medullaries has a micturtion centre, reflexive bladder cannot be established, flabby rectal sphincter, and urinary incontinence may occur after CM injury. Injury blow L2 can only hurt cauda equina.
6. Cauda equnia injury. Fracture and dislocation beneath L2 can cause Cauda equnia. The symptom is flaccid paresis under injured surface. Cauda equina scatters in spinal canal dispersively, and has high activity, therefor it cannot be injured completely, it's very rare that cauda equnia rupture up completely. The symptoms of two sides are unsymmetric, intense pain and vary degrees of sensation ,sphincter, sexual dysfunction. Furthermore, serious spinal cord injury will cause flaccid paresis, it's a pathophysiology phenomenon of lose advanced central control, called spinal cord shock. 2 -4 weeks later, due to the substantial spinal cord injury, vary degrees of spastic paralysis will occur.