When diagnosing a spinal cord injury, one of the most critical distinctions is whether the injury is complete or incomplete. This classification profoundly affects prognosis, required care, and the value of your legal claim.

Defining Complete Spinal Cord Injuries

A complete spinal cord injury means total loss of motor function (movement) and sensory function (feeling) below the level of injury. If you have a complete injury at the T6 level, you have no voluntary movement or sensation from that point down.

Complete injuries are diagnosed when there is no sacral sparing—no preserved motor or sensory function in the lowest sacral segments (S4-S5). This is assessed through the ASIA examination.

Characteristics of Complete Injuries

  • No voluntary muscle movement below injury level
  • No sensation to touch, pain, or temperature below injury level
  • No sacral sparing (no sensation around the anus or voluntary anal contraction)
  • Classified as ASIA A on the impairment scale

Prognosis for Complete Injuries

Complete injuries rarely show significant neurological recovery. While medical advances continue, most individuals with complete injuries do not regain meaningful function below the injury level.

However, aggressive rehabilitation can maximize function above the injury level and teach compensatory techniques for greater independence.

Defining Incomplete Spinal Cord Injuries

An incomplete spinal cord injury preserves some motor or sensory function below the injury level, including the sacral segments. The degree of preserved function varies enormously—from barely detectable sensation to near-normal movement.

Characteristics of Incomplete Injuries

  • Some voluntary movement and/or sensation below injury level
  • Sacral sparing present (some S4-S5 function preserved)
  • Classified as ASIA B, C, D, or E
  • Wide variability in functional outcomes

Prognosis for Incomplete Injuries

Incomplete injuries have significantly better prognosis. Many patients improve over months to years, particularly with intensive rehabilitation.

However, improvement cannot be guaranteed or precisely predicted. Some patients with incomplete injuries achieve remarkable recovery while others see minimal improvement.

How Classification Affects Your Life

Complete Quadriplegia (Cervical Complete)

  • Paralysis of all four limbs
  • May require ventilator support (C1-C4)
  • Typically requires 24-hour attendant care
  • Very limited independence without significant assistance
  • Lifetime care costs often exceed $5 million

Complete Paraplegia (Thoracic/Lumbar Complete)

  • Paralysis of legs and varying degrees of trunk
  • Full arm and hand function
  • Can often achieve significant independence
  • Typically use manual wheelchair
  • Lifetime care costs typically $1-2 million

Incomplete Injuries

  • Highly variable function depending on preserved abilities
  • May walk with braces, canes, or other assistive devices
  • Care needs depend on specific deficits
  • May improve significantly over time

Impact on Legal Claims

Complete Injuries

Complete injuries typically justify larger damage awards because:

  • Prognosis is more certain—lifetime care needs are predictable
  • Greater paralysis means higher care costs
  • Impact on employment is typically total or near-total
  • Quality of life impacts are extensive

Courts and juries understand the permanence of complete injuries, making damage calculations more straightforward.

Incomplete Injuries

Incomplete injuries present legal complexities:

  • Uncertain prognosis complicates damage calculations—will the plaintiff improve?
  • Defense may argue current limitations will resolve
  • Need medical experts to establish realistic recovery expectations
  • Damages may need to account for range of outcomes

However, incomplete injuries can still result in substantial awards when limitations are significant and expected to persist.

Medical Evidence Requirements

Proving whether an injury is complete or incomplete requires:

  • ASIA examination performed by qualified physician
  • MRI imaging showing extent of spinal cord damage
  • Serial examinations documenting any changes over time
  • Neurologist or physiatrist testimony explaining classification

Early and accurate classification is crucial—misclassification can affect treatment decisions and legal strategy.

The Importance of Timing

Classification may change in the weeks following injury:

  • Spinal shock immediately after injury can mask preserved function
  • True classification becomes apparent as swelling decreases
  • Reassessment at 72 hours and periodically thereafter is standard

An injury that initially appears complete may be reclassified as incomplete once spinal shock resolves. Initial assessment should not be considered definitive.

Conclusion

The complete versus incomplete distinction fundamentally affects your life and your legal claim. Complete injuries carry more certain prognosis but greater permanent limitations. Incomplete injuries offer hope for recovery but create legal complexity around damage calculations. Accurate classification through proper medical evaluation is essential for both appropriate treatment and fair compensation.