Chronic spinal cord injury

Last reviewed: 27 Dec 2022
Last updated: 18 Jan 2023



History and exam

Key diagnostic factors

  • presence of risk factors
  • motor weakness
  • loss of fine motor co-ordination
  • spasticity
  • paraesthesia, numbness, dysaesthesia
  • hyperreflexia and ankle clonus
  • pathological reflexes
  • contractures
  • loss of perianal sensation, voluntary anal contraction, and anal tone
  • autonomic dysreflexia
  • syrinx
More key diagnostic factors

Other diagnostic factors

  • central (midline) pain
  • girdle pain
  • musculoskeletal or visceral pain
  • unsteady gait
  • urinary incontinence or retention
  • constipation
  • sexual dysfunction
  • non-specific malaise
  • radicular pain
Other diagnostic factors

Risk factors

  • spinal cord trauma or ischaemia
  • higher-level spinal cord lesion
  • extremes of age
  • narrow spinal canal
  • male sex
More risk factors

Diagnostic investigations

Investigations to consider

  • MRI spine
  • EMG
  • urodynamic studies
  • bladder ultrasound
  • renal ultrasound
  • micturition cysto-urethrogram
  • bone densitometry (DEXA)
  • laboratory evaluation
More investigations to consider

Treatment algorithm


progressive neurological deficit

stable neurological status



Cristina Sadowsky, MD

Clinical Director

International Center for Spinal Cord Injury

Kennedy Krieger Institute

Associate Professor Physical Medicine and Rehabilitation

Johns Hopkins School of Medicine




CS has received grant reviews from the American Institute of Biological Sciences and Grand Rounds Sinai Hospital in Baltimore, and has consulted for General Dynamics Information Tech Inc. CS is an author of a number of references cited in this topic.

Travis Edmiston, MD

Assistant Professor for Physical Medicine and Rehabilitation

International Center for Spinal Cord Injury

Kennedy Krieger Institute




TE declares that he has no competing interests.


Dr Cristina Sadowsky and Dr Travis Edmiston would like to gratefully acknowledge Dr Kenneth Casey and Dr Jwalant Mehta, previous contributors to this topic.


KC and JM declare that they have no competing interests.

Peer reviewers

Steven Kirshblum, MD

Medical Director and Director of Spinal Cord Injury Services

Kessler Institute for Rehabilitation

West Orange


University of Medicine and Dentistry of New Jersey/New Jersey Medical School




SK declares that he has no competing interests.

Deborah Short, MRCP

Consultant in Rehabilitation Medicine

Robert Jones and Agnes Hunt Hospital




DS declares that she has no competing interests.

  • Differentials

    • Non-compressive myelopathy
    • Compressive myelopathy
    More Differentials
  • Guidelines

    • Best practice guidelines: spine injury
    • CDC clinical practice guideline for prescribing opioids for pain: United States, 2022
    More Guidelines
  • Patient leaflets

    Constipation in adults

    Deep vein thrombosis

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer