Chronic spinal cord injury

Last reviewed: 18 Apr 2022
Last updated: 04 Dec 2018



History and exam

Key diagnostic factors

  • presence of risk factors
  • motor weakness
  • loss of fine motor coordination
  • 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
  • micturition cysto-urethrogram
More investigations to consider

Treatment algorithm


progressive neurological deficit

stable neurological status



Kenneth Casey, MD, FACS

Clinical Associate Professor of Surgery (Neurosurgery)

Michigan State University School of Medicine

Clinical Associate Professor of Physical Medicine and Rehabilitation

Wayne State University School of Medicine

Surgical Director Intensive Care

Oakwood Southshore Medical Center



KC declares that he has no conflicts of interest.


Dr Kenneth Casey would like to gratefully acknowledge Dr Jwalant S. Mehta, a previous contributor to this topic. JSM declares that he has 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.

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