This chapter is confined to consideration of closed spinal cord injuries. The term paraplegia indicates paralysis of the lower limbs with sensory loss and involvement of bladder, bowel and autonomic functions. The term will be used for any clinically complete spinal cord lesion below the cervical cord. The term tetraplegia (quadraplegia) indicates a higher lesion causing, in addition, total or partial paralysis and sensory loss in the upper limbs. The terms paraplegia and tetraplegia, unless further defined, describe a clinically complete lesion. The terms paraparesis and quadraparesis are not used in this chapter but are widely used to describe incomplete lesions. The term ‘paraplegia’ has also been widely used to encompass both tetraplegia and paraplegia.

Descriptions and scales used to quantify initial severity of spinal cord lesion and outcomes

Until the late 1960s, descriptive terms were usually employed to describe initial severity such as ‘complete’, ‘virtually complete’ and ‘incomplete’. Outcomes were described as ‘unchanged’, ‘improved’ and ‘worse’. These descriptions enabled various authors to claim success for their chosen methods of treatment!

In 1969 Frankel et al. in a retrospective analysis of the outcome of non-surgical postural reduction of spinal injuries introduced a simple classification which was subsequently called the Frankel classification. This classification remained the standard for almost 20 years. The Frankel classification consists of the letters A-E as follows:

1. A Complete: the lesion is found to be complete, both motor and sensory, below the segmental level named.

2. B Sensory incompleteness only: implies that there is some sensation present below the level of the lesion but that the motor paralysis is complete below that level. This does not apply when there is slight discrepancy between motor and sensory levels but does apply to ‘sacral sparing’.

3. […]