**2. Factors that determine the course of spinal cord injury and its classification**

The level and length of SCI, as well as the timeline of the treatment of spinal cord compression, affect the grade and severity of neurological problems and, ultimately, mobility and self-care of patients, as well as their prognosis and recovery, and return to normal life [33]. The cervical spine trauma is associated with spinal cord lesions in 12–70% of injured people and characterized by the predominance of severe damages (contusion, compression, haematomyelia) and high mortality rates (35–70%). Spinal cord lesions occur in 31–75% of thoracic and lumbar spine traumas [21, 26, 27, 29, 34]. In general, injuries of the cervical spine account for 17–61% of cases [30, 34], thoracic – 7.2–40% [26, 29, 34, 35], and lumbar spine – from 8.7 to 57.8% [26, 29, 31, 34].

Types of spinal cord trauma include contusion, concussion, compression, crush, and disruption. The spinal cord's compression is found in 20–26.7% of the injured persons, compression and contusion – in 40–50.5%, compression and crush – in 7–15.7%, and anatomical disruption – in 4.3–7.1% of patients [34]. The grade of the spinal cord injury is one of the principal prognostic factors. The distinction is made between "complete" and "incomplete" SCI, or its morphological disruption (anatomical or axonal). Complete SCI at the cervical level is reported for 33.7–52% of patients, thoracic level – 12.5-54%, and at the lumbar level – 15–21% [33].

In addition to SCI, non-traumatic spinal cord lesions may occur due to epidural abscess and hematoma, intradural tumor or other types of metastatic tumors, and complications after surgical treatment [7, 36]. The treatment of the acute phase in SCI cases takes more time than the treatment of spinal cord lesions of non-traumatic origin. Also, patients with SCI are more likely to have urinary tract infections and other complications [37].

Before early 1990s, a uniform or generally recognized classification system of SCI was not available. Physicians usually distinguished different levels of injury, complete and incomplete SCI.

**5**

*Cytokine Profile as a Marker of Cell Damage and Immune Dysfunction after Spinal Cord Injury*

Then, in 1992 the American Spinal Injury Association (ASIA) developed a classification system for identifying the severity of spinal cord injury based on

1.A = complete spinal cord injury: no motor or sensory function is preserved in

2.В = incomplete injury: sensory function preserved but not motor function is preserved below the neurological level and includes the sacral segments S4-S5;

3.С = incomplete injury: motor function is preserved below the neurological level, but less than half of key muscles below the neurological level have a muscle grade less than 3 (i.e., they are not strong enough to move against

4.D = incomplete injury: motor function is preserved below the neurological level, and at least half of key muscles below the neurological level have a muscle

Many researchers indicate that in addition to diagnostic implications the ASIA scale has tremendous prognostic value [38, 40–43]. Later, the AO Subaxial Cervical Spine Injury Classification (SLIC) system was published, which includes morphological information in its scoring that helps determine the extent of the patient's

Practicing surgeons and radiologists use classification and scoring systems Subaxial Cervical Injury Classification and Severity (SLICS) and Thoracolumbar Injury Classification and Severity (TLICS), respectively, to evaluate the severity of cervical and thoracolumbar spine injuries [45]. Besides, the Spinal Cord Independence Measure (SCIM) has been developed to assess functional improvements of the spinal cord in the course of treatment and rehabilitation. Also, the

1. acute phase – less than first 48 hours after the injury; the clinical course comprises of spinal shock and, as a result, the symptoms and signs are similar for

2. early (subacute) phase is defined to be 48 h – 14 days after the injury; likewise in the acute phase, clinical observations may include a syndrome of complete block of conduction in the spinal cord due to spinal shock, altered blood and

3.intermediate phase is defined to be 14 days – 3 months; spinal shock symptoms disappear, and the actual severity and range of spinal cord injury is

4. chronic phase – more than 3 months after the injury; the recovery of spinal cord functions occurs depending on the SCI grade; neurological status may deteriorate due to the scarring process, cyst formation, post-traumatic

SCI is classified chronologically into the following four phases:

cerebrospinal fluid flow; edema and swelling of the spinal cord;

grade of 3 or more (i.e., the joints can be moved against gravity);

5.Е = normal: motor and sensory functions are normal.

*DOI: http://dx.doi.org/10.5772/intechopen.95614*

the sacral segments S4-S5;

gravity);

injury [44].

SCIM has prognostic value [46].

various grades of SCI;

determined;

syringomyelia, etc. [23, 47–51].

descriptions of motor and sensory functions [38, 39].

*Cytokine Profile as a Marker of Cell Damage and Immune Dysfunction after Spinal Cord Injury DOI: http://dx.doi.org/10.5772/intechopen.95614*

Then, in 1992 the American Spinal Injury Association (ASIA) developed a classification system for identifying the severity of spinal cord injury based on descriptions of motor and sensory functions [38, 39].


Many researchers indicate that in addition to diagnostic implications the ASIA scale has tremendous prognostic value [38, 40–43]. Later, the AO Subaxial Cervical Spine Injury Classification (SLIC) system was published, which includes morphological information in its scoring that helps determine the extent of the patient's injury [44].

Practicing surgeons and radiologists use classification and scoring systems Subaxial Cervical Injury Classification and Severity (SLICS) and Thoracolumbar Injury Classification and Severity (TLICS), respectively, to evaluate the severity of cervical and thoracolumbar spine injuries [45]. Besides, the Spinal Cord Independence Measure (SCIM) has been developed to assess functional improvements of the spinal cord in the course of treatment and rehabilitation. Also, the SCIM has prognostic value [46].

SCI is classified chronologically into the following four phases:


*Connectivity and Functional Specialization in the Brain*

annual increase of people with disabilities after SCI [18].

spine, especially its upper portion [13–16]. The leading causes of death comprise respiratory problems, cardiovascular disorders, thromboembolic events, infectious complications, and suicides [17]. Disability rates after vertebral column and spinal cord injuries vary from 57.5 to 100%, and the data indicate a trend towards an

Prominent underlying SCI causes include road traffic injuries (36–43%), falls from height (24.2–63.2%), shallow water diving (3–32%), sports activities and accidents (22.5%) [19–22], while criminal traumas account for 10-25% of the injuries [23]. The leading causes of injuries vary for different years and across geographic regions [24]. In this context, spinal cord injuries related to ocean waves

Spinal cord injuries resulting from vertebral column trauma are reported for 36–72% of patients [10, 11, 26, 27]. Craniocerebral trauma is more commonly associated with cervical spine fractures (18–72%). Thoracic spine fractures are usually combined with multiple non-vertebral injuries, such as bone fractures (10.3–48%), traumas of the thoracic cavity and its internal organs (as high as 52%), and lumbar spine injuries – with broken limb bones (up to 27%) and pelvic bones (up to 15%), and damage of the abdominal organs (9.8–18.7%) [21, 27–31]. By type, SCIs are divided into open (penetrating) and closed (nonpenetrating) injuries to the spine.

are commonly reported in the coastal areas, among beachgoers, etc. [25].

In peacetime, closed SCI account for 70.1–88.6% of cases [26, 32].

lumbar spine – from 8.7 to 57.8% [26, 29, 31, 34].

infections and other complications [37].

complete and incomplete SCI.

**classification**

**2. Factors that determine the course of spinal cord injury and its** 

The level and length of SCI, as well as the timeline of the treatment of spinal cord compression, affect the grade and severity of neurological problems and, ultimately, mobility and self-care of patients, as well as their prognosis and recovery, and return to normal life [33]. The cervical spine trauma is associated with spinal cord lesions in 12–70% of injured people and characterized by the predominance of severe damages (contusion, compression, haematomyelia) and high mortality rates (35–70%). Spinal cord lesions occur in 31–75% of thoracic and lumbar spine traumas [21, 26, 27, 29, 34]. In general, injuries of the cervical spine account for 17–61% of cases [30, 34], thoracic – 7.2–40% [26, 29, 34, 35], and

Types of spinal cord trauma include contusion, concussion, compression, crush, and disruption. The spinal cord's compression is found in 20–26.7% of the injured persons, compression and contusion – in 40–50.5%, compression and crush – in 7–15.7%, and anatomical disruption – in 4.3–7.1% of patients [34]. The grade of the spinal cord injury is one of the principal prognostic factors. The distinction is made between "complete" and "incomplete" SCI, or its morphological disruption (anatomical or axonal). Complete SCI at the cervical level is reported for 33.7–52% of patients, thoracic level – 12.5-54%, and at the lumbar level – 15–21% [33].

In addition to SCI, non-traumatic spinal cord lesions may occur due to epidural

Before early 1990s, a uniform or generally recognized classification system of SCI was not available. Physicians usually distinguished different levels of injury,

abscess and hematoma, intradural tumor or other types of metastatic tumors, and complications after surgical treatment [7, 36]. The treatment of the acute phase in SCI cases takes more time than the treatment of spinal cord lesions of non-traumatic origin. Also, patients with SCI are more likely to have urinary tract

**4**

Spinal cord injury triggers the development of a complex series of pathophysiological reactions, including primary and secondary damage of the nervous tissue [52–54]. The inflammatory response to the primary structural changes in the spinal cord is followed by the release of multiple regulatory peptides, including proinflammatory cytokines [55, 56].
