Spinal Injuries

Location and Definition

The spine consists of 33 vertebrae (or bones) and runs from the base of the skull to the tailbone (called the coccyx). It is divided into five functional areas: cervical spine, thoracic, lumbar, sacral and coccygeal.


The spinal cord transmits motor information from the brain to the muscles and transmits sensory information from the skin, joints etc. to the brain. The spinal cord can also produce responses (called reflexes) by receiving sensory messages and sending motor messages without any input from the brain.


The spinal cord can be injured at any point along its axis. The injury is classified according to where the point of injury is. For instance, an injury at the 4th cervical vertebrae is called ‘C4’.

Quadriplegia (also known as tetraplegia) is the partial or complete loss of use of all limbs and torso. Paraplegia is the loss of use of the legs.

Another distinction is made between complete and incomplete injuries. A complete injury is where transmission of all motor and sensory information is blocked from the point of injury downwards (paralysis occurs in this region). An incomplete injury is were transmission of some motor and sensory information is blocked from the point of injury downwards.

The degree of impairment and resulting effects (or sequelae) are based on whether the injury is complete or incomplete and the site of the injury. For example, the nerve supply for hands is located below T1; hence, an injury to that vertebra may have long-term effects on hand function.


The causes of spinal cord injury are classified as either traumatic or atraumatic. A traumatic cause is an event, such as a slip and fall, that causes structural damage to the body. An atraumatic cause is when the body undergoes structural damage not as a result of an event but because of a disease, tumor, etc.

Short-Term treatment

Where a spinal injury is suspected, acute medical treatment includes but is not limited to: immobilizing the back and neck to prevent further injury; assistance with the patient’s breathing; and preventing them from going into shock.

Ongoing Sequelae

Although one should always consult with their healthcare professionals to learn the effects of one’s particular spinal injury, some long-term effects of spinal injury may include: motor and sensory difficulties; bladder and bowel dysfunction; and sexual dysfunction.

Potential Complications

There are several potential complications from a spinal injury such as muscle stiffness (aka spasticity), chronic pain (musculoskeletal, visceral and/or neuropathic pain), increased incidence of diabetes and cardiovascular disease, a cyst in the spinal cord (aka syringomyelia), fragility and decreased bone density etc.

Long-Term Treatment

Depending on the degree of impairment, a patient with spinal injury may need, in terms of future care, one or more of the following: a ventilator, attendant care support, mobility aides (e.g. a walker), housing modifications, climate controls, lifts, vehicle modifications, transportation assistance, housekeeping and home maintenance support, caregiver support, medication, counseling, and therapy.

Legal Ramifications

Spinal cord injuries are often catastrophic in nature but it depends on the facts. Recall that different benefits and maximum benefit levels apply according to whether an injury is a minor injury, catastrophic injury or neither. For example, quadriplegia or paraplegia are specifically included in the definition of a catastrophic impairment. Consult with your lawyer about the legal classification of your spinal injury.


In Applicant v. RSA Insurance (https://canlii.ca/t/j5f9v), the applicant was injured in a MVA on November 10, 2016 and sought statutory accident benefits. The respondent took the position that the applicant was not catastrophically impaired. The applicant disagreed with this decision and applied to the License Appeal Tribunal for dispute resolution. The issue at this written hearing was whether the applicant’s injuries met the legal definition of a catastrophic impairment. The Tribunal decided that they did. The definition of catastrophic impairment at issue (s. 3.1(1) of the SABS) requires that there be a “permanent” grade on the American Spinal Injury Association (ASIA)’s Impairment Scale. Two doctors with spinal specialties assessed the applicant as having a score of “D” on the ASIA Impairment Scale. The respondent’s argument focused on the word “permanent”. On December 14, 2016 – about a month after the injury – the applicant’s classification was “C”; a month after that, her classification was “D”. The respondent’s IE assessor opined that the applicant’s condition had the potential to improve within a two-year period. The respondent argued that the applicant’s condition was changing and that it was not at a point when the determination could be made that her injury was “permanent”. The Tribunal chose the applicant’s argument, in favor of coverage. First, the main objective of insurance law is consumer protection. Second, an interpretation that is consistent with or promotes the legislative purpose should be adopted. Third, coverage provisions should be interpreted broadly and exclusion clauses narrowly. Fourth, if the legislature had intended for the provision to have a temporal element it would have given it one. Fifth, the phrase is “is or will be [a permanent grade on the ASIA scale]” and this supports an interpretation of the relevant part of the definition not being restricted to a grade on the scale at a particular time. Sixth, the IE assessor did not opine that the applicant’s grade “D” scale was going to improve to an “E” (considered normal, on the scale). Sixth, the Tribunal consulted the definition of “permanent” contained in the American Medical Association (AMA)’s Guide as “unlikely to change substantially or by more than 3 per cent” or likely to continue without a fundamental or a marked change (para. 27); and the Tribunal did not interpret the IE assessor’s opinion to mean that the applicant’s condition was likely to improve substantially or by more than 3 per cent or that her condition would have a fundamental or marked change. Therefore, the applicant was held to have sustained a catastrophic impairment.

Krista O’Connell, “Spinal Cord Injury” (September 17, 2018): https://www.healthline.com.
Lisa Zaretsky and Bonnie Koreen, “Spinal Cord Injuries”, Sprains, Strains and Automobiles: A Medically Illustrated Guide to Commonly Litigated Injuries. Toronto, Ontario: Carswell, January 1, 2011.
Statutory Accident Benefits Schedule (or “SABS”), made under the Insurance Act, R.S.O. 1990, c.I.8, s 3(1).