From the Guidelines
Spinal cord injuries at the C6-C7 level typically result in quadriplegia with preserved shoulder and elbow function but impaired hand and wrist function. Patients with this level of injury maintain the ability to flex their elbows and extend their wrists, allowing for tenodesis grip, but experience weakness or paralysis in wrist flexion, finger movements, and hand intrinsics 1.
Key Manifestations
- Respiratory function is usually preserved, though some may have reduced vital capacity
- Autonomic dysfunction manifests as orthostatic hypotension, neurogenic bowel and bladder requiring intermittent catheterization, and thermoregulatory issues
- Sexual function is affected with men experiencing reflexogenic erections but impaired ejaculation
- Sensory loss occurs below the injury level, with preserved sensation in the shoulders, upper arms, and radial forearm
- Patients may develop spasticity, neuropathic pain, and are at risk for pressure injuries, deep vein thrombosis, and autonomic dysreflexia (a medical emergency triggered by noxious stimuli below the injury level)
Management Considerations
- The use of a bundle to facilitate respiratory weaning, including an abdominal contention belt, active physiotherapy, and a mechanically-assisted insufflation/exsufflation device, may be beneficial in patients with traumatic cervical cord injury 1
- Tracheostomy may be considered to accelerate ventilatory weaning, particularly in patients with upper level spinal cord injury, but its timing and indications should be individualized based on the patient's specific needs and injury level 1
Prognosis and Rehabilitation
- Most patients with C6-C7 injuries can achieve independence in activities of daily living with adaptive equipment, and many can operate manual wheelchairs with specialized rims and potentially drive with vehicle modifications
- Rehabilitation should focus on maximizing functional ability, preventing complications, and promoting quality of life, with a multidisciplinary approach involving physical therapy, occupational therapy, and other specialties as needed.
From the Research
Manifestations of Spinal Cord Injury Level C6-C7
The manifestations of spinal cord injury (SCI) at levels C6-C7 can vary, but some common effects include:
- Motor function deficits, which are the most visible consequence of SCI 2
- Sensory functional impairments that affect personal and social behaviors 2
- Spasticity, a neurological impairment that affects the control of muscle tone as a consequence of an insult, trauma, or injury to the central nervous system, such as SCI 2, 3, 4, 5
- Painful lower limb spasticity, which can be treated with oral anti-spastic and benzodiazepine drugs, intrathecal baclofen, or botulinum toxin type A injections 3, 4, 5
- Limited mobility and gait, which can be improved with the use of orthoses and rehabilitation programs 3, 6
Treatment Options
Treatment options for SCI at levels C6-C7 include:
- Pharmacological approaches, such as baclofen, which is the most effective drug for spasticity treatment 2, 5
- Nonpharmacological approaches, such as physical therapy and rehabilitation programs 3, 6
- Surgical interventions, such as intrathecal baclofen therapy (ITB) and spinal cord stimulation (SCS) 4
- Alternative therapies, such as botulinum toxin type A injections, which can be used to treat focal spasticity 3
Rehabilitation and Participation
Rehabilitation programs can help improve participation and satisfaction with participation in individuals with SCI at levels C6-C7, including: