Beyond the Injury Level: Functional Outcome Variability in Cervical Spinal Cord Injury: A Case Series

Abstract

Introduction: Spinal cord injury (SCI) is damage to the spinal cord that causes motor, sensory, and autonomic dysfunction. Global incidence ranges from 13 to 220 cases per one million people. Many complications are irreversible. 
Objective: To describe and compare three patients with SCI at different injury levels and examine variations in rehabilitation outcomes using the ADL scale and ASIA Impairment Scale. 
Methods: This descriptive observational study included three hospitalized male patients with SCI. Collected data consisted of age, etiology, time to admission, comorbidities, neurological status, autonomic dysfunction, ADL level, ASIA classification, and rehabilitation interventions. 
Results: The cases showed different neurological and functional outcomes. Case 1 (T10 to L1, ASIA A) had complete motor loss in the lower limbs, impaired proprioception, and total dependence in ADL. Case 2 (C3 to C7, ASIA B) showed severe motor deficits with incomplete sensory preservation and remained fully dependent. Case 3 (C5 to C6, ASIA B) demonstrated better recovery potential, including improved upper limb strength and partial sensory preservation. All patients experienced urinary and bowel dysfunction. Differences in age, injury level, completeness, comorbidities, and early surgical care contributed to outcome variation. Based on the ICF framework, these differences reflect variations in body functions, activities, and participation. Community-based rehabilitation may support long-term independence. 
Conclusion: SCI outcomes depend on lesion level, completeness of injury, age, comorbidities, and early multidisciplinary management. Incomplete injuries, especially ASIA B, show better potential for neurological and functional recovery. The use of ICF principles can guide rehabilitation goals and improve functional independence.