Written and reviewed by Josh Kohanim, Esq., California Bar No. 328609 · Reviewed
In this guide
An incomplete injury leaves partial function, and families are often told the injury is incomplete without being told what that means. The grading scale, the named injury patterns, and what the medical record has to capture decide these claims. The general claim structure is on our Los Angeles spinal cord injury lawyer page.
What incomplete means
The classification comes from the International Standards for Neurological Classification of Spinal Cord Injury, an exam of sensation, muscle strength, and function at the anus. The American Spinal Injury Association explains the logic in one line: the completeness of the injury turns on whether motor or sensory messages can still travel to the lowest level of the cord. Sensation is scored as normal, altered, or absent; strength is scored from absent to normal on a six point scale.
| Grade | What it means |
|---|---|
| A, complete | No muscle movement, light touch, pin prick, or pressure sensation in or around the anus |
| B, sensory incomplete | Sensation present at the anus, possibly a few preserved movements just below the level |
| C, motor incomplete | Muscles move well below the level, but many are not strong enough to lift against gravity |
| D, motor incomplete | Most muscles below the level are strong enough to lift against gravity |
| E, normal | Tested sensation and movement have returned to normal on the exam |
Grade D is where most of the argument happens. It means most muscles below the injury can lift against gravity, and it does not mean recovered. The national cost figures put a motor functional AIS D injury, grade D on the ASIA Impairment Scale, at $472,190 in the first year and $2,144,693 over a lifetime for someone injured at 25, in 2025 dollars. Our page on lifetime cost of care carries the rest of that table with its methodology.
The kinds of incomplete injury
Incomplete injuries fall into recognized patterns, and naming the right one matters because each carries a different mechanism and a different expected course. The descriptions below come from the StatPearls review of spinal cord injuries, published by the National Library of Medicine and updated June 2, 2025.
| Syndrome | What it looks like | Typical mechanism |
|---|---|---|
| Central cord | Greater weakness in the arms than the legs | Cervical hyperextension with pre-existing stenosis (narrowing); the most common incomplete form |
| Brown-Sequard | Weakness on one side, loss of pain and temperature on the other | Injury to one half of the cord |
| Anterior cord | Paralysis with loss of pain and temperature, vibration and position sense preserved | Compromised blood flow in the anterior spinal artery |
| Posterior cord | Loss of touch, vibration, and position sense, with motor function preserved | More often infectious, toxic, or metabolic than traumatic |
| Conus medullaris | Loss of Achilles reflexes and of bowel, bladder, and sexual function | Damage at the terminal end of the cord |
Central cord syndrome is the pattern that generates the most litigation, because its usual mechanism is a hyperextension injury in a neck that already had narrowing. The defense reads that as proof the spine was degenerating anyway. The medicine reads it as the reason a survivable crash produced a cord injury in this person, which is a different point entirely.
How much recovery to expect
StatPearls reports improvement of at least one AIS grade in 19% of patients graded A, 73% of grade B, 87% of grade C, and 46% of grade D. Recovery rates are highest in lumbar injuries and lowest in thoracic ones, and penetrating injuries recover notably less than blunt trauma. Those numbers measure whether the letter changed, not whether the person recovered their life.
The claim consequence is timing. Function keeps moving through the first year, so a settlement signed at month four is a bet on a prognosis nobody has yet. It is also why the defense pushes early resolution in exactly these cases, and why every ISNCSCI exam, the standard neurological classification exam, in the chart, with its date, is evidence.
Why insurers undervalue incomplete injuries
An incomplete injury does not look like the picture an insurance adjuster has of a spinal cord case. The claimant walks into the deposition, the sworn interview the defense takes, shakes hands, and sits through four hours. Surveillance shows them carrying groceries on a good day. The imaging may show cord signal change that means nothing to a lay reader. The visible half of this injury is the half that recovered.
The half that did not recover is the expensive one, and it runs on schedules rather than symptoms. Bladder management with catheters and infection risk. A bowel program with a fixed time cost every day. Spasticity, meaning involuntary muscle tightness, neuropathic pain from the damaged nerves, and the medication that manages both. In injuries at or above T6, a chest-level segment of the cord, the risk of autonomic dysreflexia, where an ordinary trigger such as a full bladder produces dangerous hypertension, meaning high blood pressure. None of that appears on a video, and all of it appears in the chart.
The answer is documentation rather than argument. We get the ISNCSCI exams and grades into the record with their dates, and we get bladder and bowel management written by the treating team. We also get a functional evaluation that measures endurance and repetition rather than a single effort, because most of these injuries fail on the fifth repetition rather than the first.
When this analysis does not apply
The exam came back normal. The national data records a normal neurological category in 0.4% of cases at discharge, and a grade E exam with continuing symptoms is a hard claim to build on a cord theory. It is often better analyzed as a spinal column injury, which is covered on back and neck injuries that are not cord injuries.
The narrowing came first. In older adults with pre-existing stenosis, causation becomes the contest rather than damages. The record that wins it is the one showing what the person could do the week before the crash, so employment records, gym logs, and prior imaging matter more than the argument does.
The deficit is a nerve root problem, not a cord problem. Radiculopathy from a disc herniation produces weakness and numbness in one limb without involving the cord. It is a real injury with a different proof structure, and after a crash it runs through our Los Angeles car accident lawyer page.
The injury is complete. If nothing crosses the lowest segment, the questions on this page are the wrong ones, and paralysis, paraplegia, and tetraplegia covers what changes at each level instead.
Documenting an incomplete injury claim
Incomplete does not mean minor; it means signal still crosses the injury. Two thirds of spinal cord injuries are in this group, the grade often improves, and the daily cost of the parts that do not improve continues for decades. Get the grade documented at every stage, get the bladder, bowel, pain, and endurance findings written down by the people treating them, and do not close the file while the neurology is still moving.