Which clinical manifestation would you expect immediately after sustaining a functional transection of the spinal cord at C7-C8?

• A. Spasticity
• B. Incontinence
• C. Flaccid paralysis
• D. Respiratory failure

Answer: (C)

Immediate loss of function below the injury due to spinal shock. A complete transection at C7–C8 disrupts all descending and ascending signals, so the muscles below the lesion lose their motor input and reflexes are suppressed. This produces flaccid paralysis with areflexia below the level of injury right away.

Spasticity and hyperreflexia come later, after the spinal shock subsides and the spinal circuits begin to regain some activity, leading to an upper motor neuron pattern. Urinary function also changes with spinal shock—reflex bladder activity is suppressed initially, so retention is more typical than incontinence early on. Respiratory failure is unlikely at this level because the diaphragm (C3–C5) remains functional, though intercostal muscles may be weaker.

So the immediate presentation is flaccid paralysis due to the acute loss of reflex activity and motor tone below the lesion.