Neuroimaging of the cervical cord has demonstrated above-level neurodegeneration after traumatic spinal cord injury. In this study, we investigated below-level neurodegeneration with optimized high-resolution MRI sequences, including diffusion tensor imaging and structural imaging, applied to the lumbar cord in patients with cervical injury. Our results demonstrate that atrophy and axonal degeneration are prominent in the lumbar cord reflected by structural and diffusivity changes. Furthermore, the extent of these changes is related to clinical impairment. This study shows neurodegeneration below the level of injury and demonstrates the clinical feasibility of acquiring readouts of tissue-specific changes in the lumbar cord.