Spinal cord injury

Background

Anatomy

• Dorsal columns
  • Proprioception, vibration
  • Decussation at medulla
• Corticospinal Tract
  • Voluntary motor
    • Upper extremity fibers more central, lower extremity fibers more lateral
  • Decussation at medulla
• Spinothalamic
  • Crude touch, pressure, pain, temperature
  • Decussates 1-2 levels above entry point to spinal cord

Spinal Cord Syndromes

Complete Transection

• Higher lesions are a/w spinal shock and autonomic dysfunction
• Priapism implies a complete injury
• Sacral sparing excludes complete transection
  • Can only be assessed AFTER spinal shock has ended, ie after return or bulbocavernosus/cremasteric reflexes
  • Sacral sparing manifests as intact great toe flexor function, perianal sensation, rectal motor function

Anterior Cord

• Etiology
  • Direct anterior cord compression
  • Hyperflexion injury of cervical spine
  • Thrombosis of anterior spinal artery
• Symptoms
  • Paraplegia below level of lesion
  • Preservation of modalities carried by dorsal columns ie vibration, proprioception
• Poor prognosis

Central Cord

• Etiology
  • Hyperextension
  • Disruption of blood flow to the spinal cord
  • Cervical spinal stenosis
  • Typically elderly patient with significant DJD (ligamentum flavum compresses cord, causing contusion to central portion of spinal cord)
• Symptoms
  • Quadriparesis (upper extremities > lower extremities)
  • Some loss of pain and temperature sensation also greater in upper extremities
• Prognosis good
• Tx and work-up - consider IV methylprednisolone within 8 hrs of injury, surgery consultation, and cervical MRI

Brown-Sequard

• Etiology
  • Transverse hemisection of spinal cord
  • Unilateral cord compression
• Symptoms
  • Ipsilateral spastic paresis
  • Loss of proprioception and vibratory sensation
  • Contralateral loss of pain and temperature sensation
• Prognosis good

Cauda Equina

• See Cauda Equina Syndrome

See Also

• Spinal Cord Trauma
• Spinal Cord Levels

Source

• Tintinalli
• SAEM
• eMedicine