Spinal cord injury

Background

Anatomy

Spinal cord tracts

• 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

Spinal Cord Syndromes

• Complete spinal cord transection syndrome
• Anterior cord syndrome
• Central cord syndrome
• Brown-Séquard syndrome
• Epidural compression syndromes
  • Spinal cord compression (non-traumatic)
  • Cauda equina syndrome
  • Conus medullaris syndrome
  • Epidural abscess (spinal)
  • Epidural hematoma (spinal)

Complete spinal cord transection syndrome

• 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

Brown-Sequard syndrome

• Etiology
  • Transverse hemisection of spinal cord
  • Unilateral cord compression
• Symptoms
  • Ipsilateral spastic paresis
  • Ipsilateral loss of proprioception, vibration but contralateral loss of pain, temperature (ie 'sensory dissociation')
• Good prognosis

See Also

• Spinal Cord Trauma
• Spinal Cord Levels

Source

• Tintinalli
• SAEM
• eMedicine