Anterior cord syndrome: Difference between revisions

(Created page with "==Background== thumb|Spinal cord tracts *Etiology **Direct anterior cord compression **Hyperflexion injury of cervical spine **Thrombosis of an...")
 
 
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==Background==
==Background==
[[File:Dermatoms alt.png|thumb|Sensory dermatome by spinal level.]]
[[File:Spinal cord tracts.svg|thumb|Spinal cord tracts]]
[[File:Spinal cord tracts.svg|thumb|Spinal cord tracts]]
[[File:Anterior Cord.png|thumb|Anatomy of anterior cord injury.]]
*Etiology
*Etiology
**Direct anterior cord compression
**Direct anterior [[Cord Compression]] (e.g. disc protrusion, posterior [[abdominal aortic aneurysm]], mass)
**Hyperflexion injury of cervical spine
**Hyperflexion injury of cervical spine
**Thrombosis of anterior spinal artery
**Thrombosis of anterior spinal artery


==Clinical Features==
==Clinical Features==
**Paraplegia below level of lesion
*[[weakness|Paraplegia]] below level of lesion (corticospinal)
**Preservation of modalities carried by dorsal columns ie vibration, proprioception
*[[numbness|Loss of pain]]/temperature (lateral spinothalamic)
*Autonomic dysfunction, [[hypotension|orthostasis]]
*Bowel, bladder, sexual dysfunction
*Preservation of modalities carried by dorsal columns i.e. vibration, proprioception, 2-point discrimination


==Differential Diagnosis==
==Differential Diagnosis==
{{Spinal cord syndromes DDX}}
{{Spinal cord syndromes DDX}}
*Etiologies
**[[Trauma]], [[vertebral fractures]]
**Ischemia, atherosclerosis, anterior spinal artery
**Malignancy
**[[Infection]]
**Spondylosis, disk herniation
**Aortic disease - [[AAA|aneurysm]], [[dissection]]
**Iatrogenic - spinal injections, epidural catheters, aortic cross-clamp


==Workup==
==Evaluation==
*Labs based on severity
**[[ABG]] if lesion affects above C5
**Shock labs if [[neurogenic shock]]
**Trend CBC to rule out [[hemorrhagic shock]]
*Imaging with CT and MRI


==Management==
==Management==
*Poor prognosis
{{Acute spinal cord injury treatment}}


==Disposition==
==Disposition==
*Admit


==See Also==
===Prognosis===
*Poor


==External Links==
==External Links==


==Sources==
==See Also==
*[[Spinal cord syndromes]]
 
==References==
<references/>
<references/>


[[Category:Neuro]]
[[Category:Neurology]]
[[Category:Trauma]]
[[Category:Trauma]]

Latest revision as of 11:24, 24 October 2020

Background

Sensory dermatome by spinal level.
Spinal cord tracts
Anatomy of anterior cord injury.

Clinical Features

  • Paraplegia below level of lesion (corticospinal)
  • Loss of pain/temperature (lateral spinothalamic)
  • Autonomic dysfunction, orthostasis
  • Bowel, bladder, sexual dysfunction
  • Preservation of modalities carried by dorsal columns i.e. vibration, proprioception, 2-point discrimination

Differential Diagnosis

Spinal Cord Syndromes

Evaluation

Management

Acute Management of Spinal Cord Injury

  • Neurogenic shock management
  • Consider intubation injuries at C5 or above
    • Manual in-line stabilization reduces cervical movement better than C-collar, but be careful of tracheal pressures inadvertently applied which can worsen laryngeal visualization[1][2]
    • Direct laryngoscopy causes C-spine extension at atlanto-occipital junction, C1-C2, and C4-C7 in order from most to least
    • Consider video laryngoscopy with hyperangulated stylet or bougie assisted DL to intubate higher-grade laryngoscopy views of vocal cords without C-spine overextension[3]
    • Post-intubation sedation takes into consideration hemodynamics and potential intraoperative EMG and evoked potential monitoring by anesthesia
  • Consider surgical intervention for:
  • Steroids are no longer recommended
    • Administration of methylprednisolone (MP) for the treatment of acute spinal cord injury (SCI) is not recommended. Clinicians considering MP therapy should bear in mind that the drug is NOT approved by the FDA for this indication. There is no Class I or Class II medical evidence supporting the clinical benefit of MP in the treatment of acute SCI. Scattered reports of Class III evidence claim inconsistent effects likely related to random chance or selection bias. However, Class I, II, and III evidence exists that high-dose steroids are associated with harmful side effects including death.[6]
    • See EBQ:High Dose Steroids in Cord Injury for further discussion

Disposition

  • Admit

Prognosis

  • Poor

External Links

See Also

References

  1. ↑ The effect of laryngoscopy of different cervical spine immobilisation techniques. Heath KJ. Anaesthesia. 1994 Oct; 49(10):843-5.
  2. ↑ Manual in-line stabilization increases pressures applied by the laryngoscope blade during direct laryngoscopy and orotracheal intubation. Santoni BG, Hindman BJ, Puttlitz CM, Weeks JB, Johnson N, Maktabi MA, Todd MM. Anesthesiology. 2009 Jan; 110(1):24-31.
  3. ↑ Cervical spinal motion during intubation: efficacy of stabilization maneuvers in the setting of complete segmental instability. Lennarson PJ, Smith DW, Sawin PD, Todd MM, Sato Y, Traynelis VC. J Neurosurg. 2001 Apr; 94(2 Suppl):265-70.
  4. ↑ Improvement of motor-evoked potentials by ketamine and spatial facilitation during spinal surgery in a young child. Erb TO, Ryhult SE, Duitmann E, Hasler C, Luetschg J, Frei FJ. Anesth Analg. 2005 Jun; 100(6):1634-6.
  5. ↑ Effects of dexmedetomidine on intraoperative motor and somatosensory evoked potential monitoring during spinal surgery in adolescents. Tobias JD, Goble TJ, Bates G, Anderson JT, Hoernschemeyer DG. Paediatr Anaesth. 2008 Nov; 18(11):1082-8.
  6. ↑ Hurlbert RJ et al. Pharmacological therapy for acute spinal cord injury. Neurosurgery. 2013 Mar;72 Suppl 2:93-105 http://www.ncbi.nlm.nih.gov/pubmed/23417182
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