View source for Spinal cord injury

==Background==
[[File:Dermatoms alt.png|thumb|Sensory dermatome by [[spinal cord levels]].]]
*Penetrating injury
**[[GSW]]
***Most are stable injuries and only require supportive orthosis, [[analgesia]]
***Bullet removal does not improve neuro status for stable cervical and thoracic lesions
***Bullet removal may improve neuro status for thoracolumbar region injury (T11-L2)
**Stabbing
***Vertebral instability is generally not an issue
***Delayed deficits are rare
****If do occur related to retained fragment of blade within spinal canal

===Anatomy===
[[File:Spinal cord tracts.svg|thumb|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

===Peds===
*In patients <10yr, spinal injury occurs mainly in upper cervical vertebrae
*In patients >10yr, majority of injuries occur in lower cervical spine, similar to adults
*Odontoid fractures are among most common cervical spine injuries in children
**Do not confuse with normal anatomic variations in odontoid seen in children up to 7yr old
*SCIWORA
**Spinal cord injury without radiologic abnormality
**MRI has shown significant pathology in many of these patients
**Symptoms
***Delayed onset (within 48hr) of [[numbness]], [[paresthesias]] in  extremities
*Transient quadriparesis ("stinger")
**Occurs most often in boys after sports injuries
**Paresthesias or [[weakness]] of extremities lasting from seconds to minutes
***Complete recovery within 48hr

==Clinical Features==
[[File:Cord s.png|thumb|Incomplete lesions of the spinal cord: Central cord syndrome (top), Anterior cord syndrome (middle), and Brown-Séquard syndrome (bottom).]]
{{Spinal cord syndromes DDX}}

==Differential Diagnosis==
{{Blunt neck trauma DDX}}

==Evaluation==
[[File:Cervical Spine MRI (T2W).jpg|thumb|MRI with fractured cervical vertebra compressing spinal cord.]]
*Clinical (see [[spinal cord syndromes]])
*X-ray
**See [[C-spine (NEXUS)]] and [[C-Spine X-Ray]]
*Consider:
**CT
**MRI

==Management==
{{Acute spinal cord injury treatment}}

==Disposition==
*Admit

==See Also==
*[[Cervical spine fractures and dislocations]]
*[[Cervical injury (peds)]]
*[[Spinal Cord Levels]]
*[[Spinal cord compression (non-traumatic)]]
*[[Focal neurologic deficits]]
*[[Neurogenic Shock]]
*[[Spinal Shock]]
*[[Autonomic dysreflexia]]
*[[Thoracic and Lumbar Spine Injuries]]

==References==
<references/>

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