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

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 syndrome

  • 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 syndrome

  • Most common incomplete spinal cord injury
  • Etiology
    • Hyperextension injury of cervical spine
    • 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 (characteristically with worse function in the UL than in the LL)
    • Possible loss of pain and temperature sensation, also greater in upper extremities
  • Good prognosis
  • Tx and work-up - consider IV methylprednisolone within 8 hrs of injury, surgery consultation, and cervical MRI

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

Cauda Equina

See Also

Source

  • Tintinalli
  • SAEM
  • eMedicine
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