Complete spinal cord transection syndrome

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Background

Spinal cord tracts

Clinical Features

  • Higher lesions are associated with 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

Differential Diagnosis

Spinal Cord Syndromes

Workup

Management

  • Consider intubation injuries at C5 or above
  • Steroids are no longer recommended (see below)
  • Surgical intervention for:

Steroids

"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 Food and Drug Administration (FDA) approved for this application. 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."[1]

Disposition

See Also

External Links

References

  1. 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