Spinal cord trauma

Background

ANATOMY

1. Doral column: proprioception, vibration and touch and decussate @ medulla
2. Lat corticospinal: voluntary motor and cross @ medulla. Upper extremity fibres more centrally, lower extremity fibres more lateral
3. Ant spinothalamic: pain, temp. and light touch. Cross just one level above entry point to spinal cord.

Spinal Cord Syndromes

COMPLETE TRANSECTION

1. higher lesions assoc w/ spinal shock &autonomic dysfunction
2. sacral sparing (perianal sens, rectal tone, or toe flexor) excludes complete transection

ANTERIOR CORD

1. hyperflexion injury or blood supply prob (hypotension or aortic dissection)
2. loss of motor (variable) and pain/temp
3. proprioception, vibration and touch spared (Doral column)

CENTRAL CORD

1. hyperext of neck
2. neuro deficit more pronounced in upper than lowe extremites
3. Loss of distal upper extremity pain, tem and strength

BROWN-SEQUARD

1. ipsilateral loss strength, vibration, position
2. contralteral loss pain and temp

CONUS MEDULLARIS/CAUDA EQUINA

1. Difficulty w/ urination (retention or incont) and sphincter control
2. sexual dysf
3. distal motor weakness
4. saddle anesthesia
5. (Conus Medullaris usually B/L sxs; Cauda Equina is usually unilateral)

See Also

Trauma: Spinal Fractures

Neuro: Neurogenic Shock

Neuro: Cord Compression

Source

DONALDSON 9/07 (Adapted from Lampe, Hockberger, Brower, and Mistry)