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.

I. COMPLETE TRANSECTION

-higher lesions assoc w/ spinal shock &autonomic dysfunction

-sacral sparing (perianal sens, rectal tone, or toe flexor) excludes complete transection

II. ANTERIOR CORD

-hyperflexion injury or blood supply prob (hypotension or aortic dissection)

-loss of motor (variable) and pain/temp

-proprioception, vibration and touch spared (Doral column)

III. CENTRAL CORD

- hyperext of neck

-neuro deficit more pronounced in upper than lowe extremites

-Loss of distal upper extremity pain, tem and strength

IV. BROWN- SEQUARD

-ipsilateral loss strength, vibration, position

-contralteral loss pain and temp

V. CONUS MEDULLARIS/CAUDA EQUINA

-Difficulty w/ urination (retention or incont) and sphincter control

-sexual dysf

-distal motor weakness

-saddle anesthesia

(Conus Medullaris usually B/L sxs; Cauda Equina is usually unilateral)

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

Authors: