Spinal cord injury
Background
Anatomy
- Dorsal columns
- Proprioception, vibration
- Decussation at medulla
- Corticospinal Tract
- Voluntary motor
- Upper extremity fibers more central, lower extremity fibers more lateral
- Decussation at medulla
- Voluntary motor
- 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
- 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
- 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
- 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
- Epidural compression syndromes
- Spinal cord compression
- Cauda equina syndrome
- Conus medullaris syndrome
See Also
Source
- Tintinalli
- SAEM
- eMedicine