Spinal cord injury
Revision as of 23:32, 18 July 2011 by Rossdonaldson1 (talk | contribs)
Background
Anatomy
- Doral columns
- Proprioception, vibration touch
- Decussation at medulla
- Corticospinal Tract
- Voluntary motor
- Upper extremity fibers more central, lower extremity fibers more lateral
- Decussation at medulla
- Voluntary motor
- Spinothalamic
- Pain, temp, touch
- Decussates one level 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
- Perianal sensation, rectal tone, bulbocavernosus/cremasteric reflexes
Anterior Cord
- Etiology
- Direct anterior cord compression
- Flexion of cervical spine
- Thrombosis of anterior spinal artery
- Symptoms
- Complete paralysis below the lesion with loss of pain and temperature sensation
- Preservation of proprioception and vibratory function
- Prognosis poor
Central Cord
- Etiology
- Hyperextension injuries
- Disruption of blood flow to the spinal cord
- Cervical spinal stenosis
- Symptoms
- Quadriparesis (greater in upper extremities than lower extremities)
- Some loss of pain and temperature sensation also greater in the upper extremities
- Prognosis good
Brown-Sequard
- Etiology
- Transverse hemisection of spinal cord
- Unilateral cord compression
- Symptoms
- Ipsilateral spastic paresis
- Loss of proprioception and vibratory sensation
- Contralateral loss of pain and temperature sensation
- Prognosis good
Cauda Equina
- Etiology
- Peripheral nerve injury
- Symptoms
- Variable motor and sensory loss in the lower extremities
- Sciatica
- Bowel/bladder dysfunction
- Saddle anesthesia
- Prognosis good