13. Trauma of the spine and spinal cord

Question 1

Spinal cord injuries

Answer 1

1. Acute transverse spinal cord injury/spinal shock
2. Central cord syndrome
3. Anterior cord syndrome: incomplete lesion
4. Brown-Sequard syndrome
5. Conus medullaris syndrome
6. Cauda equina syndrome

Question 2

Vertebral fractures

Answer 2

1. Jefferson fracture
2. Dens fracture
3. Hangmans fracture

Question 3

Acute transverse spinal cord injury (spinal shock)

Answer 3

• Lesion of all descending pathways: motor, sensory, autonomic dysfunction.
• Anesthesia of all sensory modalities below the lesion

Question 4

Signs of acute transverse spinal cord injury

Answer 4

• Paraparplegia/tetraparesis (corticospinal tract injury)

Starts as flaccid paralysis, turns into spastic paralysis:
- Acute phase = spinal shock –> lower motor neuron signs (hours-weeks). Areflexia, hypotonia
- After acute phase = signs of upper motor neuron lesion –> hypertonia + pyramidal signs + hyperreflexia +3

Also affect the autonomic: paralytic ileus, BP drop, urinary retention + overflow incontinence

Question 5

Bown-Sequard syndrome

Answer 5

Transverse hemisection. Rare, mainly due to trauma

Question 6

Symptoms of Brown-Sequard syndrome

Answer 6

• Dorsal column: ipsilateral loss of proprioception, vibration, touch
• Autonomic: autonomic dysfunction or horner syndrome
• lateral corticospinal tract: ipsilateral spastic paralysis below lesion
• anterior grey horn: flaccid paralysis at lesion
• Spinothalamic: contralateral loss of pain and temp

Question 7

Anterior cord syndrome

Answer 7

• Damage of ant. 2/3 of spinal cord
• Interruption of blood supply from anterior spinal artery
• Corticospinal tract: bilateral spastic paralysis below lesion
• Spinothalamic: bilateral loss of pain and temp sensation
• Anterior horn: bilateral flaccid paralysis at lesion
• Autonomic dysfunction

Question 8

Central cord syndrome

Answer 8

• Flexion type of injury to the cervical spine = whiplash injury
• Bilateral pastic paralysis below lesion (lateral corticospinal tract)
• Bilateral sensory loss of pain/temperature (spinothalamic tract)
• Autonomic: horner syndrome (usually C or T level)
• Intact proprioception

Question 9

Conus medullaris syndrome

Answer 9

Lesion around L2. Sensory loss in perianal region and inner thighs (saddle anasthesia). Loss of bladder control (overflow incontinence) without leg weakness or stretch reflex.

Question 10

Cauda equina syndrome

Answer 10

the compression of a collection of nerve roots called the cauda equina
- Reticular pain in several dermatomes
- Flaccid paralysis of lower limbs
- Loss of deep tendon reflexes

Question 11

Dens fracture

Answer 11

• C2 fracture
• Motor vehicle accident
• Medulla compression = fatal
• Neck pain radiating to occipital region

Question 12

Hangmans fracture

Answer 12

• C2-axis trauma
• From hanging
• Body of C1 slides forward on C2, fracture of C2 arches