Incomplete spinal cord injuries

Question 1

Define an incomplete spinal cord injury?

Answer 1

• a spinal cord injury with some preservation motor or sensory function below the injury level
  
  • voluntary anal contraction- sacral sparing
  • or palpable/visible muscle contracture below tht injury level
  • or perinanal sensation

Question 2

What is the epidemiology of incomplete spinal cord injury?

Answer 2

• 11,000 new cases of spinal cord injury pa in US
• 34% incomplete tetraplegia
• central cord most common
• 17% incomplete paraplegia
• 47% complete

Question 3

What is the prognosis of spinal cord injuries?

Answer 3

• Most important prognostic variable relating to neurological recovery is COMPLETENESS of lesion

Question 4

What is central cord syndrome?

Answer 4

• The most common incomplete spinal cord injury

Question 5

What is the epidemiology of central cord syndrome?

Answer 5

• Elderly
• minor extension injury
  
  • ​due to ant ostephytes & posterior infolded ligamentum flavum, stenotic spondylytic cervical canal

Question 6

what is the pathophysiology of central cord syndrome?

Answer 6

• Anatomy of spinal cord is why upper extremities and hand perferentially affected
• hands and upper limb located centrally in corticospinal tract

Question 7

What are the signs and symptoms of central cord syndrome?

Answer 7

Symptoms

• weakness of hand dexterity
• hyperpathia
  
  • burning in upper limbs

sign

• Loss motor deficit worse UE cf LE
• Hands more pronounced motor deficit than arms
• Perserved
  
  • Sacral sparing
• Late signs
  
  • UE have LMN signs- clumsey
  • LE has UMN- spastic

Question 8

What are the tx of central cord syndrome?

Answer 8

• Non op vs operative
• contraversial
• progressive neurology= surgery

Question 9

what is the prognosis of central cord syndrome?

Answer 9

• Final outcome
  
  • Good prognosis although full functional recovery is rare
  • usually ambulatory at final FU
  • usually regain bladder control
  • UL & hand recovery less predictable
  • Often permanent CLUMSY HANDS
• Recovery occurs with
  
  • LL first
  • Bowel and bladder
  • prox UL
  • Hand last

Question 10

Describe Anterior Cord syndrome?

Answer 10

• Incomplete spinal cord injury charcterised by
  
  • motor dysfunction
  • dissociated sensory deficit below level of SCI

Question 11

What is the pathophysiology of anterior cord syndrome?

Answer 11

• Injury to anterior spinal cord caused by
  
  • Direct compression ( osseous) of spinal cord
  • Anterior spinal artery injury
    
    • ant 2/3 spinal cord supplied by ant spinal A

Question 12

What is the mechanism of anterior cord syndrome?

Answer 12

• Flexion/Compression injury to spinal cord

Question 13

What is seen on examination of a patient with anterior cord syndrome?

Answer 13

• Lower limb affected more than UL
• Loss
  
  • lateral cortiospinal tract- motor
  • lateral spinalothalamic tract- pain/temperature
• Perserve
  
  • Dorsal Columns
    
    • Proprioception/vibration sense

Question 14

What is the prognosis of anterior cord syndrome?

Answer 14

• Worse prognosis of incomplete SCI
• Most likely to mimic complete cord syndrome
• 10-20% chance of motor recovery

Question 15

What is Brown Sequard Syndrome?

Answer 15

• Complete cord Hemisection
• usually seen with Penetrating injuries

Question 16

What is seen on examination of a patient with brown sequard syndrome?

Answer 16

• Ipsilateral Deficit
  
  • Lateral corticospinal tract
    
    • motor function
  • dorsal columns
    
    • vibration sense
    • proprioception
• ​​Contralateral deficit
  
  • ​lateral spinothalamic tract
    
    • ​pain
    • temperature
    • LST crosses at spinal cord ( 2 levels below)

Question 17

What is the prognosis of Brown- sequard syndrome?

Answer 17

• Excellent
• 99% ambulatory at final follow up
• best prognosis from a motor activity

Question 18

What is posterior cord syndrome?

Answer 18

• Very rare
• loss of proproception- dorsal columns
• preserved motor, pain and light touch