Spinal Cord Injuries and Syndromes

Question 1

Define spinal cord injury.

Answer 1

• An insult to the spinal cord resulting in
changed neurological function
– Motor
– Sensory
– Autonomic
• May be temporary or permanent
• May be complete or incomplete (some sens
&/or motor function)
• Level of injury dictates affected symptoms
(e.g. tetraplegia from c-spine level, paraplegia T-
&L-spine)

Question 2

Outline complete cord syndrome.

Answer 2

• Complete loss of motor and sensory function
(including perineum) below the level of the
traumatic lesion
• Symptoms that remain >24 hours generally are
permanent
• Note: respiratory dysfunction from loss of intercostal function, +/- phrenic nerve (C3-5-) in high C-spine injuries

Question 3

List the incomplete cord syndromes.

Answer 3

• Central cord syndrome
• Brown-sequard syndrome
• Anterior cord syndrome
• Posterior cord syndrome

Question 4

Outline central cord syndrome.

Answer 4

• Most common incomplete syndrome
- incomplete C-spine injury
• Usually c-spine hyperextension injury, often seen in the elderly
- Injury to central corticospinal tract
• Motor weakness
• Upper extremities more affected than lower extremities
• Sensory loss is variable (below level of injury)

Question 5

Outline Brown-Sequard syndrome.

Answer 5

• Associated with a hemisection lesion of the cord from
  penetrating trauma
• In MCQs - often someone stabbed in the back
• Hemisection of the cord results in a lesion in each of the three main neural systems (the principal UMN pathway of the corticospinal tract/one or both dorsal columns/and the spinothalamic tract)
• Corticospinal tract: Ipsilateral loss of motor function (spastic paralysis below level of injury due to loss of UMN moderation.
• Dorsal column: loss of vibration, proprioception function and fine touch (dorsal column medial lemniscus pathway)

• Lateral spinothalamic tract: contralateral loss of pain and temperature sensation

NB/ if lesion is above the level of T1 it will produce ipsilateral Horner’s syndrome with involvement of the oculosympathetic pathway.

Question 6

Outline anterior cord syndrome.

Answer 6

Commonly a flexion injury – burst fracture, herniated disc

• Variable loss of:
– Motor function
– Pain
– Temperature sensation

• Preservation of:

• Proprioception
• Vibration
• Touch

Question 7

Outline posterior cord syndrome.

Answer 7

Very rare condition caused by lesion of the posterior
portion of the spinal cord e.g. Posterior spinal artery
disruption

Loss of proprioception, vibration and touch
Preservation of motor pain and temperature

Question 8

What are the consequences of spinal cord injury?

Answer 8

SPINAL SHOCK:

• LOSS OF REFLEXES, MOTOR & SENSORY 
FUNCTION & AUTONOMIC TONE BELOW LEVEL 
OF LESION
• RESOLVES OVER 24-48H BUT MAY LAST FOR 
DAYS
• SYMPTOMS:
– HYPOTENSION (loss of vascular sympathetic tone)
– FLACCID PARALYSIS
– LOSS OF SENSATION
– LOSS OF REFLEXES
– BLADDER INCONTINENCE
– BRADYCARDIA (above T2)
– HYPOTHERMIA (inability to regulate temperature)
– INTESTINAL ILEUS
– CARDIAC ARREST IF ABOVE C3
– LOSS OF RESPIRATORY CONTROL (intercostals +/- phrenic)