Spinal Cord Injury

Question 1

What are the main 2 types of spinal cord injury

Answer 1

Complete spinal cord injury: results in the total loss of motor and sensory function below the level of the injury. The injury site is usually associated with a complete spinal cord disruption, leading to permanent paralysis and sensory loss.

Incomplete spinal cord injury: results in partial loss of motor and sensory function below the level of injury. The injury site is usually associated with partial spinal cord disruption, leading to varying patterns of paralysis and sensory loss.

Question 2

Aetiology of spinal cord injury

Answer 2

Vascular: spinal artery occlusion, aortic dissection, arrhythmia
Infection: abscess, polio, HIV, HTLV, syphilis, TB, transverse myelitis
Trauma
Autoimmune: MS, neuromyelitis optica, sarcoidosis
Metabolic: B12/copper deficiency
Degenerative disease
Genetic: spinocerebellar ataxis, hereditary spastic paraplegia

Question 3

Features of anterior cord injury

Answer 3

Caused by stroke, external compression and flexion injuries

Bilateral loss of pain and temperature sensation
Bilateral spastic paralysis + UMN signs
Fine touch, proprioception, vibration preserved

Question 4

Features of posterior cord injury

Answer 4

B12 deficiency → subacute cord degeneration

Bilateral loss of fine touch, proprioception, vibration sensation

Question 5

Features of Brown-Sequard syndrome

Answer 5

Ipsilateral spastic paralysis below the level of the lesion
Ipsilateral loss of fine touch, proprioception and vibration sense
Contralateral loss of pain and temperature sensation

Question 6

What causes central cord syndrome (syringomyelia)

Answer 6

Fluid-filled cyst (Syrinx) around the spinal canal
Associated with Chiari malformation

Question 7

Features of central cord syndrome

Answer 7

Upper limbs affected first, lower limbs affected much later
“Cape-like” loss of pain and temperature sensation

Question 8

Differentials for spinal cord injury

Answer 8

Spinal cord concussion: transient loss of spinal cord function, resolving within 48 hours
Spinal stenosis: spinal canal narrows, compressing the spinal cord. Affects the lumbar region, presents with glute/leg pain on walking or standing (spinal claudication) - relieved by forward flexion or sitting

Question 9

Investigations for spinal cord injury

Answer 9

FBC
U&Es
LFTs
B12 and folate
ESR/CRP
Aquaporin 4/MOG (neuromyelitis optica)

MRI spine
CT spine
LP

Question 10

Management for spinal cord injury

Answer 10

1. CA-E
2. Full in-line spinal immobilisation
3. Send to major trauma centre (NOT spinal cord injury)
4. Analgesia: IV morphine OR IN diamorphine/ketamine
5. Contact specialist neurosurgical or spinal surgeon