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Flashcards in Incomplete spinal cord injuries Deck (18):
1

Define an incomplete spinal cord injury?

  • 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

2

What is the epidemiology of incomplete spinal cord injury?

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

3

What is the prognosis of spinal cord injuries?

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

4

What is central cord syndrome?

  • The most common incomplete spinal cord injury

5

What is the epidemiology of central cord syndrome?

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

6

what is the pathophysiology of central cord syndrome?

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

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7

What are the signs and symptoms of central cord syndrome?

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

8

What are the tx of central cord syndrome?

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

9

what is the prognosis of central cord syndrome?

  • 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

10

Describe Anterior Cord syndrome?

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

11

What is the pathophysiology of anterior cord syndrome?

  • 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

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12

What is the mechanism of anterior cord syndrome?

  • Flexion/Compression injury to spinal cord

13

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

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

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14

What is the prognosis of anterior cord syndrome?

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

15

What is Brown Sequard Syndrome?

  • Complete cord Hemisection
  • usually seen with Penetrating injuries

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16

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

  • 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)

17

What is the prognosis of Brown- sequard syndrome?

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

18

What is posterior cord syndrome?

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

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