Spinal Cord Injury

• fracture or dislocation of vertebra which compresses, stretches, or tears the spinal cord
• most common in spinal regions that are most flexible (C1-C7, T12-L2)
  
• laceration usually results in permanent damage
• complete transection/crush injury results in loss of function at and below the level of the injury
• C3-C5 injury often affects phrenic nerve (respiration)
• spinal shock initially, recovery of reflexes over time, and potentially the function of intact tracts
  

early spinal shock with increasing impairment

• no function at or below level of injury
• includes motor, sensory and autonomic function

later recovery from spinal shock

• gradual recovery of reflexes (hypereflexia)
• extent of permanent damage revealed

Treatment

• surgery (repair tissue and relieve pressure)
• treat complications of immobility
• rehabilitation

Clinical Syndromes

• Central Cord Syndrome
  • A lesion, occurring almost exclusively in the cervical region, that produces sacral sensory sparing and greater weakness in the upper limbs than in the lower limbs
• Brown-Sequard Syndrome
  • A lesion that produces relatively greater ipsilateral proprioceptive and motor loss and contralateral loss of sensitivity to pain and temperature
• Anterior Cord Syndrome
  • A lesion that produces variable loss of motor function and of sensitivity to pain and temperature, while preserving proprioception
• Posterior Cord Syndrome
  • Implies damage to the dorsal columns of spinal cord, manifesting with loss of of proprioception and localized light touch injury downwards
• Conus Medullaris Syndrome
  • Injury of the sacral cord (conus) and lumbar nerve roots within the spinal canal, which usually results in an areflexic bladder, bowel and lower limbs. Sacral segments may occasionally show preserved reflexes, eg. bulbocavernosus and micturition reflexes.
• Cauda Equina Syndrome
  • Injury to the lumbosacral nerve roots within the neural canal resulting in areflexic bladder, bowel and lower limbs

Incomplete Injury:

• If partial preservation of sensory function is found below the neurological level (most caudal segement with normal motor and sensory function on both sides) and includes the lowest sacral segement, the injury is defined as incomplete. Sacral sensation includes sensation at the anal mucocutaneous junction as well as deep anal sensation. To be motor incomplete, an individual must be sensory incomplete and have either voluntary anal sphincter contraction or motor function preserved in more than 3 levels below the motor level.
• The test of motor function in the anal sphincter is the presence of voluntary contraction of the external anal sphincter upon digital examination.

Complete Injury:

• This term is used when there is an absence of sensory and motor function in the lowest sacral segment