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Spinal Cord Lesions

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Topic updated on 06/13/17 7:24pm

Overview
  • Types of spinal cord injuries
    • presentation depends on location of lesion and tracts involves
    • possible injury locations include
      • central
      • anterior
      • posterior
      • hemitranssection
  • Most important prognostic variable relating to neurologic recovery is completeness of the lesion (severity of neurologic deficit) 
Central Cord Syndrome
  • Introduction
    • most common incomplete cord injury 
      • often in elderly with minor extension injury mechanisms
      • often preexisting cervical spondylosis
  • Physical exam
    • motor deficit worse in UE than LE (some preserved motor function) 
    • hands have more pronounced motor deficit than arms
  • Prognosis
    • good prognosis although full functional recovery rare
    • usually ambulatory at final follow-up
Anterior Cord Syndrome
  • Introduction
    • injury to anterior spinal cord caused by 
      • direct compression (osseous) of the anterior spinal cord by flexion/compression injury and/or vertebral burst fracture 
      • anterior spinal artery injury
        • anterior 2/3 spinal cord supplied  by anterior spinal artery
  • Physical exam
    • lower extremity affected more than upper extremity
    • motor and pain loss
    • preserved proprioception, vibratory sense (posterior columns spared)
  • Prognosis
    • most likely to mimic complete cord syndrome
    • most severe of incomplete cord injuries with worst prognosis
Brown-Sequard Syndrome
  • Introduction
    • caused by complete cord hemitransection
      • usually seen with penetrating trauma
  • Physical exam
    • ipsilateral deficit
      • motor function
      • propioception
      • vibratory sense
    • contralateral deficit
      • pain
      • temperature
        • spinothalamic tracts cross at spinal cord level
        • classically 2-levels below
  • Prognosis
    • excellent prognosis
    • 99% ambulatory at final follow up
Posterior Cord Syndrome
  • Introduction 
    • very rare
  • Physical exam
    • loss of proprioception
    • preservation of motor, pain, light touch


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