NOTES

NOTES
SPINAL CORD INJURY

GENERALLY, WHAT IS IT?

PATHOLOGY & CAUSES DIAGNOSIS
▪ Damage/inflammation of spinal cord → loss DIAGNOSTIC IMAGING
of function, sensation
MRI
▪ Secondary compression of spinal cord
RISK FACTORS
▪ Traumatic spine injury, tumours,
inflammatory disease TREATMENT
SURGERY
SIGNS & SYMPTOMS ▪ Decompression surgery
▪ Brown–Sequard syndrome (BSS)
▫ Contralateral loss of pain, temperature; OTHER INTERVENTIONS
ipsilateral hemiparesis ▪ Stabilize vitals, immobilize acute injuries
▪ Cauda equina syndrome (CES)
▫ Severe back pain, sciatica, saddle
anesthesia, incontinence, sexual
dysfunction

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 Chapter 88 Spinal Cord Injury

BROWN–SÉQUARD SYNDROME
(BSS)
osms.it/brown-sequard-syndrome
COMPLICATIONS
PATHOLOGY & CAUSES ▪ Progression to complete paralysis
▪ AKA spinal hemiparaplegia
▪ Spinal cord hemisection (damage limited to SIGNS & SYMPTOMS
one half) → paralysis on side of lesion; loss
of sensation on opposite side ▪ Contralateral pain, temperature loss;
▪ Neurological fallout from damage to spinal ipsilateral hemiparesis, proprioception/
tracts vibration sense loss
▫ Corticospinal tract: loss of upper motor
neuron innervation → ipsilateral spastic
paralysis, below level of lesion; damage DIAGNOSIS
to lower motor neuron at level of spinal
injury → ipsilateral flaccid paralysis of DIAGNOSTIC IMAGING
muscles supplied at spinal level
▫ Dorsal column (medial lemniscus): MRI
ipsilateral loss of vibration, ▪ Unilateral spinal cord pathology/
proprioception, fine touch hemisection of spinal cord
▫ Spinothalamic tract: contralateral loss of
pain, temperature sensation; 1–2 levels
below lesion
TREATMENT
OTHER INTERVENTIONS
CAUSES ▪ Traumatic injuries
▪ Spinal fractures, gunshot wounds, ▫ Cervical spine/lower dorsal vertebra
stab wounds, crush injury, tumours, immobilization
inflammatory diseases

CAUDA EQUINA SYNDROME (CES)

osms.it/cauda-equina-syndrome
CAUSES
PATHOLOGY & CAUSES ▪ Lower back disc herniation, spinal
stenosis, cancer, trauma, epidural abscess/
▪ Simultaneous compression of multiple hematoma
lumbosacral nerve roots below level (L2)
of conus medullaris (distal bulbous part of
spinal cord) → neuromuscular, urogenital
symptoms

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 COMPLICATIONS
▪ Paraplegia, persistent bowel/bladder
TREATMENT
problems, sexual dysfunction, loss of
sensation
SURGERY
▪ Surgical decompression (e.g. laminectomy)

SIGNS & SYMPTOMS OTHER INTERVENTIONS

▪ Red flags (urgent investigation/treatment Sudden onset CES
required) ▪ Medical emergency
▫ Severe back pain; saddle anesthesia; ▫ Early treatment (< 48hrs) of
incontinence/sexual dysfunction compressive lesions → significantly
▪ Muscle weakness in lower leg with absent/ better outcomes, prevents progression
reduced deep tendon achilles/patellar reflex to paraplegia
▪ Gait disturbance
▪ Sciatica-like pain in one/both legs: low back
pain, radiates down leg
▪ Numbness in saddle distribution
▫ Anesthesia/paresthesia of S3–S5
dermatomes → anesthesia/paresthesia
perineum, external genitalia, anus,
perianal region
▪ Loss of bowel/bladder control
▪ Absent anal reflex, bulbocavernosus reflex
▪ Decreased tone of urinary, anal sphincters
▪ Detrusor weakness → urinary retention/
post-voiding residual incontinence
▪ Sexual dysfunction

DIAGNOSIS
DIAGNOSTIC IMAGING Figure 88.1 An MRI scan of the spine in
the sagittal plane demonstrating a L4/L5
Spine MRI (with gadolinium contrast) intervertebral disc prolapse compressing the
▪ Compression of S2–S4 nerve roots by cauda equina. The individual presented with
mass/herniation symptoms of cauda equina syndrome.

Bladder ultrasound
▪ Post-void residual > 250ml

OTHER DIAGNOSTICS
Clinical examination
▪ Regional anesthesia, muscle weakness,
abnormal reflexes, abnormal gait

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