Spinal Cord Syndromes
Spinal Cord Syndromes
Spinal Cord Syndromes
The syndromes are named according to the presumed location of injury in the transverse plane of the spinal cord International standard classification is applied.
Recognise types of injury Information helps to select treatment Each has different prognosis for recovery
Damage to upper cervical cord and medulla Upwards can extend upto pons Downwards upto C4.
CMS: PRESENTATION
1. 2. 3. 4.
Respiratory dysfunction Hypotension Tetraplegia Aneasthesia from C1 to C4 Sensory loss on face Dejerine pattern or onion skin pattern
CMS: MECHANISM
Traction injury Severe dislocation Antero posterior compression Protruded disc Past usually associated with death Present prompt first aid treatment, greater number of survivors reach hospital
CMS: EXAMINATION
Face trigeminal nucleus pons Trigeminal tract- pons medulla and spinal cord upto C4- descending spinal tract Sensory loss around month lesion in medulla. Sensory loss forehead, chin, ear C3-C4
CMS: INJURIES
Atlanto occipital injury of Bell Atlanto axis injury & dislocation Odontoid fracture
CSCS: MECHANISM
A - Hypertension injury
Antero posterior compression Elderly people Central haematomyelia Surrounding oedema
Mechanism- compression between bony spurs ant. and ligamentum flavum post., central necrosis, involves ant. horn cells.
CSCS: MECHANISM
B In absence of orteophytes
Vascular aetiology
9 Compromise of medullary artery perfusion 9 Vertebral artery stretching 9 Ant. spinal artery spasm / occlusion 9 Venous infarcts
CSCS: MECHANISM
C - Acute traumatic prolapse of cervical disc D - Mechanical compression
Clinical manifestations
Arms weaker than legs, flaccid arms acutely, legs normal or variably weak, upper motor neuron deficits in upper limbs develop Trigeminal sensory deficit (onion skin , spinal tract of V) + Cranial nerve dysfunction (IX, X, or XI) Usually good
+
Variable
compression of cord
A large prolapsed disc compresses the ant. spinal cord post. column is intact
ACS: MECHANISM
Mechanical stress factors Cord is pulled between compression and dentate ligament Pyramided fibers bear the greatest stress
ACS: PRESENTATION
Spasticity Disturbance of gait Modified sensory changes
ACS: TREATMENT
BSS: MECHANISM
BSS: MECHANISM
Hyperextension injuries Flexion injuries Facet lock Associated with burst fracture CAUSE:- spinal cord compression
BSS: PRESENTATION
Present from the beginning Gradual evolution within days possible Common in cervical spine. Sphincter may be spared
body
Cord ends between L1 L2 disc space
D12 burst fracture compress the conus. All lumbar and sacral segments can be compressed
CMS: PRESENTATION
DL injuries common Lower motor neuron flaccid paralysis Flaccid sphincters Chronic spasticity Atrophy of muscles Perianal sensation may be preserved (sacral sparing) Low pressure high capacity neurogenic bladder
Acute central disc prolapse L4/5. Medially placed sacral roots sustain maximum compression
CES: OUTCOME
Prognosis for neurological recovery is much better Lower motor nerves have more resilience to trauma Fever secondary injury mechanisms Greater regeneration capability