Partial spinal cord injury syndromes

Anterior cord syndrome

The anterior part of the spinal cord is usually injured by a flexion-rotation force to the spine producing an anterior dislocation or by a compression fracture of the vertebral body with bony encroachment on the vertebral canal. There is often anterior spinal artery compression so that the corticospinal and spinothalamic tracts are damaged by a combination of direct trauma and ischaemia. This results in loss of power as well as reduced pain and temperature sensation below the lesion.

 

Central cord syndrome

This is typically seen in older patients with cervical spondylosis. A hyperextension injury, often from relatively minor trauma, compresses the spinal cord between the irregular osteophytic vertebral body and the intervertebral disc anteriorly and the thickened ligamentum flavum posteriorly. The more centrally situated cervical tracts supplying the arms suffer the brunt of the injury so that classically there is a flaccid (lower motor neurone) weakness of the arms and relatively strong but spastic (upper motor neurone) leg function. Sacral sensation and bladder and bowel function are often partially spared.

 

Posterior cord syndrome

This syndrome is most commonly seen in hyperextension injuries with fractures of the posterior elements of the vertebrae. There is contusion of the posterior columns so the patient may have good power and pain and temperature sensation but there is sometimes profound ataxia due to the loss of proprioception, which can make walking very difficult.

 

Brown–Séquard syndrome

Classically resulting from stab injuries but also common in lateral mass fractures of the vertebrae, the signs of the Brown-Séquard syndrome are those of a hemisection of the spinal cord. Power is reduced or absent but pain and temperature sensation are relatively normal on the side of the injury because the spinothalamic tract crosses over to the opposite side of the cord. The uninjured side therefore has good power but reduced or absent sensation to pin prick and temperature.

 

Conus medullaris syndrome

The effect of injury to the sacral cord (conus medullaris) and lumbar nerve roots is usually loss of bladder, bowel and lower limb reflexes. Lesions high in the conus may occasionally represent upper motor neurone defects and function may then be preserved in the sacral reflexes, for example the bulbocavernosus and micturition reflexes.

 

Cauda equina syndrome

Injury to the lumbosacral nerve roots results in areflexia of the bladder, bowel, and lower limbs.

The final phase in the diagnosis of spinal trauma entails radiology of the spine to assess the level and nature of the injury.