NOTES NOTES SPINAL CORD INJURY GENERALLY, WHAT IS IT? PATHOLOGY & CAUSES ▪ Damage/inﬂammation of spinal cord → loss of function, sensation RISK FACTORS DIAGNOSIS DIAGNOSTIC IMAGING MRI ▪ Secondary compression of spinal cord ▪ Traumatic spine injury, tumours, inﬂammatory disease SIGNS & SYMPTOMS ▪ Brown–Sequard syndrome (BSS) ▫ Contralateral loss of pain, temperature; ipsilateral hemiparesis ▪ Cauda equina syndrome (CES) ▫ Severe back pain, sciatica, saddle anesthesia, incontinence, sexual dysfunction 680 OSMOSIS.ORG TREATMENT SURGERY ▪ Decompression surgery OTHER INTERVENTIONS ▪ Stabilize vitals, immobilize acute injuries
Chapter 88 Spinal Cord Injury BROWN–SÉQUARD SYNDROME (BSS) osms.it/brown-sequard-syndrome PATHOLOGY & CAUSES ▪ AKA spinal hemiparaplegia ▪ Spinal cord hemisection (damage limited to one half) → paralysis on side of lesion; loss of sensation on opposite side ▪ Neurological fallout from damage to spinal tracts ▫ Corticospinal tract: loss of upper motor neuron innervation → ipsilateral spastic paralysis, below level of lesion; damage to lower motor neuron at level of spinal injury → ipsilateral ﬂaccid paralysis of muscles supplied at spinal level ▫ Dorsal column (medial lemniscus): ipsilateral loss of vibration, proprioception, ﬁne touch ▫ Spinothalamic tract: contralateral loss of pain, temperature sensation; 1–2 levels below lesion COMPLICATIONS ▪ Progression to complete paralysis SIGNS & SYMPTOMS ▪ Contralateral pain, temperature loss; ipsilateral hemiparesis, proprioception/ vibration sense loss DIAGNOSIS DIAGNOSTIC IMAGING MRI ▪ Unilateral spinal cord pathology/ hemisection of spinal cord TREATMENT OTHER INTERVENTIONS CAUSES ▪ Spinal fractures, gunshot wounds, stab wounds, crush injury, tumours, inﬂammatory diseases ▪ Traumatic injuries ▫ Cervical spine/lower dorsal vertebra immobilization CAUDA EQUINA SYNDROME (CES) osms.it/cauda-equina-syndrome PATHOLOGY & CAUSES ▪ Simultaneous compression of multiple lumbosacral nerve roots below level (L2) of conus medullaris (distal bulbous part of spinal cord) → neuromuscular, urogenital symptoms CAUSES ▪ Lower back disc herniation, spinal stenosis, cancer, trauma, epidural abscess/ hematoma OSMOSIS.ORG 681
COMPLICATIONS ▪ Paraplegia, persistent bowel/bladder problems, sexual dysfunction, loss of sensation SIGNS & SYMPTOMS ▪ Red ﬂags (urgent investigation/treatment required) ▫ Severe back pain; saddle anesthesia; incontinence/sexual dysfunction ▪ Muscle weakness in lower leg with absent/ reduced deep tendon achilles/patellar reﬂex ▪ 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 TREATMENT SURGERY ▪ Surgical decompression (e.g. laminectomy) OTHER INTERVENTIONS Sudden onset CES ▪ Medical emergency ▫ Early treatment (< 48hrs) of compressive lesions → signiﬁcantly better outcomes, prevents progression to paraplegia DIAGNOSIS DIAGNOSTIC IMAGING Spine MRI (with gadolinium contrast) ▪ Compression of S2–S4 nerve roots by mass/herniation Bladder ultrasound ▪ Post-void residual > 250ml OTHER DIAGNOSTICS Clinical examination ▪ Regional anesthesia, muscle weakness, abnormal reﬂexes, abnormal gait 682 OSMOSIS.ORG Figure 88.1 An MRI scan of the spine in the sagittal plane demonstrating a L4/L5 intervertebral disc prolapse compressing the cauda equina. The individual presented with symptoms of cauda equina syndrome.