SPINAL CORD INJURY

CLINICAL NEUROLOGY
Prepared by: UTKARSHA AND VIVEK
BPT 3rd year
 OVERVIEW
.WHAT IS SPINE ?

.WHAT IS SPINAL CORD INJURY?

.ETIOLOGY

.CLASSIFICATION OF SPINAL CORD INJURY

.ASIA IMPAIREMENT SCALE

.DESIGNATION OF LESION LEVEL

.CLINICAL SYNDROMES

.CLINICAL FEATURES

.COMPLICATIONS
 WHAT IS SPINAL CORD?
.which
Spinal cord is the major bundle of nerves
carry impulses from/ to the brain to the
rest of the body.

.They
It is surrounded by rings of bone-vertebrae.
function to protect spinal cord
 WHAT IS SPINAL CORD
INJURY?
A spinal cord injury is
an injury to the spinal
cord resulting in the
change /loss either
temporary and
permanent, in the cord’s
normal motor , sensory
ETIOLOGY :-
Spinal cord injuries can be divided into two broad etiological
categories-
Traumatic injuries and non traumatic damage.

# TRAUMATIC INJURIES: They result from damage caused by a traumatic

event such as motor vehicle accident , fall or gun shot wound.

# NON TRAUMATIC DAMAGE: Results from any disease or any

pathological influence like

. Vascular malfunctions: thrombosis , embolus, haemorrhage and

arteriovenous malformations.
.degenerative disease: rheumatoid arthritis
.INFECTIONS: TRANSVERSE MYELITIS , SPINAL NEOPLASMS,
SYRINGOMYELLA, ABCESS OF THE SPINAL CORD

.NEUROLOGICAL DISEASE : MULTIPLE SCELEROSIS AND AMYLOTROPHIC

LATERAL SCELEROSIS
 CLASSIFICATION OF
SPINAL CORD INJURIES
Spinal cord injuries are divided into two broad functional
categories:-
# TETRAPLEGIA : refers to the complete
paralysis of all the four extremities and trunk
including the respiratory muscles and results
from lesions of the cervical cord

# PARAPLEGIA : refers to the complete

paralysis of all or part of the trunk and both lower
extremities which results from the lesions of the
thoracic or lumbar spinal cord or cauda equina.
 DESIGNATION OF LESION
LEVEL
NEUROLOGICAL LEVEL : refers to the most caudal level of the spinal cord with
normal motor and sensory functions on both left and right sides of the body.

MOTOR LEVEL: level which has normal motor functions bilaterally.

It is determined by testing the strength of the key muscle on both the left and the right
side. Scoring of muscle strength is based on 6 point ordinal scale used for MMT .
Sensory level: refers to the level having normal sensory functions on both
sides of the body.
It is determined by testing the patients sensitivity to light touch and pin prick on
both the left and the right sides. Scoring of sensation is based on 3 point ordinal
scale
Where 0= absent, 1= impaired, 2= normal
 ASIA IMPAIREMENT SCALE
Individuals with incomplete injuries may have variable clinical presentations in
terms of motor and sensory functions below the neurological level, so the ASIA
IMPAIREMENT SCALE was created so that climicians and researchers could
better communicate the degree of impairement of individuals with spinal cord
injuries .

DERMATOME : Area of a skin supplied by a single spinal cord segment.

MYOTOME: Muscle which is supplied by a spinal cord segment .

ZONES OF PARTIAL PRESERVATION :if the patient has motor and sensoy
functions below the neurological level, but does not have function at s4 and s5 ,
then the areas of intact motor and sensory function below the neurological level
are termed as zones of partial preservation.
 COMPLETE AND INCOMPLETE
LESION
COMPLETE LESION : characterized by no sensory or motor
functions below the level of lesion , not even in the lowest sacral
segments [ s4 nd s5 ] caused by a comp;lete transection , severe
compression or extensive vascular impairement to the cord.

INCOMPLETE LESION : characterized by variable neurological

findings with partial loss of sensory and motor functions below the
lesion . It results from contusions due to pressure on cord from
displaced bone or soft tissue or from swelling within spinal canal.
 CLINICAL SYNDROMES
BROWN SEQUARD SYNDROME
IT occurs from the hemisection of the spinal cord [ damage to the one side ] and is
caused by penetration wounds ie. Gunshot wound or stab
.in this partial lesions occur more frequently
.true hemisections are rare.
.the clinical features of this syndrome are asymmetrical.
.on the ipsilateral side [ same] side of the lesion , there is loss of sensation in the
dermatome segment corresponding to the level of lesion.
. On the contralateral side [opposite ] side of the lesion, damage of the
spinothalamic tract which results in the loss of sense of pain and temperature.
.lateral column damage which results in the decreased reflexes , lack of superficial
reflexes, clonus and a positive Babinski sign.
.dorsal column damage which results in the loss of proprioception, kinesthesia and
vibratory sense.
BROWN SEQUARD SYNDROME
ANTERIOR CORD SYNDROME :
it is frequently related to the flexion injuries of the cervical region with
resultant damage to the anterior portion of the cord or its vascular supply
from the anterior spinal artery.
. There is typically compression of the anterior cord from fracture,
disclocation or cervical disc protusion.
.this syndrome is characterized by loss of motor functions [ corticospinal
tract damage].
Loss of sense of pain and temperature [ spinothalamic tract damage].
.proprioception , kinesthesia and vibratory sense are generally preserved
because they are mediated by the posterior columns with a separate
vascular supply from the posterior spinal arteries.
ANTERIOR CORD SYNDROME
POSTERIOR CORD SYNDROME
It is an extremely rare syndrome resulting dur to the
defects in the function of the posterior column.
The clinical picture includes :
.preservation of motor functions, sense of pain and light
touch.
.there is loss of proprioception and epicritic sensations [
eg. Two point discrimination, graphesthesia, stereogenesis
] below the level of lesion.
.a wide based steppage gait pattern is typical.
POSTERIOR CORD SYNDROME
 CENTRAL CORD SYNDROME
Central cord syndrome most commonly occurs from the hyperextension
injuries to the cervical region.

. It has also been associates with the congential and degenerative narrowing
of the spinal canal.

. The compressive forces give rise to haemorrhage and oedema, producing

damage to the most central aspects of the cord.

.there is characteristically more severe neurological involvement of the

upper extremeties [Ues], cervical tracts are more centrally located than the
Les.
.bladder dysfunction, urinary retention and varying degree of sensory loss
below the level of region.
CENTRAL CORD SYNDROME
 CAUDA EQUINA
Cauda equina lesions are peripheral nerve[ LMN] ,lower motor
neuron injuries.
. They have the same potential to regenerate as peripheral
nerves elsewhere in the body.
.full return of innervation is not common because
.There is a large distance between lesion and the point of
innervation.
Axonal regeneration may not occur along the original
distribution of the nerve
 CLINICAL PRESENTATION AND
COMPLICATIONS
DIRECT COMPLICATIONS:-

.SPINAL SHOCK
.AUTONOMIC DYSREFLEXIA
.POSTURAL HYPOTENSION
.IMPAIRED TEMPERATURE CONTROL
.RESPIRATORY IMPAIREMENT
.SPASTICITY
.BLADDER AND BOWL DYSFUNCTION
.SEXUAL DYSFUNCTION
INDIRECT COMPLICATIONS :-

.RESPIRATORY COMPLICATION
.PRESSURE SORES
.DEEP VEIN THROMBOSIS
.CONTRACTURES
.PAIN
MANAGEMENT :-
.EMERGENCY CARE
.FRACTURE STABILIZATION
.IMMOBILIZATION
- TONGS
-HALO DEVICES
- TURNING FRAMES AND BEDS
THANK YOU