Spinal Cord Syndrome

Aka: Spinal Cord Syndrome, Epidural Spinal Cord Compression, Acute Spinal Cord Compression, Spinal Cord Compression, Partial Cord Syndrome, Quadriplegia, Paraplegia

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II. Definitions

  1. Paraplegia
    1. Complete paralysis of the lower part of the body including the legs
    2. Level of thoracolumbar spine lesion determines deficits
  2. Quadriplegia
    1. Paralysis of all four limbs and trunk
    2. Level of Cervical Spine lesion determines deficits

III. Symptoms

  1. Acute neck or back pain
  2. Extremity weakness or paralysis
  3. Sensory deficits with broader distribution than individual Dermatomes
  4. Changes in bowel or Bladder function (e.g. acute urinary or stool retention or Incontinence)
  5. Spinal mass (e.g. Epidural Neoplasm) may result in pain worse when lying down (supine, recumbent)

IV. History

  1. Acute Spinal Trauma
    1. Cervical Spine Injury is most common level of cord injury
  2. Epidural Neoplasm
    1. Thoracic Spine involvement is more common
    2. Review malignancy risk factors
  3. Epidural Abscess Risks
    1. Thoracic Spine involvement is more common
    2. Fever
    3. Immunosuppression
    4. Intravenous Drug Abuse
  4. Spinal Epidural Hematoma Risks
    1. Anticoagulation
    2. Spinal Procedures (e.g. Spine Surgery)

V. Exam

  1. See Trauma Exam
  2. See Neurologic Exam
  3. Back exam
  4. Post-void Bladder scan or POCUS for Residual Volume
  5. Rectal Exam for tone

VI. Exam: Distinguishing Upper from Lower Motor Neuron Injury

  1. Upper Motor Neuron Lesion (lesion proximal to the spinal cord anterior horn cells)
    1. Hyperreflexia
    2. Clonus
    3. Motor Spasticity
    4. Increased Muscle tone
    5. Babinski Sign positive
    6. Muscles without atrophy (normal Muscle mass)
  2. Lower Motor Neuron Lesion (lesion distal to the spinal cord anterior horn cells)
    1. Motor Weakness to Flaccid Paralysis
    2. Muscle Atrophy
    3. Muscle Fasciculations
    4. Deep Tendon Reflexes decreased or lost

VII. Types: Spinal Cord Syndrome

  1. Trauma - Complete transection of the spinal cord
    1. Complete Cord Syndrome
  2. Trauma - Partial spinal cord injuries
    1. Anterior Cord Syndrome
    2. Central Cord Syndrome
    3. Posterior Cord Syndrome
    4. Spinal Cord Hemisection (Brown-Sequard Syndrome, rare)
    5. Neuropraxia (Stinger, Burner)
  3. Other cord syndromes
    1. Spinal Shock
    2. Cauda Equina Syndrome
    3. Conus Medullaris Syndrome
      1. Similar to Cauda Equina, but with compression at L1-L2 and sensory deficits at Lumbosacral Spine
  4. Images
    1. CordSyndrome.jpg

VIII. Causes

  1. Traumatic Spinal Injury
  2. Epidural Neoplasm
  3. Spinal Epidural Abscess
  4. Spinal Epidural Hematoma

IX. Differential Diagnosis

  1. See Peripheral Neuropathy
  2. See Cervical Spinal Stenosis
  3. See Lumbar Spinal Stenosis
  4. See Claudication

X. Imaging

  1. CT Spine
    1. First-Line study in Spine Trauma
  2. MRI Spine
    1. Indicated in suspected Epidural Neoplasm, Spinal Epidural Abscess, Epidural Abscess or cord syndrome
    2. CT Myelography may be considered when MRI is contraindicated

XI. Management

  1. See Spinal Trauma
  2. See Epidural Neoplasm
  3. See Spinal Epidural Abscess
  4. See Spinal Epidural Hematoma

XII. References

  1. Dasburg (2020) Crit Dec Emerg Med 34(6): 28-9
  2. Decker in Chorley and Bachur (2014) Overview of Cervical Spinal Cord Injuries..., UpToDate, Wolters-Kluwer
  3. Wagner (1997) Emerg Med Clin North Am 15:699-711 [PubMed]

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Related Topics in Cervical Spine Disorders

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