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)

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: 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

VI. 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

IX. 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

XI. 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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