C-Spine

Spinal Cord Syndrome

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Spinal Cord Syndrome, Epidural Spinal Cord Compression, Acute Spinal Cord Compression, Spinal Cord Compression

  • 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)
  • 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)
  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
  • 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. Spinal Cord Hemisection (Brown-Sequard Syndrome, rare)
    4. 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
  • 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
  • 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]