Incomplete SCI Syndromes

Posted bythespinebookadminPosted inTopics, Trauma

Complete vs Incomplete 

  • Incomplete: SCI with preserved motor or sensory below the injury level 
  • Incomplete if: 
    • Sacral sparing: Voluntary anal contraction and sensation and great toe flexor 
    • Palpable or visible muscle contraction below injury level 
  • *bulbocavernosus is intact  
    • means NOT in spinal shock 
    • intact in Complete SCI too 

Anterior Cord 

  • Presentation 
    • Motor dysfunction 
    • Partial sensory deficit 
    • Mimics complete cord  
    • SACRAL SPARING 
  • Pathophysiology 
    • Direct compression anteriorly 
    • Anterior spinal artery injury  
      • Artery of Adamkemwicz T8-L1 on L side (br of L posterior intercostal) 
  • Outcomes 
    • 10% motor recovey 
    • Worst prognosis 

Brown Sequard 

  • Presentation 
    • Ipsilateral: motor, dorsal (proprioception) (cross at pyramids) *remember motor and proprio go together 
    • Contralateral: sensation pain temperature (2 levels below) 
  • Pahtophysiology 
  • Outcomes 
    • Best prognosis 

Central Cord 

  • Presentation 
    • Motor function affected (Lateral Cortico Spinal Tracts) more than sensory 
    • UE affected more than LE 
    • Hyperpathia (burning pain in hands) 
    • Can have bladder retention (hartman says retention but I don’t think tthats the case, it should be neurologic spastic bladder), bowel and sexual dysfunction 
    • Sacral sparing 
  • Prognosis 
    • Ambulation, b/b usually return 
    • UE usually not fully normal – clumsy hands 
  • Management 
    • Medical 
      • ICU Monitoring 
      • MAP >85 
      • Collar 
      • Early mobilization 
    • Surgical 
      • Contrroversial 
      • Absolute indication:  
        • spinal instability 
        • Progressive deficit 
      • Larouche looks at MRI – is the cord swollen in the canal – if it is, then maybe it would benefit from decompression 
  • Outcomes 
    • Recover distal to proximal  
    • Incomplete in UE 
    • Hand disability common 
    • Ambulation returns in 86% 

Cervicomedullary Syndrome