SPINAL CORD INJURY

• Preeti Dubey
• BPT FINAL YEAR
 CONTENT

1. Introduction
2. Incidence
3. Etiology
4. Risk factor
5. Classification
6. Clinical manifestations
7. Investigation
8. Management
 TRACTS

ASCENDING TRACT DESCENDING TRACT

1. Dorsal column tract 1. Corticospinal tract
2. Spinocortical tract
Anterior SCT
Lateral SCT
3. Dorsal spinocerebellar pathway
4 Ventral spinocerebellar pathway
 INTRODUCTION

-Spinal cord injury is damage to the spinal cord that

causes temporary and permanent changes in its
function.
-SCI is damage to the spinal cord that results in a loss
of functions such as mobility or feeling.
-Symptoms may include loss of muscle function,
sensation, or autonomic function in the parts of the
body served by the spinal cord below the level of the
injury.
 INCIDENCE

• SCI is highest among persons age 16-30, in whom 53.1% of

injuries.
• Males represent 81.2% of all reported SCIs and 89.8% of all
sport-related injuries.
• Among both genders, auto accidents, falls and gun shots are the
three leading causes of SCI.
• Sports and recreation-related SCI injuries primarily affect
people under age 29.
 ETIOLOGY

Most common cause:-

.Motor vehicle crashes (24%)
. Violence and related injuries (24%)
. Fall (22%)
. Sports related injuries (8%)
Other causes
. Cerebral spondylosis
. Osteoporosis
. Tumors
. Vascular disease
. Rhematoid arthritis
 RISK FACTORS

• Alcohol intoxication
• Drug abuse
• Osteoporosis
• Participation in high risk activities-
diving and sports
 CLASSIFICATION

COMPLETE SPINAL CORD INCOMPLETE SPINAL CORD

INJURY INJURY

1. Tetraplegia 1. Anterior cord injury

2. Central cord injury
2. Paraplegia
3. Brown-sequard syndrome
4. Posterior cord injury
5. Conus medullaris syndrome
6. Cauda equina syndrome
 CLASSIFICATION

1. Complete SCI
- Total motor and sensory loss distal to the
injury after spinal shock is over.
- two types:-
a. Tetraplegia/quadriplegic
b. Paraplegia
 CONTD….

. Incomplete spinal cord Injury

2

Motor or sensory functions is spared distal to the cord injury.

- six types
a.Anterior cord syndrome
Causes: damage to anterior Spinal artery
: Hyperflexion injury
Characteristics:
-It causes damage to anterior 2/3 of spinal cord.
- damages Spinothalamic tract, corticospinal tract and anterior grey horn
- complete motor loss below the level of lesion
- B/L loss of pain and temperature ,crude touch at and below the level of injury
 CONTD

b. Central cord lesion

causes: Hyperextension injury
Syringomyelia
Characteristics
- damages lateral Spinothalamic tract , anterior grey horn,
anterior white commissure, descending autonomic fibres
- patient present with upper limb weakness, urinary
retention and sensory loss below the level of lesion
- upper limb are classically more affected than lower limb
with motor dysfunction more than the sensory loss.
 CONTD…

C. Brown-sequard syndrome
causes: Gun shot
Stab woud
Spinal cord tumors
Characteristics:
- Rare form of incomplete spinal cord injury which results
after damage to one side of the spinal cord ( hemisection)
- damages dorsal column tract, Spinothalamic tract ,
corticospinal tract, anterior grey horn, dorsal and ventral
cerebellar pathway
- loss of sense of vibration, deep touch or pressure, joint
position sense and motor paralysis below and at the level of
injury on the same side
-Loss of sense of pain and temperature on the C/L side
 CONTD…

D. Posterior cord syndrome

causes: Bacteria ( syphilis)
Genetic ( friedreich’s ataxia )
Multiple sclerosis
Vit. B12 deficiency
Characteristics:-
- rare condition producing damage to the
dorsal column ( sensation of light touch,
proprioception and vibration)
- preservation of motor function and pain and
temperature pathways
 CONTD…..

• E Conus medullaris syndrome

• Causes by injury to conus medullaris and lumbar roots
• Injury present at level of T12 to L2
• Patients present with a combination of UMN and LMN palsies
character: saddle anesthesia, urinary retention,loss of bowel
reflex, loss of bowel reflex, lower limb motor weakness,
paresthesia and numbness and chronic low back pain
F. Cauda equina syndrome
• Caused by damage to the cauda portion of spinal cord
• Characterized by muscles weakness/ flaccidity in lower
limb,wasting of muscles and loss of reflexes
 CLINICAL FEATURES

• Pain
• Breathing difficulty
• Sensitivity to stimuli
• Muscle spasm
• Loss of sensation
• Loss of autonomic activity
• Loss of bowel control
• Loss of bladder control
• Sexual dysfunction
• Loss of function such as mobility or sensation
 INVESTIGATION

1. History taking
2. Physical examination
3. Imaging- x-ray
- x-ray
- CT scan
-MRI
 MANAGEMENT

1. Emergency care
. Maintaining the airway, breathing and circulation
. Immobilisation
2. Medication
. Methyl prednisolone
3. Surgical management
. Surgical decompression
. Posterior laminectomy
. Surgical stabilization- spinal fusion, fixation of Vertebra, fixation of
spine
. Disectomy ,foramenotomy
. Artificial disc implantation
4. Rehabilitation
THANK YOU