Introduction Defined as spinal cord injury with some preserved motor or sensory function below the injury level including: voluntary anal contraction (sacral sparing) login to view 1 more bullet OR palpable or visible muscle contraction below injury level OR perianal sensation present Epidemiology Incidence 11,000 new cases/year in US login to view 4 more bullets Anatomy Descending tracts (motor) lateral corticospinal tract (LCT) ventral corticospinal tract Ascending tracts (sensory) dorsal columns (DC) login to view 3 more bullets lateral spinothalamic tract (LST) login to view 3 more bullets ventral spinothalamic tract (VST) login to view 1 more bullet Classification Clinical classification anterior cord syndrome (see below) Brown-Sequard syndrome central cord syndrome posterior cord syndrome ASIA classification method to scale ASIA Impairment Scale A No motor or sensory function is preserved in the sacral segments S4-S5 Complete B Sensory function preserved, but motor function is not preserved below the neurological level and includes the sacral segments S4-S5 Incomplete C Motor function is preserved below the neurological level, and more than half of key muscles below the neurological level have a muscle grade less than 3 Incomplete D Motor function is preserved below the neurological level, and at least half of key muscles below the neurological level have a muscle grade of 3 or more Incomplete E Motor and sensory functions are normal Normal Central Cord Syndrome Epidemiology incidence login to view 1 more bullet demographics login to view 2 more bullets Pathophysiology believed to be caused by spinal cord compression and central cord edema with selective destruction of lateral corticospinal tract white matter anatomy of spinal cord explains why upper extremities and hands are preferentially affected login to view 1 more bullet Presentation symptoms login to view 3 more bullets physical exam login to view 5 more bullets late clinical presentation login to view 2 more bullets Treatment nonoperative vs. operative login to view 1 more bullet Prognosis final outcome login to view 5 more bullets recovery occurs in typical pattern login to view 4 more bullets Anterior Cord Syndrome A condition characterized by motor dysfunction dissociated sensory deficit below level of SCI Pathophysiology injury to anterior spinal cord caused by login to view 3 more bullets Mechanism usually result of flexion/compression injury Exam lower extremities affected more than upper extremities loss login to view 5 more bullets preserved login to view 3 more bullets Prognosis worst prognosis of incomplete SCI most likely to mimic complete cord syndrome 10-20% chance of motor recovery Brown-Sequard Syndrome Caused by complete cord hemitransection usually seen with penetrating trauma Exam ipsilateral deficit login to view 5 more bullets contralateral deficit login to view 4 more bullets Prognosis excellent prognosis 99% ambulatory at final follow up best prognosis for motor activity Posterior Cord Syndrome Introduction very rare Exam loss login to view 1 more bullet preserved login to view 1 more bullet Prognosis Most important prognostic variable relating to neurologic recovery is completeness of the lesion (severity of neurologic deficit)