SPINAL CORD INJURY Etiology [1] [3]
TRAUMATIC
Other Terms Most frequent cause of injury in adult rehabilitation
SCI populations
Definition / Description [6] [3] [1] [9] o Falls
Is used to refer to neurological damage of the spinal o stab wounds
cord following trauma. [1] [3] o gunshot wounds
o sports activities
Gradings , Types / Classifications[1] [9]
NON-TRAUMATIC
ASIA Impairment Scale Vascular malfunction,
A = Complete Vertebral subluxation due to ra
No motor or sensory function is preserved in the infection such as syphilis or transverse myelitis,
sacral segment S4 to S5 Ca, or neoplasms,
Abscesses of spinal cord,
B = Incomplete neurological disease such as ms, als.
Sensory but not motor function is preserved below
the neurological level and includes the sacral Predisposing/ Risk Factors [9] [16] [17]
segments S4 to S5 M>F
Ages between 16 and 30.
C = Incomplete Elderly (d/t fall)
Motor function is preserved below the neurological Engaging in risky behavior.
level, and more than half of key muscles below the Having a bone or joint disorder
neurological level have a muscle grade less than 3
D = Incomplete Epidemiology [6] [1][2][4]
Motor function is preserved below the neurological Thought to primarily affect young adults
level, and at least half of key muscles below the M>F (M=73.8% F=21.7%) 4:1 ratio
neurological level have a muscle grade less than 3 Injury results from damage caused by traumatic events
such as MVA 40.4%, falls 27.9%, violence 15%, sports
Complete vs Incomplete [9] 8%
Complete SCI - involves lack of all motor Unmarried > married
and sensory fxn below the level of injury
Characteristics of Injury:
Incomplete SCI - indicates some remaining
Tetraplegia: C5 is most common level of injury
sensory or motor fxn below the affected area.
Paraplegia: T12 is most common level of injury
TRAUMATIC and Non Traumatic
Trauma is the most frequent cause of SCI where in Anatomic Consideration [1][2][3][5][14]
MVA contributes 40.4% where in Falls (27.9%) ,
violence (15%) and sports (8%) The vertebral column consists of:
7 cervical , 12 thoracic , 5 lumbar , 5 sacral , 4 coccyx
Non-Traumatic damage in adult populations
generally result from disease or pathological
Spinal Cord
influence. It contributes for ~39% of all SCIs
Located in upper two-thirds of the vertebral column.
Functional Categories [1][9] The terminal portion of the cord is the conus medullaris,
which becomes cauda equina (horse’s tail) at
Tetraplegia - complete paralysis of all four
approximately the L2 vertebrae
extremities and trunk including the respiratory
The spinal cord has an inner core of gray matter,
muscles and results from lesions of the spinal
surrounded by white matter. The white matter consists of
cord
nerve fibers, neuroglia, and blood vessels.
Paraplegia - complete paralysis of all or part of The nerve fibers form spinal tracts, which are divided
the trunk and both lower extremities (LEs), into ascending, descending, and intersegmental tracts.
resulting from lesions of the thoracic or lumbar
spinal cord or cauda equina.
Ascending sensory tracts: [1]
, Spinal cord injury can be sustained through different
Dorsal column - conveys proprioception, vibratory mechanisms, with the following 3 common abnormalities
sensation, deep touch, and discriminative touch leading to tissue damage:
Anterior Spinothalamic – conveys light/crude touch,
pressure, pain
Destruction from direct trauma
Lateral Spinothalamic – conveys pain and
Compression by bone fragments, hematoma, or disk
temperature
material
Dorsal and Ventral spinocerebellar tracts - (conveys
Ischemia from damage or impingement on the spinal
unconscious proprioception)
arteries
Spinotectal tract – conveys spinovisual reflexes
Spinoreticular tracts – conveys deep and chronic pain
Spino-olivary tract – conveys info to cerebellum from
cutaneous & proprioceptive organs
Main descending motor tracts: [1]
Lateral corticospinal - fine motor function
Anterior corticospinal – gross and postural motor
function
Lateral and medial vestibulospinal - medial
vestibulospinal (positioning of head and neck); lateral
and medial vestibulospinal (posture and balance)
Lateral and medial reticulospinal - (posture, balance,
automatic gait-related movements)
Rubrospinal tracts - (movement of limbs)
Tectospinal tract – Reflex head turning
Descending autonomic tracts - ANS (fight/flight
response)
Signs and Symptoms [1][3][4]
Anterior cord syndrome
MOI: Hyperflexion
Affected tracts: Spinothalamic & Corticopinal tract
Damage is mainly in the anterior cord resulting in loss of
motor function, pain and temperature with preservation
of light touch, proprioception and vibration sense
Brown Sequard Syndrome
MOI: GSW or stab wounds; flexion rotation forces
Affected tracts: Dorsal column, spinothalamic, lateral
corticopinal tract
Hemisection of the spinal cord
Ipsilateral weakness and loss of position and vibration
sense below the level of the lesion, with contralateral
Pathophysiology [10] [8] loss of pain and temperature a few segments below the
level of the lesion
Spinal cord injury (SCI), as with acute stroke, is a
dynamic process. In all acute cord syndromes, the full Central cord syndrome “Walking SCI’
extent of injury may not be apparent initially. Incomplete MOI: Hyper extension injuries
cord lesions may evolve into more complete lesions. Loss of more centrally located cervical tracts/ arm
More commonly, the injury level rises 1 or 2 spinal function, with preservation of more peripherally located
levels during the hours to days after the initial event. lumbar and sacral tracts/ leg function; early loss of pain
A complex cascade of pathophysiologic events related to and temperature
free radicals, vasogenic edema, and altered blood flow UE > LE
accounts for this clinical deterioration. Normal Motor > Sensory
oxygenation, perfusion, and acid-base balance are
required to prevent worsening of the spinal cord injury.
Cauda Equina
TRAUMATIC
Other Terms Most frequent cause of injury in adult rehabilitation
SCI populations
Definition / Description [6] [3] [1] [9] o Falls
Is used to refer to neurological damage of the spinal o stab wounds
cord following trauma. [1] [3] o gunshot wounds
o sports activities
Gradings , Types / Classifications[1] [9]
NON-TRAUMATIC
ASIA Impairment Scale Vascular malfunction,
A = Complete Vertebral subluxation due to ra
No motor or sensory function is preserved in the infection such as syphilis or transverse myelitis,
sacral segment S4 to S5 Ca, or neoplasms,
Abscesses of spinal cord,
B = Incomplete neurological disease such as ms, als.
Sensory but not motor function is preserved below
the neurological level and includes the sacral Predisposing/ Risk Factors [9] [16] [17]
segments S4 to S5 M>F
Ages between 16 and 30.
C = Incomplete Elderly (d/t fall)
Motor function is preserved below the neurological Engaging in risky behavior.
level, and more than half of key muscles below the Having a bone or joint disorder
neurological level have a muscle grade less than 3
D = Incomplete Epidemiology [6] [1][2][4]
Motor function is preserved below the neurological Thought to primarily affect young adults
level, and at least half of key muscles below the M>F (M=73.8% F=21.7%) 4:1 ratio
neurological level have a muscle grade less than 3 Injury results from damage caused by traumatic events
such as MVA 40.4%, falls 27.9%, violence 15%, sports
Complete vs Incomplete [9] 8%
Complete SCI - involves lack of all motor Unmarried > married
and sensory fxn below the level of injury
Characteristics of Injury:
Incomplete SCI - indicates some remaining
Tetraplegia: C5 is most common level of injury
sensory or motor fxn below the affected area.
Paraplegia: T12 is most common level of injury
TRAUMATIC and Non Traumatic
Trauma is the most frequent cause of SCI where in Anatomic Consideration [1][2][3][5][14]
MVA contributes 40.4% where in Falls (27.9%) ,
violence (15%) and sports (8%) The vertebral column consists of:
7 cervical , 12 thoracic , 5 lumbar , 5 sacral , 4 coccyx
Non-Traumatic damage in adult populations
generally result from disease or pathological
Spinal Cord
influence. It contributes for ~39% of all SCIs
Located in upper two-thirds of the vertebral column.
Functional Categories [1][9] The terminal portion of the cord is the conus medullaris,
which becomes cauda equina (horse’s tail) at
Tetraplegia - complete paralysis of all four
approximately the L2 vertebrae
extremities and trunk including the respiratory
The spinal cord has an inner core of gray matter,
muscles and results from lesions of the spinal
surrounded by white matter. The white matter consists of
cord
nerve fibers, neuroglia, and blood vessels.
Paraplegia - complete paralysis of all or part of The nerve fibers form spinal tracts, which are divided
the trunk and both lower extremities (LEs), into ascending, descending, and intersegmental tracts.
resulting from lesions of the thoracic or lumbar
spinal cord or cauda equina.
Ascending sensory tracts: [1]
, Spinal cord injury can be sustained through different
Dorsal column - conveys proprioception, vibratory mechanisms, with the following 3 common abnormalities
sensation, deep touch, and discriminative touch leading to tissue damage:
Anterior Spinothalamic – conveys light/crude touch,
pressure, pain
Destruction from direct trauma
Lateral Spinothalamic – conveys pain and
Compression by bone fragments, hematoma, or disk
temperature
material
Dorsal and Ventral spinocerebellar tracts - (conveys
Ischemia from damage or impingement on the spinal
unconscious proprioception)
arteries
Spinotectal tract – conveys spinovisual reflexes
Spinoreticular tracts – conveys deep and chronic pain
Spino-olivary tract – conveys info to cerebellum from
cutaneous & proprioceptive organs
Main descending motor tracts: [1]
Lateral corticospinal - fine motor function
Anterior corticospinal – gross and postural motor
function
Lateral and medial vestibulospinal - medial
vestibulospinal (positioning of head and neck); lateral
and medial vestibulospinal (posture and balance)
Lateral and medial reticulospinal - (posture, balance,
automatic gait-related movements)
Rubrospinal tracts - (movement of limbs)
Tectospinal tract – Reflex head turning
Descending autonomic tracts - ANS (fight/flight
response)
Signs and Symptoms [1][3][4]
Anterior cord syndrome
MOI: Hyperflexion
Affected tracts: Spinothalamic & Corticopinal tract
Damage is mainly in the anterior cord resulting in loss of
motor function, pain and temperature with preservation
of light touch, proprioception and vibration sense
Brown Sequard Syndrome
MOI: GSW or stab wounds; flexion rotation forces
Affected tracts: Dorsal column, spinothalamic, lateral
corticopinal tract
Hemisection of the spinal cord
Ipsilateral weakness and loss of position and vibration
sense below the level of the lesion, with contralateral
Pathophysiology [10] [8] loss of pain and temperature a few segments below the
level of the lesion
Spinal cord injury (SCI), as with acute stroke, is a
dynamic process. In all acute cord syndromes, the full Central cord syndrome “Walking SCI’
extent of injury may not be apparent initially. Incomplete MOI: Hyper extension injuries
cord lesions may evolve into more complete lesions. Loss of more centrally located cervical tracts/ arm
More commonly, the injury level rises 1 or 2 spinal function, with preservation of more peripherally located
levels during the hours to days after the initial event. lumbar and sacral tracts/ leg function; early loss of pain
A complex cascade of pathophysiologic events related to and temperature
free radicals, vasogenic edema, and altered blood flow UE > LE
accounts for this clinical deterioration. Normal Motor > Sensory
oxygenation, perfusion, and acid-base balance are
required to prevent worsening of the spinal cord injury.
Cauda Equina
