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Cervical spine fractures
Published in Charles M Court-Brown, Margaret M McQueen, Marc F Swiontkowski, David Ring, Susan M Friedman, Andrew D Duckworth, Musculoskeletal Trauma in the Elderly, 2016
Spinal cord injuries are devastating, especially to the elderly where the chance of mortality is greater than 80%. Various spinal cord injury patterns are seen. A complete cord injury is where there is no motor sensory function below the level of injury. Incomplete patterns include anterior cord, Brown-Sequard, central cord and posterior cord syndromes. Anterior cord syndrome causes loss of function of distal motor and pain and temperature functions due to injury of the anterior two-thirds of the spinal cord. Only posterior cord function remains. The prognosis is extremely poor. Brown-Sequard syndrome is a hemi-cord injury where there is ipsilateral loss of motor function and contralateral loss of sensory function. Central cord syndrome is a common injury pattern seen in elderly patients due to pre- existing cervical stenosis. In this syndrome there is greater loss of upper extremity function than lower extremity function. This pattern of neurologic injury is due to the lamination of axonal tracks where the upper extremities are more medial and thus affected to a greater degree in central cord syndrome than the more laterally placed lower extremity tracts. This prognosis is variable and many patients can make a significant recovery. Posterior cord syndrome is rare; there is only loss of dorsal column function and thus light touch, proprioception and vibration.
Fractures of the thoracolumbar spine
Published in Sebastian Dawson-Bowling, Pramod Achan, Timothy Briggs, Manoj Ramachandran, Stephen Key, Daud Chou, Orthopaedic Trauma, 2014
Ghias Bhattee, Reza Mobasheri, Robert Lee
Particular injury patterns are indicative of specific patterns of incomplete injury to the spinal cord in the cervical, thoracic or lumbar spine. These patterns often result from characteristic injury mechanisms. An understanding of the arrangement of the different neurological pathways (see Fig. 6.3) helps to understand these patterns. Anterior cord syndrome – comprises paraplegia and loss of temperature, light touch or pain sensation. Vibration sense and proprioception are preserved. This is a relatively common injury pattern and carries a poor prognosis, especially if there remains no sacral temperature, light touch or pain sensation 24 hours following injury.Posterior cord syndrome – is extremely rare and is characterized by absent proprioception and vibration sense, with preservation of all motor and other sensory modalities.Central cord syndrome – classically follows extension injury to the neck, falling forward and hitting the front of the head against a hard object. There may be no bony injury, although often underlying vertebral osteoarthritis is present. There is relatively greater loss of motor function in the upper (flaccid paralysis) than lower limbs (spastic paralysis), and prognosis is relatively favourable. Sacral sparing is seen. Central cord syndrome is discussed in more detail in Chapter 7.Brown-Séquard syndrome – results from hemicord injury, most commonly following penetrating trauma. The clinical features are a combination of ipsilateral loss of power, vibration sense and proprioception, with contralateral absence of temperature, light touch or pain sensation.
Complications after Spinal Cord Injury
Published in Stephen M. Cohn, Matthew O. Dolich, Complications in Surgery and Trauma, 2014
Michael Y. Wang, Barth A. Green
Specific neurological syndromes have been described for particular partial cord injuries. The anterior cord syndrome is characterized by complete paralysis and hypalgesia (anterior and anterolateral column function) below the level of injury with preservation of position sense, vibration, and light touch (posterior column function). This syndrome occurs most commonly after ischemia in the territory supplied by the anterior spinal artery which supplies the corticospinal and spinothalamic tracts. The central cord syndrome is characterized by motor dysfunction more pronounced in the distal upper extremities accompanied by varying degrees of sensory loss and bladder dysfunction. This injury occurs characteristically following a hyperextension injury in an elderly patient and can be seen in the absence of any clear radiographic disruption of the bones or ligaments. Most patients recover the ability to walk, with partial restoration of upper extremity strength. The posterior cord syndrome is an uncommon presentation where position and vibration are impaired due to injury to the dorsal columns. The Brown–Sequard syndrome, or hemi-section cord syndrome, presents with ipsilateral paresis and loss of proprioception below the level of the lesion and contralateral loss of pain and temperature sensation. This can be the result of penetrating injuries or tumor compression and is usually not seen in a pure form. The conus medullaris syndrome occurs with injuries at the thoracolumbar junction. This syndrome has components of both spinal cord and nerve root injury due to the dense population of lower nerve roots emerging from the caudal end of the spinal cord. Symmetrical lower extremity motor impairment and anesthesia with bowel and bladder dysfunction are typically seen. Recovery from this syndrome is unlikely, unlike the cauda equina syndrome where partial recovery is possible with early decompression. Cauda equina injuries occur at spinal levels below the termination of the cord at L1 or L2.
Posterior cord syndrome associated with postoperative seroma: The case to perform a complete neurologic exam
Published in The Journal of Spinal Cord Medicine, 2020
Meghan Cochrane, Marika Hess, Natalie Sajkowicz
Posterior cord syndrome can result from vascular ischemia to the posterior circulation of the spinal cord, intrinsic cord disease, and external compression by a space-occupying lesion within the posterior spinal canal.5–8 Intraspinal space-occupying conditions, such as extramedullary tumors, spondylosis, and epidural abscess, are reported causes of cord compression; however, a seroma causing a mass effect with cord effacement and compression is exceedingly rare.9,10 Seromas following surgical procedures are well-known conditions that are generally considered benign and self-limiting. The incidence of postoperative seromas is unknown because most patients do not get routine imaging studies. Sterile seromas form as a result of trauma-induced inflammation resulting in increased capillary permeability and leakage in the dead space resulting from the surgical procedure.11 Signs associated with seromas include pain, bulging mass at the incision site, and signs that refer to the dorsal column as described here.12 Cases of seroma accumulation have been attributed to the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) which was not used in this patient.10,13–15 A few cases of seroma formation following multilevel laminectomy without the use of rhBMP-2 have been reported.10,12 In these cases, patients presented with localized pain, without associated neurological symptoms.
Vertebral solitary bone plasmacytoma in a young adult with Trisomy 21: A case report
Published in The Journal of Spinal Cord Medicine, 2020
Nadia Bouattour, Olfa Hdiji, Anis Hachicha, Brahim Kammoun, Salma Sakka, Nouha Farhat, Hanen Hajkacem, Fatma Kolsi, Slim Charfi, Mariem Dammak, Zaher Boudawara, Tahya Boudawara, Chokri Mhiri
A 21-year-old female with Trisomy 21 was admitted to our neurology department with acute weakness and paresthesias in the two lower limbs. No bowel or bladder dysfunction was reported. Neurological examination elicited mild intellectual disability, flaccid paraparesis, posterior cord syndrome identified by loss of proprioceptive sensation and diminished vibration sense in the lower extremities. No sensory level was found. We noted localized lumbar paraspinal muscles contraction with provoked pain in palpation of spinous processes. Cauda equina compression was suspected. A lumbar spine MRI was emergently performed. It showed a tumor mass invading the vertebral body and the posterior arch of the L4 vertebra, associated with invasion of the epidural space extending 55 mm in height. This process invaded almost the entire canal lumen and the cauda equina. The lesion was hypointense on T1 and T2 sequences, and enhanced intensely after injection of Gadolinium contrast (Fig. 1).
Posterior cord syndrome: Demographics and rehabilitation outcomes
Published in The Journal of Spinal Cord Medicine, 2021
William McKinley, Adam Hills, Adam Sima
Posterior cord syndrome has a somewhat rare occurrence which, no doubt, relates to the paucity of PCS outcome-related literature. The incidence of PCS noted in this study (about 2%) is similar to that cited in past studies.2,3 Despite this low occurrence rate, individuals with PCS can have significant functional impairments and SCI-associated medical complications, and often require admission for acute inpatient rehabilitation.