- See:
Sacral Sparing:
- Definition:
-
complete cord injury implies unequivocal absence of motor or sensory function distal to injury
in absence of
spinal shock;
- w/ complete injuries, an improvement of one nerve root level can be expected in 80% of
patients, and approximately 20% will recover 2 additional function levels;
- there is also evidence that operative decompression can also allow recovery of an additional nerve root level;
-
incomplete lesion:
- present when there is any distal sparing of motor or sensory function along with
sparing of perirectal sensation;
- Discussion:
- dx of complete vs incomplete spinal cord injury cannot be made until the patient is out of spinal shock;
- return of
bulbocavernosus reflex has less prognostic significance in an incomplete cord lesion (redisdual distal
motor function or sacral sparing), and therefore, the extent of neurologic injury remains unknown;
- patients w/ incomplete lesions have the potential to regain significant fuction;
- trauma to cervical spine causing complete injury of the spinal cord often encompasses the nerve root
in the foramen between dislocated or fractured vertebrae;
- root originates from normal cord proximal to the injured cord but suffers a peripheral nerve injury;
- function of this root at level of injury is expected to return within 6 months;
- progressive muscle return and strengthening in upper extermities is due to nerve root return and must not
be mistaken for evidence of return of spinal function;
-
spinal shock (spinal cord concussion):
- usually invovles 24-72 hour period of paralysis, hypotonia, & areflexia, and
at its conclusion there may be hyperreflexia, hypertonicity, and clonus;
- return of reflex activity below level of injury indicates end of spinal shock;
-
sacral sparing:
-
diff dx of incomplete lesions:
-
central cord syndrome:
-
brown sequard syndrome
-
anterior cord syndrome
- posterior cord syndrome
- isolated nerve root injury
-
cauda equina syndrome (w/ or w/o root escape)
- conus medullaris injury (w/ or w/o root escape)
-
functional & quantitative criteria:
- naming of cord injury level by distal-most level w/ fully normal f(x) has become widely accepted;
-
Frankel scale:
- most widely used system for evaluation of functional recovery is Frankel scale, which consists
of five grades (A-E), based on motor and sensory deficits;
A
complete paralysis
B
sensory function only below the injury level
C
incomplete motor function below injury level
D
fair to good motor function below injury level
E
normal function
- Management:
-
management of the spine injured patient:
-
steroid protocol:
- note that steroids should only be given when all of the strict guidelines for infusion are met;
Incomplete traumatic quadriplegia: A ten year review.
A. Bosh et al.
JAMA. Vol 216. 1971. p 473-478.
Diagnosis and prognosis of acute cervical spine cord injury.
ES Stauffer.
CORR. Vol 112. 1975. p 9-15.
