63. Spinal cord injuries · Neurology · MU Plovdiv

Traumatic Injuries of the Spinal Cord

Majority of cases caused by sudden a d irreversible damage of the spinal cord and accompanying roots
Most frequent cause of paraplegia in developed countries

Spinal cord lesion most often is a result of traumatic luxation, lystesis or fracture of the vertebrae
Highest injury rate seen in transitional spine areas i.e. cervico-thoracic and thoraco-lumbar, which are also the most flexible
Another mechanism of damage can be a sudden, strong hyperflexion, hyperextension or rotation of the cervical segment of the spine. This trauma is known as whiplash injury

Transient clinical symptoms
Most often spinal shock develops, accompanied by short period of unconsciousness, provided trauma is in cervical segment
Temporary, reversible flaccid paralysis of the limbs with areflexia and hypesthesia below trauma level, pelvic reservoir disorders appear etc.
Gradual improvement in condition, neurological symptomatology relieves or disappears within a few days

Characterised by foci of traumatic necrosis, petechial or larger haemorrhaged and edema. The spinal cord contusion is combined with fracture, luxation, or lystesis of the adjacent vertebra
Clinical picture initially that of spinal shock with development of flaccid plegia or quadriplegia below level of trauma, areflexia, full anaesthesia and abnormality of the pelvic reservoir functions
In high cervical contusion, patients my die in acute stage due to spinal shock and brain edema, which involves medulla oblongata and causes severe bulbar syndrome
Spinal shock stage is followed by development of syndrome of spinal cord automatism. Its clinical features depend on level of lesion and are illustrated mostly by central para- quariparesis, para-hypesthesia, bladder automatism and rapid onset of decubituses due to trophic changes.
After few weeks partial recovery is observed, which depends on severity of trauma.
In severe spinal cord contusions there are definitive residual spastic para or quadriparesis, para-hypesthesia, pelvic reservoir disorders

Forms within several hours following trauma and reveals a picyure of progressive compressive transverse lesion damage of spinal cord, with development of lower paraplegia, para-anaesthesia and pelvic reservoir disorders
Often at onset there is bilateral radicular pain, provoked by compression of spinal cord roots by the hematoma

Develops slower- from several days to weeks
Generally good state of the patient, appear a gradually developed medullar compression syndrome
Prognosis is favourable if surgical treatment undertaken in a timely manner