Spinal cord function after injury
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Spinal Cord Function After Injury. spinal cord structure in relation to vertebrae types of lesions fibre tracts in spinal cord sensory loss motor loss reflexes and spinal shock neuropathic pain. Orientation of spinal cord and spinal roots with respect to vertebrae. Posterior.

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Spinal Cord Function After Injury

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Spinal cord function after injury

Spinal Cord Function After Injury

  • spinal cord structure in relation to vertebrae

  • types of lesions

  • fibre tracts in spinal cord

  • sensory loss

  • motor loss

  • reflexes and spinal shock

  • neuropathic pain


Spinal cord function after injury

Orientation of spinal cord and spinal roots with respect to vertebrae

Posterior


Spinal cord function after injury

Collapse of disc space

Disc prolapse

Slippage of vertebra over disc


Spinal cord function after injury

Collapsed vertebra in patient with severe osteoporosis


Spinal cord function after injury

Arrows indicate S3-S4 disc prolapse

Arrow indicates L4-L5 disc prolapse


Spinal cord function after injury

Arrow indicates compression fracture at C5

Arrow indicates fracture-dislocation at C6/C7


Spinal cord function after injury

Head and neck

Diaphragm

Deltiods, Biceps

Wrist extenders

Triceps

Hand

Chest muscles

(T1-T7)

Abdominal muscles

(T7-T12)

Leg muscles

Bowel, bladder

Sexual function


Spinal cord function after injury

Paralysis of the lower half of the body is called paraplegia.

Paralysis of both arms and legs is called quadriplegia (or tetraplegia).


Spinal cord function after injury

Posterior

Sensory fiber tracts

Dorsal columns

Cuneate funiculus

Gracile funiculus

Dorsal root ganglion

Upper

trunk,

arm,

neck,

head

Leg,

Lower

trunk

Touch,

vibration,

pressure,

Proprioception

Aα, Aβ

Pain,

temperature,

crude touch

Aδ, C

Ventrolateral

spinothalamic

Anterior


Spinal cord function after injury

Posterior

Motor fiber tracts

Lateral

corticospinal

anterior

horn cells

for limbs

anterior

horn cells

for trunk

Anterior

horn cells

Medial

corticospinal

Aα motor neuron

Anterior


Spinal cord function after injury

Dorsal columns

dorsal and ventral

horns

Lateral

Corticospinal,

Anterior

horn cells

motor

pain, temperature

vibration,

proprioception,

touch

Ventrolateral

spinothalamic


Spinal cord function after injury

medulla

upper limbs

Aα, Aβ(touch, vib,propriocep)

Aδ, C (pain, temp.)

Aα motor

lower limbs


Examples

Examples

The diagrams that follow indicate the motor and sensory loss as a consequence of one of the following lesions. Identify the lesion in each case and indicate on the spinal cord and spinal cord section the site, level and side of the lesion.

Lesions:

Anterior cord syndrome

Posterior cord syndrome

Central cord syndrome

Transverse cord

Hemicord (Brown-Sequard)


Spinal cord function after injury

Central cord syndrome

(small lesion) – cape distribution

Eg. Spinal cord contusion (bruise

causing bleeding in spinal column),

spinal cord tumors

Anterior cord syndrome

Eg. Trauma, multiple sclerosis,

anterior spinal artery infarct

cervical

T8/T9

Damage to spinothalamic

fibers as cross anterior

commissure


Spinal cord function after injury

Hemicord lesion

Brown-Sequard

Eg. Penetrating injuries,

lateral compression from tumors,

multiple sclerosis

E

D

Transverse cord lesion

Eg. Trauma, tumors,

multiple sclerosis (demyelination)

C

Posterior cord

Syndrome

Eg. Trauma,

extrinsic compression from

posterior tumors,

multiple sclerosis

T8/T9

T8/T9

T8/T9


Signs and symptoms of umn versus lmn lesions

Signs and symptoms of UMN versus LMN lesions

UMN lesionLMN lesion

YesWeaknessYes

No (yes, disuse)AtrophyYes

NoFasciculationsYes

Increased*ReflexesDecreased

Increased*Muscle toneDecreased

*except decreased during spinal shock


Spinal shock

Spinal Shock

  • Initially hyporeflexia (spinal shock) (24hrs up to ~2months)

    Loss of descending excitation (bleeding, oedema, inflammation, cell hypoxia, cell death, demyelination)

  • Followed by return of reflexes

    Denervation hypersensitivity (increased neurotransmitter release, increased responsiveness to neurotransmitter)

  • Followed by hyperreflexia

    Axonal and soma regrowth (neural plasticity) with denervation hypersensitivty


Neuropathic pain

Neuropathic pain

Treat early to prevent wind-up (hyperalgesia)

Drugs: opioids,

antiepileptics (block

Na+ channels),

Tricyclic antidepressants (serotonin and NA reuptake inhibitors)

Surgery: nerve root ablation

Descending inhibition

-

Enkephalin

Opioids

Inhibitory

interneuron

+

Serotonin

NA

Aδ, C

+

Glutamate

SCI → Wind-up

Denervation hypersensitivity,

increased neurotansmitter release,

increased responsiveness to neurotransmitter,

neural plasticity


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