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
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
slide3
Collapse of disc space

Disc prolapse

Slippage of vertebra over disc

slide5
Arrows indicate S3-S4 disc prolapse

Arrow indicates L4-L5 disc prolapse

slide6
Arrow indicates compression fracture at C5

Arrow indicates fracture-dislocation at C6/C7

slide7
Head and neck

Diaphragm

Deltiods, Biceps

Wrist extenders

Triceps

Hand

Chest muscles

(T1-T7)

Abdominal muscles

(T7-T12)

Leg muscles

Bowel, bladder

Sexual function

slide8
Paralysis of the lower half of the body is called paraplegia.

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

slide9
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

slide10
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

slide11
Dorsal columns

dorsal and ventral

horns

Lateral

Corticospinal,

Anterior

horn cells

motor

pain, temperature

vibration,

proprioception,

touch

Ventrolateral

spinothalamic

slide12
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)

slide14
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

slide15
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

Yes Weakness Yes

No (yes, disuse) Atrophy Yes

No Fasciculations Yes

Increased* Reflexes Decreased

Increased* Muscle tone Decreased

*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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