Types of Spinal Cord Injuries

Anterior Cord syndrome

• Hyperflexion injury

  • Loss of pain and temperature sensation

  • Loss of motor function

Central cord syndrome

• Hyperextension

  • Loss of motor and sensory function

    • affects UE > LE

    • affects motor > sensory

  • Tracts affected

    • spinothalamic

    • corticospinal

    • dorsal column

Brown- Sequard syndrome

• stab wound/ gunshot

  • C/L loss of pain and temperature sensation

  • I/L loss of vibration, position sense, and motor function (paralysis)

Cauda Equina syndrome

• Injury below L1

  • peripheral nerve injury

  • Flaccidity

  • Areflexia

  • Bowel and bladder dysfunction

Posterior cord syndrome (sensory)

• compression of posterior spinal artery

  • Loss of vibration, proprioception, 2-point discrimination, sternogenisis

  • Motor function is perserved

C1-C2

• Respiratory m.

  • Cervical spondylotic myelopathy

  • upper trap

  • Cervical extensors

• Tx

  • Ventilator or phrenic nerve stimulator

• W/C use

  • Power wheelchair

C3-C4

• Respiratory m.

  • Partial diaphragm

  • Scalenes

  • Levator scapulae

• Tx

  • Ventilator in acute phase can be weaned off

• W/C

  • Power wheelchair

C5

• Other muscles

  • Biceps, Brachioradialis, Brachialis

  • Infraspinatus, rhomboids, deltoids, supinators

• Tx

  • Ventilator in acute phase can be weaned off

• W/C

  • Manual w/c with plastic coated handrims and extensions

  • Power w/c for long distances

  • Drive with adaptive equipment

C6

• Muscles

  • Pec major, ECR, Teres Minor, SA, LD, Infraspinatus, pronator

  • Tenodesis

• Tx

  • Assisted coughing

• W/C

  • Manual w/c with plastic coated handrims and extensions

  • power w/c for long distances, slide board transfer

  • Drive with adaptive equipment

C7

• Muscles

  • FCR, EPB, EPL, Extrinsic finger ext, triceps

• Tx

  • Assisted coughing

• W/C

  • independent in home and community w/c w/ plastic coated handrims

  • independent, no slide board transfer

  • Drive with adaptive equipment , w/c in/ out

C8

• Muscles

  • FCU, FPL, extrinsic & intrinsic finger flowers

• Tx

  • Assisted coughing

• W/C

  • Can transfer from floor to chair

  • Manual, standard handrims for home, friction for community

  • Independent u/down curbs

T1-T5

• Muscles

  • intercostals, spinalis, and semispinalis

• Tx

  • Functional cough

• W/C

  • manual w/c

  • independent ramps, curbs, uneven surfaces, standing parapodium, HKAFO

T6-12

• Muscles

  • intercostals, spinalis, and semispinalis, abdominals T7 and below

• Tx

  • Functional cough

• W/C

  • manual w/c

  • independent ramps, curbs, uneven surfaces, standing parapodium, HKAFO

L1, L2, L3

• Muscles

  • Gracilis, iliopsoas, QL, RF, sartorius

• w/c

  • used for energy conservation

• L1- HKAFO

• L2- KAFO

• L3- AFO and can walk short distances at home

L4, L5, S1, S2

• Muscles

  • L4- Tibialis anterior

  • L5- Extensor digitorum

  • S1- Plantar flexors

  • S2- Hamstrings

• L4- AFO

• L5- AFO

• S1- AFO

Spastic bladder (neurogenic)

• injury above S2 sacral segment

• Bladder contracts and reflexively empties in response to certain level of filling

  • Reflex action is present

• Frequent urination, sudden and intense urges (urge incontinence), and unpredictable leaking

Flaccid bladder (autonomous)

• Seen in injury at or below S2 sacral segment

• No reflex action is present

• Inability to feel when the bladder is full, overflow incontinence (where the bladder gets overly full, stretches, and dribbles/leaks), and an inability to empty completely