S1

d

S2

Spinal Cord Trauma

T12

L1

L5

S1

Coc

T12

L1

L5

S1

Coc

T12

L1

L5

S1

Coc

Spinal Cord Trauma

Epiconus syndrome

Cauda equina syndrome

peroneal n.

femoral n.

sciatic n. dissociated sensory deficit (in some cases)

“pudendal plexus”

Conus medullaris syndrome

() femoral n.

sciatic n.

“pudendal plexus”

( )

145

7

Diseases of the Spinal Cord

Traumatic spinal cord lesions are usually due to fractures and dislocations of the spine causing displacement of fragments of bone and/or intervertebral disk. The spinal cord can also be compressed by a traumatic hemorrhage in the spinal canal or sustain direct traumatic compression in the absence of a fracture. The clinical signs of spinal cord trauma depend on the level and severity of the lesion, as shown schematically in Fig. 7.3.

Like traumatic brain injury, spinal cord trauma can be classified by severity:

Spinal concussion. Immediately after blunt trauma to the trunk, a more or less complete spinal cord transec-

tion syndrome arises, usually at a cervical or thoracic level. The neurological deficits regress completely within minutes.

Spinal contusion. The traumatic event has caused extensive structural damage and compression of the spinal cord, usually with hemorrhage. There is a partial or complete spinal cord transection syndrome (depending on the extent of the lesion), including bladder dysfunction (p. 142) and an initially flaccid paraparesis (paraplegia) or quadriparesis (quadriplegia) (phase of spinal shock, diaschisis). The transection syndrome usually improves no more than partially, if at all.

If a spinal cord contusion is very extensive, the associated cord edema and/or hemorrhage may secondarily lead to compression of the affected segments of the