- The spinal cord is connected to the brain and is about the diameter of a human finger.
- It descends down the middle of the back.
- Protected by the bony vertebral column.
- Surrounded by CSF
- Consists of millions of nerve fibers
M
S
Spinal Nerves
- C1-C7
- supply movement and feelings to the arms, neck and the upper trunk.
-
- Control breathing
Thoracic nerves
(Nerves in the upper back)
- T1-T12
- Supply the trunk and abdomen
(nerves in the lower back)
- S1-S5
- Supply the legs, bladder, bowel and sexual organs
Draining the syrinx
(shunt)
- Using a catheter, drainage tubes, and valves.
- Used for both communicating and non-communicating forms.
- Halt the progression of symptoms and relieve pain
- It can cause injury to SC, infection, blockage or hemorrhage.
- Left as last resort.
Trauma-related syringomyelia
- Surgical approach is to operate at the level of initial inury.
- Expand the space around the SC.
- Decrease fluid volume.
- This is done by removing the scar tissue and adding a patch to expand the dura.
- A disorder in which a cyst (syrinx) forms within the spinal cord.
- Syrinx expands and elongates over time.
- As a syrinx widens it compresses and injures nerve fibers.
Tumor-related syringomyelia
- Lower motor neurons of the AHCs are damgaed.
- Muscle wasting and weakness begins in the hands and then forearms and shoulders.
- Tendon reflexes are lost.
- Respiratory muscle involvement
- Syrinx extends into the medulla of the brainstem.
- The cranial nerves become affected:
- Trigeminal nerve.
- Vestibulocochlear nerve.
- Facial, palatal and laryngeal nerve palsy.
- Hypoglossal nerve.
- Most serious form.
- Cerebellum and brain stem herniate, through the foramen magnum and into the spinal cord.
- Part of the 4th ventricle may also protrude into the spinal cord.
- Rarely can enter an occipital encephalocele.
- The covering of brain/spinal cord can protrude through an abnormal opening in the back of the skull.
- Causes severe neurological defects.
Type III
- Extension of cerebellar tonsils into the foramen magnum.
- Does not involve the brain stem
- May not cause symptoms
- Most common form.
- First noticed in adolescence/ adulthood.
- Can be acquired.
- Cerebellar hypoplasia.
- Rare form
- Cerebellar tonsils are in a normal position.
- Parts of cerebellum are missing.
- Portions of the skull and SC may be visible.
- Begins between the ages 25-40
- Worsen with straining.
- Extension of both cerebellar and brain stem tissue into the foramen magnum.
- Cerebellar vermis may be partially complete/ abscent.
- Usually accompanied by a myelomeningocele
Type II
Arnold-chiari malformation
- Pain and temperature sensation are lost.
- One side may be affected more than the other.
- Dysaesthesia is common.
- Light touch, vibration and position senses in the feet are affected.
(Communicating syringomyelia)
- Appear months/years later.
- Primary symptom is pain
- May occur on one or both sides of the body.
- Can affect sweating, sexual function, and, later bladder and bowel control.
- Complication of trauma.
- Meningitis.
- Hemorrhage.
- Tumor.
- Arachnoiditis.
Non communicating syringomyelia
Ascending and descending tracts
- Blow to the spine that fractures, dislocates or crushes one or more of the vertebrae.
- Damage may occur over days or weeks because of bleeding, swelling, inflammation or accumulation in or around the spinal cord
- Arthritis, cancer, inflammation, infections or disc degeneration of the spine.
- Disruption of nerve pathways.
- Demyelination, or destruction of the protective insulation surrounding the axons.
- Ruptured or herniated disks
- Results from injury to one side of the spinal cord
- Spinal cord is damaged, but not severed completely
- Injury to the spine in the region of neck or back mainly by puncture wound that damages the spine and causes symptoms to appear due to lesion of:
- UMN pathway of the corticospinal tract
- One or both dorsal columns
- Spinothalamic tract
- Directed at the pathology causing the paralysis:
- Gunshot/ knife wound treat life threatening conditions.
- Spinal fracture identified and treated appropriately.
- Steroid to decrease cord swelling and inflammation.
Complete Transection
- Damage of nerves inside the vertebral column
- Paralysis
Causes
Trauma
- 1. RTA (44%)
- 2. violence (24%)
- 3. falls (22%)
- 4. sports (8%)
Pathophysiology
Medication
Ongoing
Rehablitation
2ry Injury
1ry Injury
Treatment
Symtoms
Emergency=Immobilization
- Response to 1ry Injury
- Starts minutes after initial injury
- Can last for weeks
- Target for therapeutic intervention
- Acute compression
- Laceration
- Distraction
methylprednisolone
Protective Mechanisms
Cascade of Cellular Events
1. Maintaining ability to breathe
2. Preventing shock
4. Avoidstool or urine retention, respiratory or cardiovascular difficulty and formation of deep vein blood clots in the extremities
5. Sedation might be administered
Acute Treatment
Diagnostic Techniques
Rule Out
Diagnosis
Anterior Cord Syndrome
It is due to vascular region at the anterior spinal artery
Complete motor defects below the lesion
Intensity of sensory deficits is due to the level of involvement in the spinal cord
Spinal cord injuries
Lateral cord syndrome
Treatment
It takes place due to compression of the nerve
Symptoms are pain, numbness or tingling in the back and legs
It can takes place without spinal stenosis
- Anterior cord syndrome
- Lateral cord syndrome
- Posterior cord syndrome
- central cord syndromre
Intitial treatment is high dose steroid called methylpredinosolone
Different types of treatment are then used later on as physiotherapy sessions
In some cases surgical operations are required
Central cord syndrome
White matter injury of the spinal cord
Disproportionate motor weakness in the upper extremeties
Variable amount of sensory loss below the level of injury
Antiedema treatment in the first 24 hours
Posterior cord syndrome
Infarction in the posterior spinal artery
Neurological symptoms are progressed and hypoventilation coma is developed
Diagnosed by MRI or angiography