Complete spinal cord transection syndrome

Background

Spinal cord tracts

Clinical Features

• Higher lesions are associated with spinal shock and autonomic dysfunction
• Priapism implies a complete injury
• Sacral sparing excludes complete transection
  • Can only be assessed AFTER spinal shock has ended, ie after return or bulbocavernosus/cremasteric reflexes
  • Sacral sparing manifests as intact great toe flexor function, perianal sensation, rectal motor function

Differential Diagnosis

Spinal Cord Syndromes

• Complete spinal cord transection syndrome
• Anterior cord syndrome
• Central cord syndrome
• Brown-Sequard syndrome
• Epidural compression syndromes
  • Syringomyelia
  • Spinal cord compression (non-traumatic)
  • Cauda equina syndrome
  • Conus medullaris syndrome
  • Epidural abscess (spinal)
  • Epidural hematoma (spinal)

Management

• Consider intubation injuries at C5 or above
• Consider surgical intervention for:
  • Progressive neurologic deficits
  • Unstable spine fractures
• Steroids are no longer recommended
  • Administration of methylprednisolone (MP) for the treatment of acute spinal cord injury (SCI) is not recommended. Clinicians considering MP therapy should bear in mind that the drug is not Food and Drug Administration (FDA) approved for this application. There is no Class I or Class II medical evidence supporting the clinical benefit of MP in the treatment of acute SCI. Scattered reports of Class III evidence claim inconsistent effects likely related to random chance or selection bias. However, Class I, II, and III evidence exists that high-dose steroids are associated with harmful side effects including death.
  • See EBQ:High Dose Steroids in Cord Injury for further discussion

See Also

• Spinal cord trauma

References

Authors

Ross Donaldson, Claire, Daniel Ostermayer, Neil Young