SPINAL CORD DISORDERS

Spinal cord anatomy:
■ Corticospinal tract: Motor pathway; fibers cross in medulla then descend
in cord.
■ Spinathalamic tract: Pain and temperature pathway; fibers first cross, then
ascend in cord.
■ Posterior (dorsal) columns: Vibration and proprioceptive pathway; fibers
ascend in ipsilateral posterior column to medulla, then cross.
■ Cauda equina: Lumbar and sacral nerve roots
CAUSES
Causes of spinal cord dysfunction include:
■ Trauma
■ Multiple sclerosis
■ Transverse myelitis
■ Spinal AVM or hemorrhage
■ Compression from tumor, disc, epidural abscess, or hematoma
■ Syringomyelia
■ Myelopathy (eg, HIV)
■ Infarction
SYMPTOMS/EXAM
■ Patients present with motor and sensory deficits depending on location of
injury.
■ Scoring motor function
■ 5 = Full strength
■ 4 = Able to resist, but weak

■ 3 = Able to move against gravity
■ 2 = Able to move when gravity eliminated
■ 1 = Muscle fires, but no movement is generated
■ 0 = No muscle firing
■ Scoring reflexes
■ 0 to 4 scale with 2 being normal (0 = no reflexes, 4 = hyperactive
reflexes with clonus)
■ Complete injury results in complete loss of motor, sensory, and autonomic
function below level of injury.
■ Partial injury often presents as a spinal cord syndrome 

DIAGNOSIS
■ MRI is imaging of choice to evaluate for compression or mass lesion.
■ Lumbar puncture is indicated to further define a suspected inflammatory
or demyelinating process.