With a complete spinal cord injury, the patient will develop complete motor and sensory loss below the level of the injury—no sacral sparing. There will be no motor or sensory below the level of the lesion after the disappearance of the spinal shock and the return of the bulbocavernosus reflex. The physician will be unable to differentiate between a complete and incomplete injury during spinal shock. Spinal shock typically lasts 24-72 hours and consists of hypotension and bradycardia.
With a complete injury, one cervical nerve root could recover in 80%.Two nerve roots may recover in some patients. Always check for sacral sparing! Preservation of any sensory or motor function indicates an incomplete lesion. The most important prognostic factor for recovery is the severity of the neurological deficit.
Central Cord Syndrome is caused by a hyperextension injury. This particular injury has a favorable prognosis, but poor recovery of the hand function. The lesion occurs in the central part of the spinal cord and the grey matter. This injury can be caused by minimal trauma in the elderly, usually caused by osteophytes. The spinal cord will become compressed between the ligamentum flavum and the intervertebral disc or a bony spur. The injury causes an upper motor neuron lesion in the lower extremity and a lower motor neuron lesion in the upper extremity. Motor weakness is more severe in the upper extremities compared to the lower extremities.
With Anterior Cord Syndrome, there will be a complete motor paralysis and impairment of the sensory functions. The damage occurs in the anterior part of the spinal cord due to vascular insufficiency or mechanical compression, such as from a bony spur or fracture. Anterior Cord Syndrome has the worst prognosis. With this type of injury, the corticospinal tract is affected and there is a very low chance of motor recovery (only 15% will show functional recovery). Anterior cord syndrome is usually a result of a flexion/compression injury. Damage to the spinal cord is usually in the anterior two-thirds of the cord. The lower extremities are effected more than the upper extremities. The posterior column is spared with position, proprioception, and sense of vibration not being affected. This injury is different from Central Cord Syndrome as central cord syndrome is caused by a hyperextension injury.
Brown-Sequard Syndrome has the best prognosis with a 90% chance of recovery. It is caused by hemisection of the spinal cord, usually due to penetrating trauma. There will be ipsilateral deficit of the motor function, proprioception, vibration, and deep touch. There is contralateral loss of pain and temperature, and the spinothalamic tract crosses at the spinal cord.
Posterior Cord Syndrome is very rare and is associated with loss of proprioception, deep touch, and vibration. The motor, pain, temperature, and light touch is preserved.
