Thanks for joining me
on this discussion of spinal cord syndromes
in the section of neurosurgery.
Remember, spinal cords can be a little confusing,
but they’re incredibly high-yield
information for examinations.
And frankly, they’re kind of fun to talk about.
We can’t talk about spinal cord syndromes
unless we have a basic understanding
of the important spinal columns.
Here, I'll describe to you three
very important spinal columns,
so that you can understand
when one of them is injured
what the resulting pattern would be.
Focus on the green areas for now.
In the dorsal space or the back
of the spinal canal is a dorsal column.
It’s important for sensory and ascending pathways.
And the anterolateral system is also important
for sensory and ascending pathways.
Now, take a look at the pyramidal tracts
on the left side of the screen.
We’ll go over each of these individually.
First, let's start with the corticospinal tracts.
You may get confused with
some of the nomenclature.
Not to worry.
I’m going to go through these slides one time
and then we’ll repeat it
just to stress to you that
sometimes it can be confusing
and it’s helpful to look at it several times.
Under the pyramidal tracts are the very
important motor and descending pathways
called the corticospinal tracts.
It's highlighted here in the circle.
The corticospinal tracts are very
important for motor function.
That motor function is, of course, at
the level below where it inserts.
Next, let's visit the dorsal columns.
The dorsal columns are part of the
sensory and ascending pathways
and controls proprioception and fine touch.
Lastly, the spinothalamic pathway.
The spinothalamic pathway is
part of the anterolateral system,
highlighted here in the circle.
The spinothalamic pathway is very important
for pain and temperature sensation and also carries the crude touch.
Now, let’s repeat.
Again, corticospinal tracts are
part of the pyramidal tracts
and are responsible for motor function.
Next, dorsal columns are important
for proprioception and fine touch.
And lastly, the anterolateral system,
including the spinothalamic pathway,
is important for pain and temperature.
This becomes very important,
particularly when we start talking
about the incomplete spinal syndromes.
Here we go.
First, Brown-Séquard syndrome.
Then anterior cord syndrome.
And last, central cord syndrome.
We’re going to discuss all of these and findings
that are classic for these incomplete cord syndromes.
You'll probably want to look at these slides
several times to commit them to memory.
Let's begin with Brown-Séquard syndrome.
Brown-Séquard syndrome is due to
a hemi-transection of the spinal cord.
Due to this hemi-transection of the spinal cord,
you can go back to the previous slides
and figure out which of the tracts are affected.
The findings include ipsilateral upper motor neuron paralysis
and loss of proprioception,
as well as contralateral loss of
pain and temperature sensation.
The reason for this is because
the spinothalamic tract crosses.
There can also be ipsilateral Lower Motor Neuron Lesion signs
at the level of the lesion
due to injury of the Anterior horn cells.
Next, let's visit the anterior cord syndromes.
The anterior cord syndromes,
as the name implies,
involves ischemia or injury to the anterior cords.
So, the dorsal column is spared.
Remember, dorsal column is important
for proprioception and fine touch,
which is preserved.
Anterior cord syndrome is
injury to the spinothalamic tract.
Remember, it's part of the
sensory and afferent pathway.
This results in ipsilateral loss of motor
pain and temperature sensation.
Recall, due to the distribution
of the anterior cord syndrome,
sometimes a corticospinal
tract is also involved,
thus explaining the loss of motor.
Lastly, we want to talk about central cord syndrome.
Central cord syndrome
usually occurs in elderly patients,
particularly in trauma
with cervical spine injury.
Central cord syndrome,
usually in elderly patients
because they may have pre-existing cervical stenosis.
It is classified as a hyperextension injury.
And the neurological exam shows
preferential sparing of the lower extremities
and weakness in the upper extremity.
there's actually varying degrees of sensory loss.
It's not a very reliable exam
for the central cord syndrome.