Spinal Cord Syndromes

00:01 Thanks for joining me on this discussion of spinal cord syndromes in the section of neurosurgery.

00:07 Remember, spinal cords can be a little confusing, but they’re incredibly high-yield information for examinations.

00:13 And frankly, they’re kind of fun to talk about.

00:16 Let’s begin.

00:17 We can’t talk about spinal cord syndromes unless we have a basic understanding of the important spinal columns.

00:24 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.

00:35 Focus on the green areas for now.

00:37 In the dorsal space or the back of the spinal canal is a dorsal column.

00:42 It’s important for sensory and ascending pathways.

00:46 And the anterolateral system is also important for sensory and ascending pathways.

00:51 Now, take a look at the pyramidal tracts on the left side of the screen.

00:55 We’ll go over each of these individually.

00:58 First, let's start with the corticospinal tracts.

01:01 You may get confused with some of the nomenclature.

01:03 Not to worry.

01:04 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.

01:13 Under the pyramidal tracts are the very important motor and descending pathways called the corticospinal tracts.

01:20 It's highlighted here in the circle.

01:23 The corticospinal tracts are very important for motor function.

01:27 That motor function is, of course, at the level below where it inserts.

01:33 Next, let's visit the dorsal columns.

01:36 The dorsal columns are part of the sensory and ascending pathways and controls proprioception and fine touch.

01:48 Lastly, the spinothalamic pathway.

01:51 The spinothalamic pathway is part of the anterolateral system, highlighted here in the circle.

01:57 The spinothalamic pathway is very important for pain and temperature sensation and also carries the crude touch.

02:05 Now, let’s repeat.

02:07 Again, corticospinal tracts are part of the pyramidal tracts and are responsible for motor function.

02:13 Next, dorsal columns are important for proprioception and fine touch.

02:19 And lastly, the anterolateral system, including the spinothalamic pathway, is important for pain and temperature.

02:28 This becomes very important, particularly when we start talking about the incomplete spinal syndromes.

02:33 Here we go.

02:35 First, Brown-Séquard syndrome.

02:36 Then anterior cord syndrome.

02:40 And last, central cord syndrome.

02:43 We’re going to discuss all of these and findings that are classic for these incomplete cord syndromes.

02:49 You'll probably want to look at these slides several times to commit them to memory.

02:55 Let's begin with Brown-Séquard syndrome.

02:58 Brown-Séquard syndrome is due to a hemi-transection of the spinal cord.

03:02 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.

03:12 The findings include ipsilateral upper motor neuron paralysis and loss of proprioception, as well as contralateral loss of pain and temperature sensation.

03:20 The reason for this is because the spinothalamic tract crosses.

03:23 There can also be ipsilateral Lower Motor Neuron Lesion signs at the level of the lesion due to injury of the Anterior horn cells.

03:32 Next, let's visit the anterior cord syndromes.

03:36 The anterior cord syndromes, as the name implies, involves ischemia or injury to the anterior cords.

03:43 So, the dorsal column is spared.

03:45 Remember, dorsal column is important for proprioception and fine touch, which is preserved.

03:52 Anterior cord syndrome is injury to the spinothalamic tract.

03:56 Remember, it's part of the sensory and afferent pathway.

04:01 This results in ipsilateral loss of motor pain and temperature sensation.

04:05 Recall, due to the distribution of the anterior cord syndrome, sometimes a corticospinal tract is also involved, thus explaining the loss of motor.

04:16 Lastly, we want to talk about central cord syndrome.

04:21 Central cord syndrome usually occurs in elderly patients, particularly in trauma with cervical spine injury.

04:29 Central cord syndrome, usually in elderly patients because they may have pre-existing cervical stenosis.

04:36 It is classified as a hyperextension injury.

04:40 And the neurological exam shows preferential sparing of the lower extremities and weakness in the upper extremity.

04:48 Remember, though, there's actually varying degrees of sensory loss.

04:51 It's not a very reliable exam for the central cord syndrome.