Lesions of the Spinal Cord

Surgery, Orthopaedic

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Lesions of the Spinal Cord
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Spinal Injury
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Brown-Sequard Lesion and Spinal Stenosis
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Spina Bifida
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Regional Survey

Lecture´s Description

The three major pathways in the spinal cord are the corticospinal tracts (in the anterior columns) carrying motor neurons, the spinothalamic tracts carrying sensory neurons for pain, touch and temperature, and the posterior (dorsal) column tracts serving deep sensibility (joint position and vibration). True lesions of the spinal cord present with a UMN spastic paresis and often a fairly precise sensory level that suggests the level of cord involvement.

Several ‘classical’ patterns are recognized. Cervical cord compression (The patient typically presents with UMN symptoms in the lower limbs and LMN signs in the upper limbs). Thoracic cord compression (This typically presents as a UMN paralysis affecting the lower limbs). Lumbar cord compression (The spinal cord terminates around the level of L1 so compression here may involve the conus medullaris or the cauda equina or both, giving a mixture of UMN and LMN signs). Brown-Séquard lesion (The pure form of this syndrome is very unusual but less pure forms are common and serve as a reminder that careful assessment of the neurological symptoms and signs is important in helping the clinician to localize the pathology and understand its aetiology).

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