This document discusses spinal cord injuries, their classification and effects. It describes the following types of spinal cord injury: concussion, contusion, compression, laceration, hemorrhage and transection. Complete transection results in loss of all sensations and motor functions below the level of injury, causing tetraplegia or paraplegia. Incomplete injuries can cause central cord syndrome, anterior cord syndrome, posterior cord syndrome or Brown-Sequard syndrome. Brown-Sequard syndrome is caused by incomplete transection on one side and results in ipsilateral sensory and motor loss and contralateral loss of pain and temperature sensation.

1. Dr.K.Jaiganesh, MD
Professor of Physiology
MGMCRI

2. Objectives
1. Complete transection of spinal cord
2. Incomplete transection of spinal cord

3. Spinal Cord Injuries
Causes (in order of frequency)
Motor Vehicle Accidents
Gunshot wounds/acts of violence
Falls
Sports injuries

4. Classification of SCI
1. Flexion: Head is suddenly &
forcefully accelerated forward
causing extreme flexion of the
neck “Kiss the Chest

5. Classification of SCI
2. Hyperextension
Automobile accidents

6. Classification of SCI
3. Vertical compression
Blow to the top of the head
Often begins with a sudden,
traumatic force

7. Classification of SCI
4. Excessive Rotation (either
flexion- or extension-rotation)

8. Classification of SCI
5. Penetrating injuries

9. Types of Cord Injury
1. Concussion
Similar to cerebral concussion
Temporary and transient disruption of cord function
2. Contusion
Bruising of the cord
Tissue damage, vascular leakage, and swelling
3. Compression - Secondary to:
Displacement of the vertebrae
Herniation of inter vertebral disk
Displacement of vertebral bone fragment
Swelling from adjacent tissue
4. Laceration
Direct damage to cord with associated bleeding, swelling and
potential disruption of cord
5. Hemorrhage
Associated with contusion, laceration, or stretching
6. Transection
Partial or complete severing of cord

10. Common sites of Spinal Injury
C-1/C-2: Delicate vertebrae
C-7: Transition from flexible cervical
spine to thorax
T-12/L-1: Different flexibility between
thoracic and lumbar regions

11. Complete spinal cord injury
Most severe form of injury
All sensations & motor functions
will be lost beneath the level of the
injury
Depend on the level of the injury!
Tetraplegia (formerly quadriplegia)
occurs with C-1 to C-8 injuries.
Paraplegia occurs with T-1 to L-4

12. Complete Cord Transection

13. Complete spinal cord injury
Stages
1. Stage of spinal shock
2. Stage of reflex activity
3. Stage of reflex failure
Spinal shock:
Begins within hour of injury &
Lasts from few minutes up to several months &
Ends with return of reflex activity: Hyper
reflexia, Muscle spasticity, Reflex bladder
emptying.

14. Reflex activity

15. Stage of spinal shock
1.Spinal Shock - Temporary loss of reflex function (a reflexia) below level of
injury beginning immediately after complete transection of spinal cord
Temporary insult to the cord
Affects body below the level of injury
Cramp like pains at the level of lesion
Loss of all sensations below the lesion
Muscles are paralyzed
Muscle tone is lost
Reflexes are lost
Bladder & the rectum are paralyzed
Sphincters paralyzed but recover their activity faster
Vasomotor tone lost, so BP falls
Skin becomes cold & blue- bed sores may develop

16. Effects of section at various levels
At C1 segment level
Quadriplegia
Maximum fall in BP
Anaesthesia
Paralysis of respiratory muscles
Death
At C5 segment level
Quadriplegia
Maximum fall in BP
Anaesthesia below the lesion
Diaphragm is not paralysed. So,
respiration is maintained
Horner’s syndrome develops

17. Effects of section at various levels
At C8
Miosis
No sweating on the face and the neck
Ptosis due to paralysis of the Muller’s
muscle
Enophthalmos
Loss of ciliospinal reflex – (stimulation
of skin over the neck produces reflex
dilatation of the pupil)
Other features remain the same
At upper thoracic level
Paraplegia
Maximum fall in BP
Anaesthesia below the lesion
No Horner’s syndrome

18. Effects of section at various levels
At lower thoracic level
BP fall is less
Other features remain the same
At or below 2nd lumbar
Minimum or no fall in BP
Paraplegia
Anaesthesia below the lesion
Other features remain the same

19. Site Sensory Motor BP RS Other
C1 Anaesthesia Quadriplegia Max Fall Paralysis
of RS
muscles
Death
C5 Anaesthesia
below
Quadriplegia Max Fall No Horner‘s
develops
C8 SAME Full
Horner‘s
Upper
Thoracic
Anaesthesia
below
Paraplegia Max fall No
Horner”s
Lower
thoracic
SAME Less BP
fall
At or
below II
lumbar
SAME No BP fall

20. Stage of reflex activity
Sensations remain lost
Voluntary movements absent
Skeletal muscle tone increases in flexors first then in
extensors
Functional activity of smooth muscle returns
Reflexes appear – Babinski reflex positive
Micturition & Defaecation reflex reappear
Mass reflex - Stroking the inner thigh – flexor
spasm,contraction of abdominal muscles &
evacuation of bladder
BP increases & skin sweats

21. Stage of reflex failure
Reflexes become functionless
Loss of muscle tone
Muscle wasting (degenerative changes)
General infection – bedsores, UTI, sepsis ----Death

22. Incomplete (partial transection)
Mixed loss of voluntary motor
activity and sensation below level of
injury as pathways are only partially
interrupted
Four patterns or syndromes
Central cord syndrome
Anterior cord syndrome
Posterior cord syndrome
Brown-Sequard syndrome

23. Cord Syndrome
Brown-Sequard syndrome
Central cord syndrome
Anterior cord syndrome
Posterior cord syndrome

24. Brown-Sequard’s Syndrome
Incomplete Transection Cord Injury
Brown-Sequard’s Syndrome
Damage to one half of the
cord on either side
Penetrating injury that
affects one side of the cord
Ischemia,infectious or
inflammatory diseases
(tuberculosis,multiple
sclerosis)& spinal cord
tumor
Ipsilateral sensory and
motor loss
Contralateral pain and
temperature sensation loss

25. Brown Sequard Syndrome
Below the level of lesion:
 Impairment of ipsilateral light
touch, proprioception and
vibration (dorsal columns) from
site of lesion, caudally
 Impairment of contralateral pain
and temperature (spinothalamic
tract) below level of lesion
 Impairment of ipsilateral
voluntary movements (UMN type
of paralysis) below level of lesion
 Temporary loss of vasomotor tone

26. Brown Sequard Syndrome
Above the lesion
 Small area of cutaneous hyperaesthesia on the
same side
 No motor involvement on both sides
At the level of lesion
 Complete sensory loss on the same side
 LMN paralysis – same side
 Vasomotor paralysis – same side
 No sensory motor & vasomotor involvement on
the opposite side

28. Brown Sequard’s Syndrome
Site Function Same side Opp. side
Above the level Sensory
Motor
Vasomotor
Normal
Normal
Normal
Normal
Normal
Normal
At the level Sensory
Motor
Vasomotor
Total sensory loss
LMN type palsy
Vaso dilatation
Normal
Normal
Normal
Below the level Sensory
Motor
Vasomotor
Dorsal column lost
UMN type palsy
Vaso dilatation
Spino thalamic lost
Normal
Normal