Causes and Syndromes of Spinal Cord Injury:
Injuries to the cervical spine constitute uncommon but nonetheless devastating occurrences to those participating in athletic events. These injuries happen primarily to athletes involved in the contact sports of football, wrestling, and ice hockey, with football injuries constituting the largest number of cases. The important work of Schneider in the mid 1960s, focusing on football-related head and neck injuries, resulted in a significant reduction in the incidence of these accidents owing to improvements in equipment, education in proper techniques, offseason conditioning, and rule changes.
Causes and Mechanisms of Spinal Cord Injury
- The mechanism of spinal cord injury can be sport related, but it is more commonly independent of the sport.
- The major mechanism of serious cervical injury is an axial load, or a large compressive force applied to the top of the head.
- This mechanism is more dangerous when the neck is slightly flexed, because the spine is brought out of its normal lordotic alignment, which does not allow for proper distribution of force to the thorax.
- Flexion puts the cervical spine in a straight line; thus, the musculature cannot assist in absorbing the force.
- Torget al indicated that injury occurs to the cervical spine when it is compressed between the body and the rapidly decelerating head.
- When a fracture results, if the bone fragments or herniated disc materials encroach on the spinal cord, neurologic damage will occur.
- This mechanism is the primary cause of cervical fracture, dislocation, and quadriplegia.
Syndromes of Spinal Cord Injury
Spinal trauma may result in a variety of clinical syndromes, according to the type and severity of the impact and bony displacement as well as the subsequent secondary insults such as:
Complete spinal cord injury is a transverse myelopathy with total loss of spinal function below the level of the lesion. This insult is caused by either anatomic disruption of the spinal cord or, more commonly, hemorrhagic or ischemic damage at the site of injury. Although the spinal cord usually remains in continuity, a physiologic block to impulse transmission results in the complete injury. Complete injury patterns are rarely reversible, although with long-term follow-up, improvement of 1 spinal level may be seen when the initial segmental traumatic spinal cord swelling resolves.
- Several patterns of incomplete spinal cord injury are common, usually produced on a vascular basis.
- The central cord syndrome causes incomplete loss of motor function with a disproportionate weakness of the upper extremities as compared with the lower extremities.
- This condition is thought to be the result of hemorrhagic and ischemic injury to the corticospinal tracts because of their somatotopic arrangement.
Fibers of cervical nerves that innervate the upper extremities are arranged more medially than those subserving function to the lower extremities. The originally described central cord syndrome also includes nonspecific sensory loss and bladder and sexual dysfunction. This injury pattern is also often seen in older patients with vertebral osteophytes and in those with hyper-extension injuries.
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