Q 1.26. Spinal Cord Syndromes

Anatomy of the Spinal Cord:

    • The spinal cord is a cylindrical structure approximately 45 cm long and 1 cm wide.
    • It extends from the external margin of the foramen magnum (as a continuation of the medulla oblongata) down to the L2 vertebral level.
    • The spinal cord is entirely housed within the spinal meningeal layers.
    • Notably, there are two enlargements:
      • Cervical enlargement: Corresponds to the brachial plexus and spans from C4/5 to T1.
      • Lumbar enlargement: Associated with the lumbosacral plexus and lies between T11 and L1/2.
    • At L1, the spinal cord transitions into the conus medullaris (medullary cone).
    • The conus medullaris is short and at L2, it gives rise to the cauda equina (the horse’s tail), which consists of the remaining spinal nerves from L2 to Co1.
  • Cervical Region:
    • Brachial Plexus Injury: Damage to the brachial plexus in the shoulder.
      • Features: Flaccid paralysis, sensory loss, Horner’s syndrome.
      • Cause: Trauma (e.g., shoulder dislocation, birth injury).
  • Thoracic Region:
        • No specific spinal cord syndromes are commonly associated with this region.


  • Lumbar Region:
    • Lumbosacral Radiculopathy: Irritation or compression of lumbar or sacral nerve roots.
      • Features: Radiating pain (sciatica), muscle weakness, reduced reflexes.
      • Cause: Disc herniation, spinal stenosis, degenerative changes.


  • Sacral Region:
    • Cauda Equina Syndrome: Compression or injury of the cauda equina (nerve roots below the spinal cord termination).
      • Features: Bilateral leg weakness, saddle anesthesia, bladder/bowel dysfunction.
      • Cause: Disc herniation, trauma, tumors.
      • Gold standard: MRI (reveals spinal nerve compression and conus medullaris involvement).
      • Urgent management is essential, involving dexamethasone, followed by radiation or surgery.
      • Prognosis varies based on etiology and ambulatory status at presentation.


Brown-Séquard Syndrome:

      • Hemisection of the spinal cord, affecting one side.
      • Ipsilateral motor weakness (due to corticospinal tract involvement).
      • Ipsilateral loss of proprioception and vibration sense (dorsal column involvement).
      • Contralateral loss of pain and temperature sensation (spinothalamic tract involvement).
      • Cause: Often due to penetrating trauma, tumors, or ischemia.


Anterior Cord Syndrome:

      • Anterior spinal artery infarction affects the anterior two-thirds of the cord.
      • Motor paralysis on the same side below the lesion.
      • Loss of pain and temperature sensation on the opposite side.
      • Cause: Often related to flexion injuries, ischemia, or trauma.


Posterior Cord Syndrome:

      • Dorsal column damage affects fine-touch, vibration, and proprioception.
      • Motor function remains intact.
      • Cause: Trauma, demyelinating disorders, or vascular issues.


Central Cord Syndrome:

  • Motor weakness and sensory loss (often affecting upper limbs more than lower limbs).
  • Cape-like distribution of sensory deficits.
  • Cause: Commonly seen in elderly patients with cervical spondylosis or traumatic hyperextension injuries.



1 geekymedics.com

2 merckmanuals.com

3 msdmanuals.com

4 mayoclinic.org

Verified by Dr. Petya Stefanova