Clinical back pain syndromes
Central cord syndrome
Central cord syndrome is the most common of the clinical syndromes, often seen in individuals with underlying cervical spondylosis who sustain a hyperextension injury (most commonly from a fall); and may occur with or without fracture and dislocations. This clinically will present as an incomplete injury with greater weakness in the upper limbs than in the lower limbs.
Brown-Sequard syndrome
Brown-Sequard syndrome (historically related to a knife wound) represents a spinal cord hemisection in its pure form, which results in:
- ipsilateral loss of propioception and vibration and motor control at and below the level of lesion
- sensory loss of all modalities at the level of the lesion
- contralateral loss of pain and temperature sensation.
Anterior cord syndrome
The anterior cord syndrome is a relatively rare syndrome that historically has been related to a decreased or absent blood supply to the anterior two-thirds of the spinal cord.
The dorsal columns are spared, but the corticospinal and spinothalamic tracts are compromised.
The clinical symptoms include a loss of motor function, pain sensation and temperature sensation at and below the injury level with preservation of light touch and joint position sense.
Cauda equina syndrome
Cauda Equina syndrome involves the lumbosacral nerve roots of the cauda equina, and may spare the spinal cord itself.
Injury to the nerve roots, which are lower motor neurons, will classically produce a flaccid paralysis of the muscles of the lower limbs and areflexic bowel and bladder. All sensory modalities are similarly impaired, and there may be partial or complete loss of sensation.
Sacral reflexes i.e. bulbocavernosus and anal wink will be absent.
Conus medullaris syndrome
Conus Medullaris Syndrome may clinically be similar to the Cauda Equina Syndrome, but the cord injury is more proximal (L1 and L2 area), relating to a thoraco-lumbar bony injury.
Depending on the level of the lesion this type of injury may manifest itself with a mixed picture of upper motor neuron (due to conus injury) and lower motor neuron symptoms (due to nerve root injury).
In some cases, this may be clinically indistinguishable from a cauda equina injury. Sacral segments may occasionally show preserved reflexes (i.e. bulbocavernosus and anal wink) with higher lesions of the conus medullaris.
