Spinal Injuries - Symptoms

A reliable sign of spinal cord injury is a clear definition of the level of injury, above which there are no neurological changes, and below which neurological functions are either completely absent or significantly reduced. The features of clinical manifestations depend on the level and degree of spinal cord injury (complete or partial).

Spinal injuries, like other fractures or dislocations, are very painful, but patients suffering from pain caused by other concomitant injuries (eg, long bone fractures) or with impaired consciousness due to intoxication or TBI may not complain of back pain.

Symptoms of spinal cord injury depending on location

Localization of damage	Possible symptoms
Above C	Respiratory paralysis and in many cases death
At or above C4	Complete tetraplegia
C1	Paralysis of the lower limbs, although flexion and abduction of the arms is possible
C6	Paralysis of the lower limbs, wrists and hands, but shoulder movements and elbow flexion are usually possible
AboveT2	In case of transverse damage, pupil dilation
Between Th12 and Th11	Paralysis of the muscles of the lower limbs above and below the knee joint
From T2 to T12	Paralysis below the knee
Ponytail	Paresis of the lower limb with hyporeflexia or areflexia and usually with pain and hyperesthesia along the distribution of the nerve roots
OT S3 to S or conus medullaris at L1	Pelvic organ dysfunction

Symptoms of Complete Spinal Cord Injury

Rupture results in immediate, complete flaccid paralysis (including loss of anal sphincter tone), autonomic dysfunction below the level of injury, and loss of sensory and reflex activity.

High cervical spine injuries (above C1) cause respiratory failure with impaired pulmonary ventilation due to impaired respiratory muscle function, especially with injuries above C3. Autonomic dysfunction in cervical spine injuries can lead to bradycardia and arterial hypotension, spinal shock, in which, unlike other forms of shock, the skin remains warm and dry. Arrhythmias and blood pressure instability are possible. Pneumonia, especially associated with mechanical ventilation, often becomes the cause of death in patients with high cervical spine injuries.

Flaccid paralysis gradually becomes spastic after several hours or days due to the strengthening of normal stretch reflexes, which arise against the background of weakening of the mechanisms that counteract them. Later, if the lumbosacral bundle is not damaged, a spasm of the flexor muscles appears, and deep tendon and autonomic reflexes are restored.

Symptoms of Partial Spinal Cord Injury

Partial loss of motor or sensory innervation occurs, which, depending on the etiology, can be permanent or short-term. Short-term dysfunction is caused by concussion, longer-term - by bruise or injury. Sometimes after concussion of the spinal cord, rapidly developing edema leads to complete dysfunction and imitates its hollow rupture. Clinical manifestations of spinal shock (not to be confused with neurogenic shock) disappear after a few days, often residual disorders remain.

The clinical picture depends on the location of the damage in the spinal cord. Several specific syndromes are distinguished.

Brown-Sequard syndrome occurs due to damage to half of the spinal cord. The patient experiences spastic paralysis on the side of the injury, loss of positional sensitivity below the injury, and loss of pain and temperature sensitivity on the opposite side.

Anterior spinal cord syndrome is the result of direct damage to this area or the anterior spinal artery. The patient loses movement and pain sensitivity on both sides below the injury.

Central spinal syndrome usually occurs in patients with spinal canal stenosis (congenital or degenerative) following hyperextension. Motor impairment in the arms is more pronounced than in the legs.

If the posterior spinal cord is damaged, the patient loses positional, vibrational and tactile sensitivity. If the spinothalamic tract is involved, pain, temperature and often superficial and deep muscle sensitivity are lost.

Hemorrhage (hematomyelia) usually occurs in the gray matter of the cervical spinal cord, leading to the development of signs of damage to lower motor neurons (muscle weakness, twitching of muscle fibers, decreased tendon reflexes of the hands), which persists for a fairly long time. Motor weakness, often proximal, is combined with selective impairment of pain and temperature sensitivity.

Symptoms of Cauda Equina Damage

Loss of movement and/or sensation is usually partial. The tone of the anal sphincter is reduced. Bowel and bladder functions are impaired, incontinence or retention is possible. Men experience erectile dysfunction, and women experience decreased libido.

Complications of spinal injury

The consequences depend on the severity and level of the injury. With injuries at level C or higher, breathing problems may occur. Reduced mobility increases the risk of blood clots and pressure ulcers. Spasticity may develop. Autonomic dysreflexia may occur in response to irritants such as pain and pressure on any part of the body. Chronic neurological pain manifests itself as a burning or tingling sensation.

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