Prof. Shahzad Shams presently works as Head and Professor of Neurosurgery Department at Lahore General Hospital, LGH, Lahore.
Symptoms of Spine Injuries
The most severe consequence of spinal trauma is complete transverse my-elopathy, in which all neurological function is absent below the level of the lesion, causing either a paraplegia or quadriplegia, depending on the level. There will also be impairment of autonomic function including bladder and bowel.
Injuries to the spinal cord will result in upper motor neuron paralysis characterized by loss of voluntary function, increased muscle tone and hyper-reflexia. Injuries to the lumbar spine causing cauda equine injuries result in lower motor neuron paralysis characterized by reduced muscle tone, wasting and loss of reflexes. A combinations of upper and lower motor neuron lesions result from a thoracolumbar injury involving the conus medullaris and cauda equine.
IN complete lesion the afferent long tracts carrying the various sensory modalities are interrupted at the level of the lesion, abolishing sensory appreciation of pain, temperature, touch, position and tactile discrimination below the lesion. Visceral sensation is also lost. Sensation may decrease over a few spinal segments before being lost altogether. Occasionally there is a level of abnormally increased sensation, hyperaestheis and hyperalgesia at or just below the lesion.
Vasomotor control. Cervical and high thoracic lesion above the sympathetic outflow at T5 may cause hypotension. Interruption of the sympathetic splanchnic vasomotor control will initially cause a severe postural hypotension as a result of impaired venous return.
Temperature control. The patient with a complete spinal lesion will not have satisfactory thermal regulation as there will be impairment of the autonomic mechanisms for vasoconstriction and vasodilatation.
There is impairment of bowel and bladder control, this is discussed later.