Spinal Cord Lesions

It is important to distinguish between complete and incomplete spinal cord injuries. The severity of injury determines the prognosis for recovery of function. The American Spinal Injury Association defines a complete neurologic lesion as the absence of sensory and motor function below the level of injury. This includes loss of function to the level of the lowest sacral segment. In contrast, a lesion is incomplete if sensory, motor, or both functions are partially present below the neurologic level of injury. This may consist only of sacral sensation at the anal mucocutaneous junction or voluntary contraction of the external anal sphincter upon digital examination.3 In assessing neurologic function, spinal shock must be considered. Patients in spinal shock lose all reflex activities. This generally resolves, with the return of the bulbocavernosus reflex occurring first. Lesions cannot be deemed complete until spinal shock has resolved. Complete lesions have a minimal chance of functional motor recovery. Patients with incomplete lesions are expected to have at least some degree of recovery.

Clinical syndromes classify incomplete spinal cord lesions. Damage to specific sections of the spinal cord results in predictable physical findings ( T§ble..248:1).

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