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Incomplete Spinal Cord Lesion

- See: Sacral Sparing:

- Definition:
    - complete cord injury implies unequivocal absence of motor or sensory function distal to injury in absence of spinal shock;
           - w/ complete injuries, an improvement of one nerve root level can be expected in 80% of patients, and approximately 20% will 
                 recover 2 additional function levels;
                 - there is also evidence that operative decompression can also allow recovery of an additional nerve root level;
    - incomplete lesion:
           - present when there is any distal sparing of motor or sensory function along with sparing of perirectal sensation;

- Discussion:
    - dx of complete vs incomplete spinal cord injury cannot be made until the patient is out of spinal shock;
    - return of bulbocavernosus reflex has less prognostic significance in an incomplete cord lesion (redisdual distal motor function or sacral 
          sparing), and therefore, the extent of neurologic injury remains unknown;
          - patients w/ incomplete lesions have the potential to regain significant fuction;
    - trauma to cervical spine causing complete injury of the spinal cord often encompasses the nerve root in the foramen between dislocated 
          or fractured vertebrae;
          - root originates from normal cord proximal to the injured cord but suffers a peripheral nerve injury;
          - function of this root at level of injury is expected to return within 6 months;
          - progressive muscle return and strengthening in upper extermities is due to nerve root return and must not be mistaken for evidence of 
                 return of spinal function;
    - spinal shock (spinal cord concussion):
          - usually invovles 24-72 hour period of paralysis, hypotonia, & areflexia, and at its conclusion there may be hyperreflexia, 
                 hypertonicity, and clonus;
          - return of reflex activity below level of injury indicates end of spinal shock;
    - sacral sparing:
    - diff dx of incomplete lesions:
          - central cord syndrome:
          - brown sequard syndrome
          - anterior cord syndrome
          - posterior cord syndrome
          - isolated nerve root injury
          - cauda equina syndrome (w/ or w/o root escape)
          - conus medullaris injury (w/ or w/o root escape)
    - functional & quantitative criteria:
          - naming of cord injury level by distal-most level w/ fully normal f(x) has become widely accepted;
          - Frankel scale:
          - most widely used system for evaluation of functional recovery is Frankel scale, which consists
                 of five grades (A-E), based on motor and sensory deficits;
            A              complete paralysis
            B              sensory function only below the injury level
            C              incomplete motor function below injury level
            D              fair to good motor function below injury level
            E              normal function

- Management:
    - management of the spine injured patient:
    - steroid protocol:
         - note that steroids should only be given when all of the strict guidelines for infusion are met

Incomplete traumatic quadriplegia: A ten-year review.
Diagnosis and prognosis of acute cervical spine cord injury.