Chronic spinal cord injury

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Case history #1

A 44-year-old man presents with a 3-month history of thoracic pain that has increased in severity in the previous 3 weeks. The pain eases by lying flat, but keeps him awake at night. He has noticed a weight loss of 20 kg in the previous 3 months associated with a loss of appetite and frequent night sweats. He has been through a rehabilitation programme for alcohol abuse. In the previous 3 weeks he has noticed that he has a progressively unsteady gait and has had frequent falls. He has noticed sharp burning paraesthesias in both lower extremities and the lower abdomen, which coincide with the onset of the severe back pain. On examination of his lower limbs, he has spasticity, brisk deep tendon reflexes, extensor plantars, and a sensory level of T6 affecting proprioception, light touch, and pinprick. He has a sharp tenderness over T6, with an angular kyphosis of T5 and T6. In due course, he was transferred to a spinal cord rehabilitation facility. Over the past 6 months, he has undergone extensive rehabilitation, including bladder care and prevention of joint contractures due to increasing spasticity. He is dependent on his wheelchair.

Case history #2

A 22-year-old man was involved in a motor vehicle accident 12 months earlier. He was driving under the influence of drugs and alcohol when the car crashed into a tree, and he was not wearing a seatbelt. He was taken to the accident and emergency department where he was found to have sustained a tear-drop fracture of C6. A neurological assessment determined that he had tetraplegia without sacral sparing. He underwent an emergency C6 vertebrectomy, cord decompression, and anterior stabilisation but the neurological deficit did not improve. He was transferred to a spinal cord rehabilitation facility 2 weeks later. Over the previous 12 months, he has undergone extensive rehabilitation, including bladder care and prevention of joint contractures due to increasing spasticity. He is dependent on his wheelchair.

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