F • Neurophysiological and Clinical Aspects of
Spinal Cord Injuries
GENERAL
The pathophysiological effects of any kind of injury to the spinal cord or cauda equina
have to be considered from four main standpoints:
1
The level of the lesion. The higher the lesion the more extensive is the loss of motor,
sensory and autonomic functions and, moreover, the greater are the metabolic changes
of the organism.
2 The extent of damage to the spinal cord in the transverse plane. This may involve
the whole cross section of the cord at any level, resulting in a complete transverse spinal
syndrome, or the damage may be partial, involving some of the long tracts or central
grey matter and its synapses, resulting in a great variety of incomplete transverse syn
dromes of more or less dissociated type.
3 The extent of damage in the vertical—i.e. longitudinal plane. This may occur as an
entity in itself, as is the case in haematomyelia, syringo- or hydromyelia. On the other
hand, it may be associated with a transverse lesion involving either a few or all segments
of the isolated cord—i.e. the part below the transverse lesion.
4 The time factor which is important in determining the damage to the cord and the
resulting symptomatology—i.e. whether the onset of the cord lesion was sudden or
gradual.
The term generally accepted for transverse lesions of the spinal cord involving
thoracic, lumbar and sacral region, is paraplegia. Tetraplegia is the Greek term used by
the writer and other authors for transverse lesion of the cervical cord. There is no clinical
or scientific reason why the term tetraplegia should not be universally accepted instead
of the often confusing, combined Greek and Latin, names: quadriplegia, quadraplegia,
or quadruplegia. It is not uncommon for the writer to be asked in court and on other
occasions to explain the 'difference' between tetraplegia and quadriplegia, and it is
really time that we brought our terminology in order.
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