CHAPTER 20
THE ACUTE COMPLETE TRANSVERSE
SYNDROME
This may be caused either by transection or severe lesion in continuity or purely by
transient physiological interruption. As a result, there is complete interruption of the
function of the anterior and posterior neuronal elements and their synaptic and root
connections at the level of the lesion. In addition, there is also a complete interruption
of the conductivity of all long tracts descending from cortical or subcortical centres of
the brain as well as of the main afferent pathways conducting impulses arising from skin,
muscles, tendons, ligaments, joints and viscera.
The various pathologies resulting in an acute transverse syndrome can be divided
into:
(a) Transection of the cord
This may occur as a result of gunshot or stab wounds or fractures and fracture-disloca
tions of the spine and may involve one or several segments according to the type of
injury. All ganglion cells and axonal elements are destroyed at the site of the severance
and the organization of their anatomical compartments is disrupted. The severed dura,
arachnoidea and pia, as well as the segment of the cord, are replaced by a dense fibrous
scar or by a piece of bone or, as in the case of stab and gunshot injuries, by a metal body.
(b) Lesions in continuity
In this condition one has to distinguish between disruption and preservation of the
segmental anatomical arrangement. In the former case, the meningeal coverings and the
outer shell of the cord at the level of the injury remain intact but the anatomical arrange
ment and organization including ganglion cells, axons and synaptic connections at
segmental level are disrupted and replaced by glial or fibrous tissue. This may occur
following crush injuries of the spine, transverse myelitis necroticans or a vascular
catastrophy.
In the case of preservation of the segmental anatomical organization, the ganglion
cells and their synaptic connections may lose their function due to the pathological
process but the axonal anatomical arrangements of the long ascending and descending
tracts within the spinal cord are not as disorganized as described above. Therefore, a
greater or lesser degree of functional recovery is possible after the cause is removed. This
may occur in certain types of pathological conditions causing gradual compression, such
as extra-medullary tumours, furthermore collapsing osteomyelitic or tuberculous verte
brae or vascular thrombosis. This problem has been discussed previously in the Chapter
on Regeneration of the spinal cord.
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