F- CLINICAL ASPECTS OF SPINAL CORD INJURIES
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onset and rapid progression caused most commonly by traumatic influences, with or
without fractures of the vertebral column, the latter is of very insidious onset and slow
progression. In both afflictions the cervico-thoracic area is the commonest site of the
lesion. The initial symptom of haemotomyelia is pain or paraesthesia in the neck radiating
into one or both arms followed by rapid development of muscular weakness or paralysis
of peripheral type due to damage or destruction of the anterior horn cells. The sensory
disturbances are due to destruction of the sensory fibres in the grey matter. When the
destruction is limited to the posterior grey commissure affecting the sensory fibres at
their decussation, analgesia and thermoanaesthesia over a greater or lesser number of
segments result. When the haemorrhage is large enough to affect or compress the spino-
thalamic and posterior column tracts, impairment or loss of all forms of sensibility in
one or both lower limbs will occur. There is also spastic paresis or paralysis below the
level of the lesion due to involvement of the pyramidal tracts. Bladder, bowel and sexual
functions are also involved and show various types of impairment.
In syringomyelia the commonest early symptoms are wasting and weakness of the
small muscles of the hands. As a result of the elongation of the syringomyelitic cavity,
most frequently situated at the base of the posterior horns, the decussations of sensory
fibres derived from the posterior roots are damaged, and pain and temperature sensibility
is impaired or abolished (dissociated sensory loss). When at a later date the spino-
thalamic tracts are compressed, pain and temperature sensibility is impaired or lost over
the greater part of the body and the lower limbs, but this sensory disturbance may be of
patchy or segmental type. The same applies to the disturbances of sweating (Guttmann
& List, 1928). When the syringomyelitic process advances to the upper cervical area, the
spinal trigeminal tract may be involved, resulting in a concentric type of dissociated
sensory loss of the face. The posterior column sensibility is, as a rule, the last to be involved
and is most pronounced in the lower limbs. Trophic changes in syringomyelia are often
very striking and osteoarthropathy (Charcot's joints) is part of the classical symptoma
tology. As in haematomyelia, bladder, bowels and sexual function are involved.
Schneider
et al.
(1954) have drawn attention to a syndrome of acute central cervical
cord injury caused by simultaneous squeezing of the cord anteriorally and posteriorally
resulting from severe retro-hyperflexion (wrongly called hyperextension) injuries of the
cervical spine. This central damage may occur without apparent damage to the vertebrae
and, according to the authors, is caused by an inward bulge of the ligamentum flavum
during retro-hyperflexion of head and neck. This central cervical cord syndrome is
characterized by a dissociation in the degree of motor paralysis or weakness between the
upper and lower limbs, the upper limbs being more affected. There are also varying
degrees of sensory disturbances below the level of the lesion, as well as bladder, bowels
and sexual disturbances.
Unilateral transverse lesion (Brown-Sequard's syndrome)
The syndrome of hemisection of the cord has been described in detail by Brown-
Sequard in 1850. However, it is, in its classical form, a rare occurrence in most countries,
with the exception perhaps of South Africa where spinal cord injuries due to stab wounds
