Physical Examination: ASIA Motor/Sensory Examination and Spinal Cord Injury Syndromes

I INTRODUCTION Traumatic spinal cord injury afflicts more than 8000 new patients per year (1). This figure will tend to increase over time as improved methods of transportation, lifesupport, and trauma care will allow for greater survival rates from high-energy trauma. The evaluation and management of patients with spinal injury are often complicated because it typically occurs in the context of polytrauma. In addition, the level of complexity in rehabilitating these patients is increased by the functional limitations placed upon the patient as a result of neurological injury. The most important part of the treatment of a patient with spinal cord injury begins with the initial assessment. The careful evaluation and clear documentation of the patient’s neurological status will allow the treating physician to best decide the appropriate initial treatment as well as to determine the prognosis for functional recovery and the long-term rehabilitation goals for each individual. This chapter will focus on the physical examination of the patient with spinal cord injury, with emphasis on the recommendations made by the American Spinal Injury Association (ASIA). It will also describe the various spinal cord syndromes that may be encountered by the treating physician

Controversies in the Treatment of Central Cord Injuries

Central cord injury or central cord syndrome is an acute cervical spinal cord injury characterized by more extensive motor weakness of the upper extremities compared with the lower extremities, usually with bladder dysfunction, and variable sensory loss below the level of the lesion. Central cord syndrome is the most common type of incomplete spinal cord injury pattern and is associated with a moderate to good prognosis. Over the last five decades, the role of surgical intervention, as well as the type and timing of surgery, continues to be the subject of considerable debate. These controversies are the focus of this article