General
- Spinal cord hemisection
Numbers
- It is seen in 2–4% of traumatic spinal cord injuries
Etiologies
- Penetrating trauma
- Radiation myelopathy,
- Cord compression by spinal epidural hematoma,
- Large cervical disc herniation (rare),
- Spinal cord tumours,
- Spinal AVMs,
- Cervical spondylosis,
- Spinal cord herniation
Presentation
- Classical findings (rarely found in this pure form)
- Ipsilateral findings
- Corticospinal tract lesioning
- Motor paralysis below lesion
- Loss of posterior column function
- Proprioception & vibratory sense loss
- Contralateral findings: dissociated sensory loss
- Lateral Spinothalamic tract lesion
- Lateral spinothalamic tract crosses immediately at anterior white commissure as it enters the spinal cord
- Loss of pain and temperature sensation inferior to lesion
- Eg R side T10 and below on LT side has loss of pain and temperature sensation
- Anterior spinothalamic tract
- Preserved light (crude) touch for two levels then below that crude touch is also lost
- Due to anterior spinothalamic tract ascends 1-2 levels (@tract of Lissauer) before crossing at the anterior white commissure
- Eg
- T10-T12 has normal crude touch
- T12 has lost of crude touch
Prognosis
- Best prognosis of any of the incomplete spinal cord injuries.
- 90% of patients regain
- Independently ambulation AND
- Anal and urinary sphincter control.