The spinal cord is the cylindrical neural structure within the vertebral canal extending from the foramen magnum to the conus medullaris at L1-L2. It carries ascending sensory tracts (dorsal columns for proprioception/vibration; spinothalamic for pain/temperature) and descending motor tracts (corticospinal, rubrospinal). The cord has cervical and lumbar enlargements corresponding to the limb plexuses. It is protected by the meninges, CSF, and the vertebral column.
Spinal cord injury produces deficits below the level of the lesion. Complete cord syndromes cause total motor and sensory loss. Partial syndromes include anterior cord (motor loss and pain/temperature loss with preserved proprioception from anterior spinal artery injury), central cord (arms weaker than legs, seen in cervical hyperextension), Brown-Sequard (ipsilateral motor and proprioception loss, contralateral pain/temperature loss from hemisection), and posterior cord (proprioception and vibration loss only). MRI is the primary imaging modality.
Hyperextension injury of the cervical spine, most common in elderly patients with pre-existing spondylosis, compresses the central cord producing disproportionate upper limb weakness (corticospinal fibres to the arms are most central), bladder dysfunction, and variable sensory loss below the injury level, managed by surgical decompression within 24 hours for progressive deficit.
Anterior spinal artery territory ischaemia or direct anterior cord compression produces immediate bilateral motor paralysis and loss of pain and temperature sensation below the injury level with preserved posterior column function (proprioception and vibration), carrying the worst prognosis of all partial cord syndromes.
