Posterior Cord Syndrome: Difference between revisions
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== Introduction == | == Introduction == | ||
Posterior Cord Syndrome is the rarest form of incomplete [[Overview of Spinal Cord Injuries|spinal cord injury]]. An individual with this form of spinal cord injury (SCI) will have intact motor function and sensations of pain, light touch, and temperature, but impairments in [[proprioception]], vibration, kinesthesia, and combined cortical functions below the level of the lesion (see: [[Sensation]]). | Posterior Cord Syndrome (PCS) is the rarest form of incomplete [[Overview of Spinal Cord Injuries|spinal cord injury]]. An individual with this form of spinal cord injury (SCI) will have intact motor function and sensations of pain, light touch, and temperature, but impairments in [[proprioception]], vibration, kinesthesia, and combined cortical functions below the level of the lesion (see: [[Sensation]]). | ||
== Clinically Relevant Anatomy == | == Clinically Relevant Anatomy == | ||
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As the name implies, the vast majority of damage with this form of incomplete spinal cord injury is towards the posterior aspects of the spinal cord. As a result, the common location of injury in Posterior Cord Syndrome is to the posterior columns and dorsal horns of the spinal cord, which are part of the [[Dorsal Column Medial Lemniscal Pathway]] (DCML). The DCML provides the sensory information of discriminative touch (two point discrimination, stereognosis, localization of touch), deep touch, vibration, conscious proprioception, and information for combined cortical functions such as graphesthesia for all body regions except the head.<ref name=":0">Al-Chalabi M, Reddy V, Alsalman I. Neuroanatomy, Posterior Column (Dorsal Column). StatPearls [Internet]. 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507888/ (accessed 31 January 2024).</ref> The end destination of this information is then carried to the primary somatosensory cortex of the [[Parietal Lobe]] for central processing.<ref name=":0" /> | As the name implies, the vast majority of damage with this form of incomplete spinal cord injury is towards the posterior aspects of the spinal cord. As a result, the common location of injury in Posterior Cord Syndrome is to the posterior columns and dorsal horns of the spinal cord, which are part of the [[Dorsal Column Medial Lemniscal Pathway]] (DCML). The DCML provides the sensory information of discriminative touch (two point discrimination, stereognosis, localization of touch), deep touch, vibration, conscious proprioception, and information for combined cortical functions such as graphesthesia for all body regions except the head.<ref name=":0">Al-Chalabi M, Reddy V, Alsalman I. Neuroanatomy, Posterior Column (Dorsal Column). StatPearls [Internet]. 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507888/ (accessed 31 January 2024).</ref> The end destination of this information is then carried to the primary somatosensory cortex of the [[Parietal Lobe]] for central processing.<ref name=":0" /> | ||
However, when considering the vascular [[Spinal cord anatomy|anatomy of the spinal cord]], specifically the posterior spinal arteries, there may be some alterations to the [[Corticospinal Tract]] or even aspects of the [[Spinothalamic tract]] due to a border zone of infusion. <ref>McKinley W, Hills A, Sima A. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7952058/ Posterior cord syndrome: Demographics and rehabilitation outcomes.] J Spinal Cord Med. 2021;44(2):241</ref>As there is generally not extensive damage to the corticospinal or spinothalamic tracts, voluntary motor function (corticospinal tract), and sensations of pain, crude touch, and temperature (spinothalamic tract) are preserved.<ref>Welniarz Q, Dusart I, Roze E. [https://pubmed.ncbi.nlm.nih.gov/27706924/ The corticospinal tract: Evolution, development, and human disorders.] Dev Neurobiol. 2017;77(7):810-829</ref> <ref>Waxman SG. Clinical Neuroanatomy 27th ed. New York: McGraw Hill, 2013.</ref> | However, when considering the vascular [[Spinal cord anatomy|anatomy of the spinal cord]], specifically the posterior spinal arteries, there may be some alterations to the [[Corticospinal Tract]] or even aspects of the [[Spinothalamic tract]] due to a border zone of infusion. <ref name=":1">McKinley W, Hills A, Sima A. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7952058/ Posterior cord syndrome: Demographics and rehabilitation outcomes.] J Spinal Cord Med. 2021;44(2):241</ref>As there is generally not extensive damage to the corticospinal or spinothalamic tracts, voluntary motor function (corticospinal tract), and sensations of pain, crude touch, and temperature (spinothalamic tract) are preserved.<ref>Welniarz Q, Dusart I, Roze E. [https://pubmed.ncbi.nlm.nih.gov/27706924/ The corticospinal tract: Evolution, development, and human disorders.] Dev Neurobiol. 2017;77(7):810-829</ref> <ref>Waxman SG. Clinical Neuroanatomy 27th ed. New York: McGraw Hill, 2013.</ref> | ||
== Incidence/Prevalence == | |||
There is a wide variance in global reports of incident rates for spinal cord injury. Recent estimates from the Global Burden of Disease suggest an incidence rate of 0.9 million spinal cord injuries, 20.6 million prevalent cases, and 6.2 million years lived with disability (YLD) in 2019. <ref name=":2">Ding W, Hu S, Wang P, Kang H, Peng R, Dong Y, Li F. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9554757/ Spinal Cord Injury: The Global Incidence, Prevalence, and Disability From the Global Burden of Disease Study 2019.] Spine (Phila Pa 1976). 2022;47(21):1532-1540. </ref> On average, spinal cord injuries appear to be more commonly afflicting males based on age standardized incidence rate (ASIR) and age standardized YLD rate (ASYR) , and injuries at neck level had higher ASYR than injuries below the neck.<ref name=":2" /> No readily available global reports suggest incidence/prevalence rates of incomplete spinal cord injury; however, the United States National Spinal Cord Injury Statistical Center reports that 67.2% of traumatic spinal cord injuries are incomplete.<ref>National Spinal Cord Injury Statistical Center. [https://www.nscisc.uab.edu/ Traumatic Spinal Cord Injury Facts and Figures at a Glance.] Birmingham, AL: University of Alabama at Birmingham, 2023</ref> See [[Epidemiology of Spinal Cord Injury]] for more information. | |||
Reports of Posterior Cord Syndrome incidence rates vary; however it is believed to be the least prevalent SCI, with estimates of 2% or less.<ref name=":1" /> <ref name=":3">Kennamer BT, DelPino BJ, Lettieri SC, Gridley DG, Hollingworth AK, Feiz-Erfan I. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9095631/ Blunt traumatic posterior cord syndrome.] Spinal Cord Ser Cases. 2022;8:52</ref> | |||
== Pathophysiology == | == Pathophysiology == | ||
The pathophysiology of spinal cord injury appears to follow mechanisms of primary and secondary injury. Primary injury refers to the resultant physical trauma to the [[Spinal cord anatomy|spinal cord]] anatomy due to impingement from fractured bone or surrounding soft tissue. This damage then disrupts components of the nervous system, such as destruction of the neural parenchyma, disruption of the axonal network, and hemorrhagic disruption to glial membranes. Secondary injury is the component which generates the most damage to the spinal cord, and involves a series of chemical and mechanical changes ultimately leading to necrosis, neural apoptosis, and glial scar formation.<ref>Anjum A, Yazid MD, Fauzi Daud M, Idris J, Ng AMH, Selvi Naicker A, Ismail OHR, Athi Kumar RK, Lokanathan Y. [https://pubmed.ncbi.nlm.nih.gov/33066029/ Spinal Cord Injury: Pathophysiology, Multimolecular Interactions, and Underlying Recovery Mechanisms]. Int J Mol Sci. 2020;21(20):7533.</ref> | |||
== | It is unclear what the most common mechanism of injury (MOI) is for Posterior Cord Syndrome due to its rarity. Common causes of PCS include posterior spinal artery ischemia, tumor, herniated disc, Vitamin B12 deficiency, and trauma.<ref name=":3" /> Trauma appears to be the least common MOI for PCS, but is thought to be associated with hyperextension injuries, though this MOI is more commonly associated with [[Central Cord Syndrome]].<ref name=":3" /> | ||
== Clinical Presentation == | == Clinical Presentation == | ||
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[[American Spinal Injury Association (ASIA) Impairment Scale]] | [[American Spinal Injury Association (ASIA) Impairment Scale]] | ||
[[Spinal Cord Injury Outcome Measures Overview]]<br> | See [[Spinal Cord Injury Outcome Measures Overview]] for all relevant outcome measures for SCI. As many individuals with PCS <br> | ||
== Resources == | |||
== Resources | |||
add appropriate resources here | add appropriate resources here | ||
Revision as of 22:02, 31 January 2024
Introduction[edit | edit source]
Posterior Cord Syndrome (PCS) is the rarest form of incomplete spinal cord injury. An individual with this form of spinal cord injury (SCI) will have intact motor function and sensations of pain, light touch, and temperature, but impairments in proprioception, vibration, kinesthesia, and combined cortical functions below the level of the lesion (see: Sensation).
Clinically Relevant Anatomy[edit | edit source]
As the name implies, the vast majority of damage with this form of incomplete spinal cord injury is towards the posterior aspects of the spinal cord. As a result, the common location of injury in Posterior Cord Syndrome is to the posterior columns and dorsal horns of the spinal cord, which are part of the Dorsal Column Medial Lemniscal Pathway (DCML). The DCML provides the sensory information of discriminative touch (two point discrimination, stereognosis, localization of touch), deep touch, vibration, conscious proprioception, and information for combined cortical functions such as graphesthesia for all body regions except the head.[1] The end destination of this information is then carried to the primary somatosensory cortex of the Parietal Lobe for central processing.[1]
However, when considering the vascular anatomy of the spinal cord, specifically the posterior spinal arteries, there may be some alterations to the Corticospinal Tract or even aspects of the Spinothalamic tract due to a border zone of infusion. [2]As there is generally not extensive damage to the corticospinal or spinothalamic tracts, voluntary motor function (corticospinal tract), and sensations of pain, crude touch, and temperature (spinothalamic tract) are preserved.[3] [4]
Incidence/Prevalence[edit | edit source]
There is a wide variance in global reports of incident rates for spinal cord injury. Recent estimates from the Global Burden of Disease suggest an incidence rate of 0.9 million spinal cord injuries, 20.6 million prevalent cases, and 6.2 million years lived with disability (YLD) in 2019. [5] On average, spinal cord injuries appear to be more commonly afflicting males based on age standardized incidence rate (ASIR) and age standardized YLD rate (ASYR) , and injuries at neck level had higher ASYR than injuries below the neck.[5] No readily available global reports suggest incidence/prevalence rates of incomplete spinal cord injury; however, the United States National Spinal Cord Injury Statistical Center reports that 67.2% of traumatic spinal cord injuries are incomplete.[6] See Epidemiology of Spinal Cord Injury for more information.
Reports of Posterior Cord Syndrome incidence rates vary; however it is believed to be the least prevalent SCI, with estimates of 2% or less.[2] [7]
Pathophysiology[edit | edit source]
The pathophysiology of spinal cord injury appears to follow mechanisms of primary and secondary injury. Primary injury refers to the resultant physical trauma to the spinal cord anatomy due to impingement from fractured bone or surrounding soft tissue. This damage then disrupts components of the nervous system, such as destruction of the neural parenchyma, disruption of the axonal network, and hemorrhagic disruption to glial membranes. Secondary injury is the component which generates the most damage to the spinal cord, and involves a series of chemical and mechanical changes ultimately leading to necrosis, neural apoptosis, and glial scar formation.[8]
It is unclear what the most common mechanism of injury (MOI) is for Posterior Cord Syndrome due to its rarity. Common causes of PCS include posterior spinal artery ischemia, tumor, herniated disc, Vitamin B12 deficiency, and trauma.[7] Trauma appears to be the least common MOI for PCS, but is thought to be associated with hyperextension injuries, though this MOI is more commonly associated with Central Cord Syndrome.[7]
Clinical Presentation[edit | edit source]
add text here relating to the clinical presentation of the condition
For a comprehensive clinical examination overview, see: Assessment of Spinal Cord Injury
Diagnostic Procedures[edit | edit source]
add text here relating to diagnostic tests for the condition
Differential Diagnosis[edit | edit source]
add text here relating to the differential diagnosis of this condition
Management / Interventions[edit | edit source]
add text here relating to management approaches to the condition
Prognosis[edit | edit source]
Outcome Measures[edit | edit source]
add links to outcome measures here (see Outcome Measures Database)
American Spinal Injury Association (ASIA) Impairment Scale
See Spinal Cord Injury Outcome Measures Overview for all relevant outcome measures for SCI. As many individuals with PCS
Resources[edit | edit source]
add appropriate resources here
References[edit | edit source]
- ↑ 1.0 1.1 Al-Chalabi M, Reddy V, Alsalman I. Neuroanatomy, Posterior Column (Dorsal Column). StatPearls [Internet]. 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507888/ (accessed 31 January 2024).
- ↑ 2.0 2.1 McKinley W, Hills A, Sima A. Posterior cord syndrome: Demographics and rehabilitation outcomes. J Spinal Cord Med. 2021;44(2):241
- ↑ Welniarz Q, Dusart I, Roze E. The corticospinal tract: Evolution, development, and human disorders. Dev Neurobiol. 2017;77(7):810-829
- ↑ Waxman SG. Clinical Neuroanatomy 27th ed. New York: McGraw Hill, 2013.
- ↑ 5.0 5.1 Ding W, Hu S, Wang P, Kang H, Peng R, Dong Y, Li F. Spinal Cord Injury: The Global Incidence, Prevalence, and Disability From the Global Burden of Disease Study 2019. Spine (Phila Pa 1976). 2022;47(21):1532-1540.
- ↑ National Spinal Cord Injury Statistical Center. Traumatic Spinal Cord Injury Facts and Figures at a Glance. Birmingham, AL: University of Alabama at Birmingham, 2023
- ↑ 7.0 7.1 7.2 Kennamer BT, DelPino BJ, Lettieri SC, Gridley DG, Hollingworth AK, Feiz-Erfan I. Blunt traumatic posterior cord syndrome. Spinal Cord Ser Cases. 2022;8:52
- ↑ Anjum A, Yazid MD, Fauzi Daud M, Idris J, Ng AMH, Selvi Naicker A, Ismail OHR, Athi Kumar RK, Lokanathan Y. Spinal Cord Injury: Pathophysiology, Multimolecular Interactions, and Underlying Recovery Mechanisms. Int J Mol Sci. 2020;21(20):7533.
