By Matt Lalande in Spinal Cord Injuries on November 23, 2021
Spinal cord Injuries are normally classified into ‘complete’ or ‘incomplete’. A complete SCI refers to injuries where there is no muscle function or sensation below the level of injury. This affects both sides of the body to the same degree. A compelte cpinal cord injury does not necessarily mean the spinal cord has been severed. This in fact rarely occurs. An incomplete SCI refers to injuries where there is some muscle function and sensation below the level of lesion or injury. There may be sensation but not movement in one limb or one side of the body or there may be movement but no sensation.
Then, a subset of SCIs is classified by their clinical presentation into 6 Spinal Cord Injury Syndromes: central cord syndrome (CCS), Brown-Sequard syndrome (BSS), anterior cord syndrome (ACS), conus medullaris syndrome (CMS), cauda equina syndrome (CES) and posterior cord syndrome (PCS).
While central cord syndrome is the most common SCI syndrome, the less commonly encountered patterns of incomplete SCI include anterior cord syndrome are the Brown-Séquard syndrome and posterior cord syndrome.
Posterior cord syndrome is rare and presents with pain and paresthesias of the neck, arms, and torso along with mild paresis of the upper extremities. It is the least common type of incomplete spinal cord injury, and generally comprises approximately 1% of all spinal cord injuries.
Posterior cord syndrome, also known as posterior spinal artery syndrome or dorsal cord syndrome, occurs when the individual has suffered damage to the posterior columns at the back of the spinal cord. It is categorized as the experience of compression or occlusion to the posterior column, during which blood and oxygen flow to the area is cut off from an injury or lesion. When this blood flow is compressed, receptors and nerves cannot reach the area and are incapable of performing their regular functions.
Usually this occurs in the dorsal (posterior) columns or the lateral corticospinal tracts. The posterior columns in the spinal cord are generally connected to an individual’s ability to feel vibration, proprioception, and fine touch. The lateral corticospinal tract is responsible for an individual’s motor functions in both the upper and lower limbs of the body, including the legs and arms.
Therefore, when an individual experiences posterior cord syndrome, they commonly lose the ability to feel vibrations and proprioception below the spinal cord. However, most individuals may continue to experience pain and temperature sensation in the area. Muscle strength may also be preserved during this type of spinal cord injury.
The posterior arteries are paired. As a result, when the posterior spinal column is damaged, the individual will generally experience the majority of pain or loss of function on the side of the body where the injury has occurred.
The most common symptom of posterior cord syndrome is loss of vibratory sensation below the site of the injury, usually within the lower body. Injured individuals may also experience loss of proprioception, including loss of balance and limited spatial movement perception.
In addition, some individuals may also experience pain or burning, or painful tingling, at or below the level of injury. Since the individual may still experience muscle strength, pain, and temperature perception in the area, this type of pain is a strong indicator of posterior cord syndrome.
Symptoms do not always appear immediately and may sometimes experience a delayed onset. After experiencing significant trauma to the spinal cord, it is essential to receive medical attention as promptly as possible, even if the individual does not feel any pain or paralysis.
The majority of cases of posterior cord syndrome are caused by non-traumatic incidents, such as:
In some cases, traumatic injuries may also result in posterior cord syndrome. Generally this occurs due to a hyperextension injury via an over-extended muscle, usually within the cervical spine (neck) or to the spinal cord itself. Car accidents, slip and falls, and sports injuries are common types of traumatic incidents that could cause posterior cord syndrome.
The movement that occurs from a sudden, unexpected collision can often cause the body to become jolted, putting specific areas at risk. During these sudden moments of pressure, it is common for the body to experience a rupture, puncture, or other traumatic lesion to the neck and back, where the spinal cord could be impacted and compressed. As a result, this can interrupt the functions of the spinal cord and render the individual seriously injured.
Since posterior cord syndrome is a rare form of incomplete spinal cord injury, a doctor will often initially determine other potential causes of the pain or loss of sensation before reaching a diagnosis for posterior cord syndrome. It is important to understand the underlying cause of posterior cord syndrome as this will be the focus for treatment in order to prevent further nerve or neurological damage.
As with many incomplete spinal cord injuries, the process of diagnosis begins with a physical exam and a study of the individual’s personal and medical history. Given that the majority of cases of posterior cord syndrome are non-traumatic and result from some type of factor in the individual’s medical history, several types of tests may be conducted to determine a diagnosis.
The most effective test to determine a spinal cord injury diagnosis is an MRI. An MRI will be capable of locating nerve damage as well as the features of the tumor or compression that have caused the posterior cord syndrome to occur. In the case of the injury caused by physical trauma, such as from a motor vehicle accident or a slip and fall, the individual will also receive brain imaging scans to ensure that they have not suffered any significant brain damage or injury during the accident.
Treatment and recovery for posterior cord syndrome differs depending on the individual’s specific situation and the cause for the injury. Early treatment is an essential component of a successful recovery.
If the posterior cord syndrome diagnosis is reached early enough, a medical team may provide spinal decompression or spinal stabilization surgery to the individual. This surgery may assist the individual in preventing further neurological damage during recovery as well as regaining some balance or stability. Spinal surgery provided may also include surgical repair for the specific cause. For example, if the individual has developed posterior cord syndrome due to a herniated or damaged disc, they may undergo a discectomy to solve the issue.
Physical rehabilitation is an important component of an individual’s recovery from posterior cord syndrome. All individuals will undergo some form of physical therapy dependent on their mobility and functions, designed to provide them with the necessary resources and abilities to reintegrate in society and return to their regular activities.
This may include some of the following types of physical exercise therapies:
There are some possible complications with posterior cord syndrome treatment. If the condition is not treated properly, the individual could potentially experience progression of neurological damage with permanent outcomes, infection, or even death. These complications depend on the specific cause of the posterior cord syndrome and whether the individual has a specific non-traumatic condition that caused the injury.
However, the majority of people who experience posterior cord syndrome are able to regain function and mobility, with 67% of patients in a clinical study able to walk again and 78% able to return home within 28 days. Most individuals regain mobility, but may find they continue to struggle with minor coordination or balance issues in the future.
Prognosis is generally good for individuals if they are capable of reaching an early diagnosis.
If you have suffered a spinal cord injury call our Hamilton Spinal Cord Injury Lawyers today. We are a team of the best personal injury lawyers in Hamilton with extensive experience in representing spinal cord injury victims and have built a reliable network of comprehensive resources, support systems, information, and professional specialists who work exclusively with spinal cord injury victims. We understand the unique frustrations and complications that come with the nature of a spinal cord injury and are here to provide support in a variety of ways.
Contact our offices no matter where you are in Ontario at 1-844-LALANDE or local in the Hamilton / Burlington/ Niagara Regions at 905-333-8888. Alternatively, you can send an email through our website contact form and we would be happy to get back to you shortly.