The most serious consequence of injury of the spine is a lesion of the spinal cord or of the spinal nerves. Paralysis at a distance from the seat of injury is the great symptom of this lesion; and as in such a case any manipulation may lead to further mischief, the surgeon must first of all determine whether there is paralysis of the parts below the seat of injury. If there is none, he then examines the bones of the spine, and after that the muscles and ligaments.
Injuries of the spinal cord and nerves are indicated by paralysis, and sometimes by signs of irritation. Two points must be specially noted—the extent of the paralysis, and the time and mode of its onset. By the first we can determine the seat of the lesion, and from the second we can generally infer its nature and cause.
Sensation to touch, to pain, and to heat should be carefully tested, and all anesthetic areas marked out. The power of voluntary motion must be tested. Areas of hyperesthesia, muscular spasm or rigidity, and pain must be carefully noted. Then the various reflexes (the superficial, the deep, and the visceral) must be tested.
<Callout type="important" title="Critical Reflex Testing">Testing reflexes is crucial for determining if there's a complete transverse lesion of the cord.</Callout>
- Anesthesia or motor paralysis corresponding to the distribution of a particular nerve indicates a lesion of that nerve. 2. Paralysis below a certain horizontal plane indicates a lesion of the spinal cord at a corresponding level.
If with complete paralysis there is also complete anesthesia to touch, pain, heat and cold, and the reflexes in the paralyzed area are entirely lost, it indicates that there is a complete transverse lesion of the cord. But if with complete paralysis and loss of reflexes the anesthesia is not complete, the lesion is not a total transverse one.
Recovery of reflexes soon after the injury shows that the temporary loss was the result of shock or of spinal concussion. Paralysis observed immediately after the injury is due to compression, bruising, or actual crushing of the cord by displaced bone or a foreign body or to hemorrhage into the cord.
Pain shooting round the trunk and down the limbs, spasmodic contraction of muscles, and exaggerated reflexes are signs of meningeal irritation. If there is complete motor and sensory paralysis of the lower limbs, with loss of sensation as high as the umbilicus, it indicates a lesion of the cord at the level of the 9th dorsal vertebra or opposite the roots of the 10th dorsal nerve.
In cases where there is no evidence of crush of cord but where a severe blow has been received on the spine, the examination may be made more deliberately. The patient standing up, the surgeon should examine the lines of the spines and transverse processes to determine whether there is any irregularity, depression, or marked lateral deviation at the injured part.
<Callout type="warning" title="Dangerous Manipulations">Manipulating a spine with suspected cord injury can exacerbate damage.</Callout>
Injuries of the ligaments and muscles are often combined with more serious lesions but occur not infrequently quite apart from them, as a result of sudden and violent twists, blows, and strains of no the spine. They are the cause of pain and of a certain amount of rigidity of the spine, which lasts for some time, especially in the case of railway accidents and other severe contusions.
Key Takeaways
- Paralysis is a key symptom indicating spinal cord or nerve injury.
- Testing reflexes helps determine the extent of the lesion and its nature.
- Immediate paralysis often indicates compression, bruising, or hemorrhage.
Practical Tips
- Carefully test sensation and voluntary motion in suspected cases of spinal injury.
- Use reflex testing to differentiate between complete and incomplete lesions.
Warnings & Risks
- Manipulating a spine with suspected cord injury can worsen damage.
- Inadequate examination may miss fractures or dislocations leading to paralysis.
Modern Application
While the diagnostic methods described here are foundational, modern imaging techniques like MRI provide more accurate and non-invasive assessments of spinal injuries. However, understanding historical diagnostic principles remains crucial for situations where advanced medical facilities are unavailable.
Frequently Asked Questions
Q: What is a critical sign indicating a lesion in a specific nerve?
Anesthesia or motor paralysis corresponding to the distribution of a particular nerve indicates a lesion of that nerve.
Q: How can one determine if there's a complete transverse lesion of the spinal cord?
If with complete paralysis there is also complete anesthesia to touch, pain, heat and cold, and the reflexes in the paralyzed area are entirely lost, it indicates that there is a complete transverse lesion of the cord.
Q: What does immediate onset paralysis after an injury suggest?
Immediate onset paralysis suggests compression, bruising, or actual crushing of the cord by displaced bone or a foreign body or to hemorrhage into the cord.