Pattern of neurological dysfunction in spinal cord disease

Abstract

Spinal cord injury includes all diseases, which affect neural structures within the spinal canal surrounded by the vertebral column, namely, the spinal cord and nerve roots leaving and entering the spinal cord. Within the spinal cord, white and gray matter contain neural structures, which represent components of both the central and peripheral nervous system. The white matter contains all long descending and ascending axon pathways mediating sensory, motor, and autonomic functions between the brain and respective end organs. The gray matter with millions of interneurons and motoneurons represents the neuronal relay station at each segmental level, which modulate sensory, motor, and autonomic function between the input and output centers. Based on the neuroanatomical organization of the neural structures within the spinal canal (spinal cord with its respective "compartments" and nerve roots), a variety of distinct patterns of neurological dysfunction relevant for clinicians, therapists, as well as scientists aiming for spinal cord repair will be described. Patterns distinguishing a spinal cord lesion from brain or peripheral nervous system disease, specific for individual spinal cord segments, as well as phenomena such as sacral sparing will be described. The relevance of the identification and description of distinct patterns in respect to the prediction of etiology, outcome, and treatment efficacy will be discussed.