26th June 2023

Complete Cord Transection

Distribution of motor and sensory loss in complete lower thoracic spinal cord transection.

Image Source: Dr D Chang – own work

In a complete cord transection, there is a loss of motor function (corticospinal), pain and temperature sense (spinothalamic), and touch and proprioception sense (dorsal column) below the lesion, which can result in paraplegia or tetraplegia with loss of all sensory input depending on the level of the lesion. The affected limbs will initially be flaccid and areflexic due to spinal shock before progressing to hypertonic and hyper-reflexive clinical findings with bilateral upgoing plantar reflexes (Babinski’s sign).

Autonomic dysfunction is also a feature, with disruption to urinary and rectal sphincter functions mediated by sympathetic/parasympathetic pathways, which can manifest as anhidrosis, impaired temperature control and loss of the cremasteric reflex (stroking of the medial thigh causing the cremaster muscle to contract and pull up the ipsilateral testicle toward the inguinal canal.)

Its aetiology is primarily due to traumatic and inflammatory causes. Inflammatory causes include multiple sclerosis and postinfectious inflammation from viral, bacterial, and fungal causes, and it can be a very rare complication of vaccination.

It can also result from trauma, such as a traumatic spinal injury or herniated intervertebral disc, and other mechanical causes, such as tumour and metastatic disease.

Prognosis of recovery in traumatic cases is poor with a less than 5 percent chance of recovery of function; recovery in nontraumatic cases is dependent on aetiology.