Clinical Pathophysiology of Spinal Signs and Symptoms

Abstract

Abstract The first task of the physician examining a patient with suspected spinal cord disease is to establish the presence or absence of such disease and, if present, then the location(s) of the lesion(s). The lesion’s anatomical coordinates are its (1) “level” in the rostrocaudal axis, and (2) the extent of the lesion in the transverse plane of the spinal cord. These coordinates are determined by clinically testing specific functions of the myotomes and dermatomes served by both nerve roots and tracts that may be involved. A third coordinate is the time-course of evolution of spinal cord dysfunction; this is often important in predicting the etiology and the physiological response of the cord to compression, and in determining prognosis. For example, a patient with a long-standing lesion, such as a benign meningioma, may manifest few signs, whereas a patient with a malignancy of comparable size that is rapidly enlarging may be paraplegic.