Anterior spinal artery syndrome due to burst fracture dislocation at C5. This is an incomplete spinal cord injury because the patient has some motor and sensory function in his extremities, as well as preserved anal tone. The patient’s pertinent neurological examination findings (e.g., bilateral loss of motor, pain and temperature with preserved deep touch, and pressure throughout the body) are consistent with an anterior cord syndrome with associated myelopathic signs. Radiographic studies show evidence of a burst fracture at the C5 level. Additionally, he has signs of upper motor neuron dysfunction (Babinski’s sign). The patient does not show evidence of spinal shock (no flaccid paralysis in extremities & reflexes are present) or neurogenic shock (no hypotension or bradycardia).

The most common level of cervical vertebral fracture is C2 (approximately 1/3 of all C2 fractures are odontoid fractures) followed by C6 and C7. The most common level of subluxation injury is the C5–6 interspace, which is the area of greatest flexion and extension in the cervical spine.

The shoulders are supplied by C4 (Table 24.1). When testing sensation on the chest, remember that there is a skip from C4 to T2, with C5 through T1 represented in the upper extremities.

Patients with injured nerve roots can have abnormal deep tendon reflexes (Table 24.2). Some patients with acute spinal cord injuries may initially have completely blunted reflexes during the acute stage of spinal shock but later develop hyperactive and brisk reflexes as the inhibitory forces from upper motor neurons are lifted.

These are graded as 0 to 4+ with 2+ being normal. 0 is no response while 1+ is a sluggish one. A reflex that is more brisk than usual is 3+ and those with a clonus present are 4 + .

Patients with complete spinal cord injuries have no motor and sensory function below the level of injury. Patients with incomplete spinal cord injuries have some residual function below the level of injury.

Inability to breathe due to diaphragmatic paralysis, as well as paralysis of all four limbs.

Radiculopathy. The main symptom associated with radiculopathy is a burning, tingling pain that radiates down the limb. Clinical signs of radiculopathy include lower motor neuron signs such as loss of reflexes, weakness, and diminished sensation along dermatomal distributions.

Myelopathy. Patients experience intermittent neck pain that radiates into the shoulders or occiput. Clinical findings of myelopathy result from a spinal cord injury and include bilateral upper motor neuron signs (Table 24.3) such as diffuse hyper-reflexia, weakness and numbness in the extremities, and upward going toes (Babinski’s sign).