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Acute and Chronic Pathomorphological Reactions to Cord Injury

  • H. Schneider

Summary

The complex pathomorphological aspects of spinal cord injury suggest the contribution of different and overlapping factors. The different aspects of the vulnerability of the spinal cord are summarized. It seems to be justified to differentiate between arterial, capillary and venous lesions. The traumatic myelopathy is characterized by the microcirculatory failure at the injured segment and increased permeability and impaired drainage of the postcapillary and venous vessels within and beyond the impact site.

The primary traumatic lesions consist of direct damage to all structures of the injured level of the spinal cord. The autodestructive and progressive involvement of the microvasculature in the central gray matter is characteristic of the early post-traumatic lesions, leading to central hemorrhagic necrosis and focal ischemia. The edema formation and the following edematous necrosis of the central white matter (predominantly in the ventral parts of the dorsal columns) indicates impaired venous drainage as the decisive pathological factor in the delayed posttraumatic phase.

The acute and chronic morphological sequelae of spinal cord injury as the cause of conduction failure for somatosensory evoked potentials involve at least two general problems of spinal cord pathology: first the pathological reactions and the lesion patterns of the white matter, second the vascular factors contributing to the traumatic malacia of the cord.

The essential anatomical picture of spinal cord injury is that of contusion, laceration and compression, either alone or in combination. The morphological changes in the cord after blunt injury depend on the type, extent and dynamic of trauma. The cord suffers first from the direct injury to axons, myelin sheaths, neurons and blood vessels. These primary lesions are followed by a chain of events leading to focal ischemia, breakdown of the microcirculation, edema and, finally, hemorrhagic necrosis of the cord. The reparative phase varies considerably. The posttraumatic myelopathies like arachnoiditis or syringomyelia become manifest months and years after the incident.

Keywords

Spinal Cord Spinal Cord Injury Gray Matter Anterior Spinal Artery Hemorrhagic Necrosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag Berlin Heidelberg 1985

Authors and Affiliations

  • H. Schneider
    • 1
  1. 1.Zentralinstitut für Seelische GesundheitMannheim 1Germany

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