15. Diseases of the spinal cord

The causes of myelopathy are various. The damage to the spinal cord may be complete (as in the case of complete spinal cord injury) but it is more often incomplete (as in the case of an incomplete traumatic spinal cord injury and most types of myelopathy due to non-traumatic causes). There are some ‘classic’ spinal cord syndromes, but they can present atypically. In practice, information from the history-taking combined with examination of the main tract systems enables the localization of the damage to be determined and a differential diagnosis to be formulated. A basic knowledge of the anatomy (the siting of tract systems, segmental levels) of the spinal cord (Chap. 4) and an understanding of central and peripheral weakness and the patterns of various sensory modalities are needed to understand neurological symptoms at spinal cord level properly. Given this knowledge, it is generally not difficult to determine the level and spread of the spinal cord problem. This chapter begins with a brief introduction including a description of a complete spinal cord injury by way of illustration (sect. 15.1). A brief section on diagnostic imaging (sect. 15.2) is followed by three sections on traumatic structural lesions (sect. 15.3), non-traumatic structural lesions (sect. 15.5) and non-structural lesions (sect. 15.6). In between (sect. 15.4) we deal with the diagnostic options for non-traumatic disorders. Demyelinating disorders follow in Chap. 25, and hereditary syndromes in Chap. 26. Spina bifida is discussed in Chap. 29 (sect. 29.3.2).