A physical therapy evaluation of a traumatic SCI patient shows complete loss of motor function, pain, and temperature below the level of the lesion on both sides, with preserved proprioception, vibration, and light touch. Which spinal tracts are most likely damaged?

A physical therapy evaluation of a traumatic SCI patient shows complete loss of motor function, pain, and temperature below the level of the lesion on both sides, with preserved proprioception, vibration, and light touch. Which spinal tracts are most likely damaged?

• A. Dorsal columns bilaterally
• B. Corticospinal tracts and spinothalamic tracts bilaterally, with preservation of the dorsal columns
• C. Lateral corticospinal tract and dorsal spinocerebellar tract on one side only
• D. Spinothalamic tracts bilaterally with preservation of all other tracts

Answer: (B)

The pattern being tested is what happens when the anterior two-thirds of the spinal cord are damaged. The corticospinal tracts (motor) and spinothalamic tracts (pain and temperature) lie in this region, so injury here causes bilateral loss of voluntary movement and loss of pain and temperature below the lesion. The dorsal columns, which carry proprioception, vibration, and fine touch, are in the posterior part and remain intact if only the anterior portion is affected. So the clinical picture—complete motor and pain/temperature loss on both sides with preserved proprioception, vibration, and light touch—fits anterior cord syndrome, typically from injury to the anterior spinal artery. This is why the best description is bilateral damage to the motor and pain/temperature pathways with dorsal columns spared. The other options don’t match: dorsal columns alone would disrupt proprioception/vibration; unilateral tract damage wouldn’t produce bilateral deficits; and spinothalamic damage with all other tracts preserved would leave motor function intact, which contradicts the motor loss observed.

The pattern being tested is what happens when the anterior two-thirds of the spinal cord are damaged. The corticospinal tracts (motor) and spinothalamic tracts (pain and temperature) lie in this region, so injury here causes bilateral loss of voluntary movement and loss of pain and temperature below the lesion. The dorsal columns, which carry proprioception, vibration, and fine touch, are in the posterior part and remain intact if only the anterior portion is affected. So the clinical picture—complete motor and pain/temperature loss on both sides with preserved proprioception, vibration, and light touch—fits anterior cord syndrome, typically from injury to the anterior spinal artery.

This is why the best description is bilateral damage to the motor and pain/temperature pathways with dorsal columns spared. The other options don’t match: dorsal columns alone would disrupt proprioception/vibration; unilateral tract damage wouldn’t produce bilateral deficits; and spinothalamic damage with all other tracts preserved would leave motor function intact, which contradicts the motor loss observed.