Which incomplete SCI syndrome is most consistent with sacral sensory sparing?

Which incomplete SCI syndrome is most consistent with sacral sensory sparing?

• A. Central cord syndrome
• B. Brown-Séquard syndrome
• C. Anterior cord syndrome
• D. Posterior cord syndrome

Answer: (A)

Central cord syndrome is tested by recognizing patterns of how specific tracts are affected in an incomplete SCI. In this syndrome, the injury centers in the cervical spinal cord and tends to hit the central gray matter and crossing fibers more than the long ascending tracts that run to the lower segments. The result is a dissociated pattern: the arms (upper extremities) show more pronounced weakness and sensory disruption, while the sacral region remains relatively spared. In practical terms, sacral sensation can be preserved even when surrounding areas are impaired, because the central lesion preferentially disrupts fibers serving the upper body and motor pathways at the level, with less impact on the sacral pathways that remain intact below the lesion. This combination—greater impairment in the upper limbs with preservation of sacral (lower) sensation—fits sacral sensory sparing best. By contrast, Brown-Séquard would produce a clear pattern of ipsilateral motor and vibration/proprioception loss with contralateral pain and temperature loss below the lesion; posterior cord syndrome mainly impairs vibration and proprioception with preserved motor function; anterior cord syndrome would typically disrupt motor and pain/temperature pathways with dorsal column modalities (pressure, vibration, proprioception) spared, which doesn’t emphasize sacral sparing in the same dissociated way.

Central cord syndrome is tested by recognizing patterns of how specific tracts are affected in an incomplete SCI. In this syndrome, the injury centers in the cervical spinal cord and tends to hit the central gray matter and crossing fibers more than the long ascending tracts that run to the lower segments. The result is a dissociated pattern: the arms (upper extremities) show more pronounced weakness and sensory disruption, while the sacral region remains relatively spared. In practical terms, sacral sensation can be preserved even when surrounding areas are impaired, because the central lesion preferentially disrupts fibers serving the upper body and motor pathways at the level, with less impact on the sacral pathways that remain intact below the lesion. This combination—greater impairment in the upper limbs with preservation of sacral (lower) sensation—fits sacral sensory sparing best.

By contrast, Brown-Séquard would produce a clear pattern of ipsilateral motor and vibration/proprioception loss with contralateral pain and temperature loss below the lesion; posterior cord syndrome mainly impairs vibration and proprioception with preserved motor function; anterior cord syndrome would typically disrupt motor and pain/temperature pathways with dorsal column modalities (pressure, vibration, proprioception) spared, which doesn’t emphasize sacral sparing in the same dissociated way.