What is the medical condition that causes spinal transection?

Spinal Cord Transection: Causes and Clinical Context

Spinal cord transection is not a "syndrome" but rather a catastrophic injury pattern most commonly caused by high-energy trauma, particularly motor vehicle accidents, falls, violence, and sports injuries, with atlanto-occipital dislocation representing one of the most severe mechanisms. 1, 2

Primary Traumatic Causes

Complete spinal cord transection occurs through several distinct traumatic mechanisms:

• High-energy trauma including motor vehicle accidents, falls from height, violence, and sports injuries are the predominant causes of complete spinal cord transection 1
• Atlanto-occipital dislocation (AOD) with complete medulla/cervical spinal cord transection represents an extreme form, historically considered fatal due to the high level of injury and typically requiring immediate resuscitation at the scene for any chance of survival 2
• Vertebral fracture-dislocations at junctions between mobile and immobile spinal segments (particularly thoracolumbar and cervical regions) can result in complete cord transection 3

Important Clinical Distinction: Central Cord Syndrome

Central cord syndrome should NOT be confused with complete transection—it represents an incomplete injury pattern:

• Central cord syndrome is actually the most common incomplete spinal cord injury, characterized by disproportionate upper extremity weakness compared to lower extremities, with variable sensory loss and bladder dysfunction 4, 5
• This syndrome typically occurs in older adults with pre-existing cervical stenosis following hyperextension injuries from low-energy falls, not from complete transection 4
• The mechanism involves compression of the central spinal cord between hypertrophic disc-osteophyte complexes and buckled ligamentum flavum, causing central gray matter injury—not anatomic transection 4

Non-Traumatic Causes of Severe Cord Injury

While less common than trauma, several non-traumatic conditions can cause severe cord damage:

• Vascular injuries including anterior spinal artery syndrome and epidural hematoma (particularly in anticoagulated patients) 1, 6
• Spinal cord ischemia from atheromatous disease, aortic surgery complications, thoracoabdominal aneurysms, or fibrocartilaginous embolic disease 4
• Infectious processes such as epidural abscess 6
• Neoplastic compression from primary or metastatic tumors 6

Critical Prognostic Factors

Complete transection carries devastating prognosis:

• Injuries resulting in complete medulla/spinal cord transection have an Injury Severity Score of 75, which is "by definition unsurvivable" without immediate resuscitation 2
• Long-term survival is possible with aggressive support, but patients remain ventilator-dependent and fully dependent for all care without prospect of functional recovery 2
• The ethical considerations of maintaining life support in such cases remain controversial 2

Clinical Classification

The ASIA Impairment Scale defines complete transection as ASIA A:

• ASIA A represents complete SCI with no motor or sensory function preserved in the lowest sacral segments 1
• This contrasts with incomplete injuries (ASIA B through D) where varying degrees of function remain below the injury level 1