REHABILITATION OF A PATIENT WITH POSTERIOR CORD SYNDROME 


Introduction: Posterior cord syndrome is a rare spinal cord injury syndrome (about 0,2% of SCI). The posterior column is damaged resulting in a defect in light touch and proprioception, while the spinothalamic tract is left intact. Causes are syphilis, B12 deficiency, posterior spinal artery infarction and more. 

Purpose: To underline the importance of sensory impairment 

Method: Case report presentation 

Results: A 54 years old male patient was admitted in the neurosurgical department because of an inability to walk during the past week with a history of fall 10 days earlier. A month earlier he had had an anterior discectomy at the C4-5 level with no functional deficit at discharge. He presented with a muscle power deficit of both upper and lower extremities and a fracture of C5 was found in CT. After surgery, he improved having normal muscle power and a sensory deficit from C4 level (AIS D, A3 neurological level) mainly of light touch and proprioception. Despite the normal muscle power, ambulation was not functional. The defective gait (sensory ataxia, muscle tone defect with the suspicion of spasticity was excluded with neurophysiologic testing as Η reflex/Μ ratio was normal) and the difficulty of fine movements lead to the diagnosis of posterior cord syndrome, followed by an in-patient rehabilitation program focused on visual control and sensory retraining. At discharge the patient could walk short distances with help and fine movements were improved. 

Discussion and Conclusion: Of major importance for the rehabilitation of a patient with an incomplete spinal cord injury are the thorough clinical examination and the subsequent modification of the rehabilitation program, especially dealing with sensory deficits, which substantially deteriorate gait and functional level in general.