Matching the findings to the cord anatomy
The client cannot move his legs and cannot feel pinprick or temperature below the injury, yet he feels light touch and knows whether his toes are moved up or down (position sense). Each finding maps to a tract. Motor function travels in the corticospinal tracts, and pain and temperature travel in the spinothalamic tracts; both lie in the front two-thirds of the cord. Fine touch, vibration, and position sense travel in the dorsal columns at the back. Loss of motor function and pain and temperature with preserved touch and position sense means the front of the cord is damaged while the back is spared: anterior cord syndrome.
How anterior cord syndrome happens
Anterior cord syndrome usually follows injury to the anterior spinal artery, flexion injury, or disc or bone fragments pressing on the front of the cord. Because the dorsal columns have a separate blood supply from the posterior spinal arteries, they are spared. The loss is bilateral below the level. Prognosis for motor recovery is generally poorer than in other incomplete syndromes, so safety teaching about protecting areas that cannot feel pain or heat is important.
| Syndrome | Motor | Pain/temperature | Touch, vibration, position |
|---|
| Anterior cord | Lost, both sides | Lost, both sides | Preserved |
| Posterior cord | Preserved | Preserved | Lost |
| Brown-Séquard | Lost same side | Lost opposite side | Lost same side |
| Central cord | Arms weaker than legs | Variable | Variable |
Why the other syndromes do not fit
Central cord syndrome typically follows cervical hyperextension in older adults and weakens the arms more than the legs; this client has a thoracic injury with leg paralysis. Brown-Séquard syndrome is a half-cord injury with a split pattern: motor and position loss on the same side and pain and temperature loss on the opposite side. His losses are on both sides without such a split. Posterior cord syndrome is the reverse of his pattern: position and vibration are lost while motor function is preserved.
Nursing implications
Because he cannot feel pain or temperature below the level, he is at risk of burns and pressure injuries he cannot sense. The nurse teaches him to check water temperature with a body part that has sensation, inspect his skin daily, and shift weight regularly. His preserved position sense can help with transfers and rehabilitation.
Exam takeaway
Key point Anterior cord syndrome: motor and pain/temperature lost, touch and position preserved. Remember that the dorsal columns carry touch, vibration, and position.