Myelotomy:[5][6]

Placing an incision on the surface of the spinal cord is known as myelotomy.

A posterior median sulcus approach - for most intramedullary gliomas and ependymomas

Lateral myelotomy - for vascular tumors such as hemangioblastoma or cavernous malformation

Limited midline myelotomy - for intractable visceral pain

Cordotomy:[7]

Cervical cordotomy - the nociceptive pathways in the lateral spinothalamic tract (anterolateral column) are surgically destroyed at the level of C1-C2. This is done for pain relief in unilateral malignancies and lower limb pathologies.

Spinal cord disorders, injuries (SCIs), or syndromes may include (but are not limited to)[8][9][10]

• Traumatic (ground-level falls in the elderly, high-energy motor vehicle accidents in any age group) 
  • The incidence and prevalence of traumatic SCI in the United States is higher compared to rates reported in the literature for other countries worldwide[11][12]
  • The average age at clinical presentation continues to increase, corresponding to the aging of the general population[11]
  • Heightened clinical suspicion should be given to vertebral compression fractures which can occur spontaneously (i.e., in the absence of trauma)[13][14][15][16][17][18]
• Infection[19]
• Tumors/malignancy (including metastatic disease)[20][21][22]
• Disc herniations[23][24]
• Spinal stenosis/degenerative conditions/facet arthropathy[23][25][26][27][28]
• Syringomyelia[29][30]

In general, the extent of disability depends on the level of injury and the underlying degree of severity of the corresponding clinical pathology.  For example, injuries at the levels of the cervical segment affect both upper and lower limbs while lesions from thoracic segments downwards affect the lower limb.[31] 

Spinal cord injury (SCI) patterns

• Descriptive
  • Tetraplegia
    • Cervical spine injury resulting in impaired arm/trunk/leg/pelvic organ function
  • Paraplegia
    • Thoracic/lumbar/sacral spinal injury leading to impaired trunk/leg/pelvic organ function
    • Preserved arm function
  • Complete injuries
    • By definition, a complete SCI yields no sparing of the motor or sensory function below the injured level
      • The patient must have already recovered from the acute phase of spinal shock (usually 48 hours from presentation)
      • Spinal shock: by definition, the temporary (typically 48 hours) loss of all spinal cord function (including reflex activity) below the level of injury
        • Absent bulbocavernosus reflex
        • Flaccid paralysis
        • Bradycardia/hypotension
• Spina bifida - Neural tube defect in which the neural tube does not completely close leaving a dorsal defect. Folate deficiency in early pregnancy is a risk factor.[32] The severity of symptoms depends on the extent of the defect; myelomeningocele is the most severe variant with the spinal cord, meninges both exposed. Other variants include meningocele, which exposes only the meninges, and spina bifida occulta which is the mildest. Symptoms include loss of lower limb sensations, lower limb weakness, urinary incontinence, bowel incontinence

Incomplete spinal cord injuries (SCIs)

• Central cord syndrome[8]
  • Most common incomplete SCI
  • Pathophysiology: central gray matter injury
  • Mechanism(s): hyperextension (i.e., from a fall) in a patient with underlying cervical spinal canal stenosis
  • Clinical presentation:
    • Upper extremity loss of motor function (lower extremity motor function no affected/minimally affected)
    • Sensory sparing variable
  • Prognosis: Good
• Anterior cord syndrome[31] 
  • Second most common incomplete SCI
  • Pathophysiology: injuries occur secondary to direct compression to the anterior spinal cord (e.g., hyperflexion injuries, anterior spinal artery occlusion, or disc prolapse)
  • Mechanism(s): hyperflexion injuries, anterior spinal artery occlusion, disc prolapse
  • Clinical presentation:
    • Loss of motor, pain, and temperature reception below the level of injury
    • Preserved dorsal column function (i.e., proprioception, vibration sensation, and deep pressure sensation)
  • Prognosis: Poor (for motor recovery specifically)
• Posterior cord syndrome[33]
  • Very rare/least common incomplete SCI pattern of injury
  • Pathophysiology: injury to the dorsal column
  • Mechanism(s): 
    • subacute combined degeneration
    • tabes dorsalis (i.e., secondary to syphilis)
    • multiple sclerosis
    • vascular malformations (arterio-venous malformation - AVM)
    • malignancy (e.g., compressive extramedullary tumors)
    • degenerative conditions (e.g., spondylosis)
  • Clinical presentation:
    • Loss of proprioception, vibration, and deep pressure sensation below the level of injury
    • Preserved ambulatory function
      • patients will complain of difficulty balancing in the dark or with his/her eyes closed
    • Classic exam consistent with a positive Romberg sign
  • Prognosis: Preserved ambulatory function; dorsal column recovery unpredictable
• Spinal cord hemisection/hemicord (Brown-Sequard syndrome)[34]
  • Rare (2% to 4% of SCIs)[35]
  • Pathophysiology: trauma to one side of the spinal cord (in cross-sectional reference)
  • Mechanism(s): 
    • Penetrating trauma (knife, gunshot wound)
  • Clinical presentation:
    • Ipsilateral loss of motor and proprioception (directly below the level of injury)
    • Contralateral loss of pain/temperature
      • Classically the contralateral pain/temperature loss occurs one to two levels below the level of injury)
  • Prognosis: 90% recover ambulatory function
• Cauda equina syndrome[33][36]
  • Pathophysiology: Injury to (only) the nerve roots of the cauda equina itself (i.e., spares the spinal cord itself) 
  • Mechanism(s):
    • disc herniations
    • burst fractures (e.g., associated hematoma from trauma)
  • Clinical presentation:
    • bilateral buttock/lower extremity pain
    • bowel/bladder dysfunction (urinary retention)
    • saddle anesthesia
    • loss of lower extremity motor/sensory function
      • differentiated from conus medullaris syndrome in that findings are asymmetrical, as opposed to symmetrical (i.e. conus medullaris motor symptoms are symmetrical on presentation)
  • Prognosis: surgical decompression within the first 48 hours appears to yield improved overall outcomes (although the overall prognosis remains guarded)
• Conus medullaris syndrome[33]
  • Often confused with cauda equina syndrome, although this must be recognized as a separate clinical entity
  • Pathophysiology: injury to the spinal cord at L1-L2 level
  • Mechanism(s):
    • Direct spinal trauma to the thoracolumbar junction[33]
  • Clinical presentation:
    • Saddle anesthesia
    • bowel/bladder dysfunction (often presents with dysfunction more acutely compared to cauda equina which can evolve over a variable period time prior to the patient's presentation)
    • classically presents with mild, symmetrical motor symptoms (often mixed upper and lower motor neuron syndromes)
      • can present with both spasticity and flaccid paresis
      • hyperreflexia and/or hyporeflexia
    • Prognosis: guarded

• Epidural anesthesia - Injecting anesthetic medications into the epidural space, using a catheter and multiple dosing is achievable.
• Subarachnoid anesthesia- anesthetic medications delivered into the subarachnoid space, usually between L3 and L5.[37]
• Lumbar puncture - Tiny needle through L3 and L5 to obtain CSF from the subarachnoid space for biochemical and microbiology investigations.