White matter changes in human spinal cord injury

Abstract

The neurological disability in human spinal cord injury (SCI) is not determined by the local gray matter changes but by the interruption of the long white matter pathways. Typically in flexion, rotation or extension injuries of the cervical spine there is central haemorrhagic necrosis of the gray matter and a variable degree of disruption of the surrounding white matter depending on the severity of the trauma. Although the central gray matter is destroyed at the level of the lesion it does not usually cause a serious clinical problem due to the overlapping segmentai innervation of myotomes and dermatomes. Within the white matter there may be involvement only of the propriospinal pathways or the lesion may extend more widely and affect the long tracts. However it is unusual for the spinal cord to be completely transected in road trauma, industrial or sporting accidents, the usual causes of SCI. More often there is some preservation of the white matter in human SCI.