Question

Tom was recently diagnosed with a tumor in the posterior aspect of his spinal cord at the level of C6 that has resulted in a C5 incomplete spinal cord injury with changes in sensation. Based on the location of the tumor: 1. What ascending spinal tract(s) have been affected? 2. What types of sensation have been affected and what types remained intact? (i.e. temperature, pain, proprioception, etc.) 3. Where on Tom’s body will the sensory deficits be present? Use specific dermatomes. After Tom undergoes surgery to remove the tumor, he presents to inpatient rehabilitation to begin therapy. 1. Given the sensory changes you discussed above, what activities would be difficult for Tom to perform? (i.e. ADLs, functional mobility…) 2. If you were Tom’s occupational therapist, what interventions would you recommend to help with his recovery

Answer 1

1. The spinal cord extends caudally from the medulla and ends at the upper lumbar vertebrae, usually between the L1 and L2, forming the conus medullaris. As the patient is suffering from the tumor at C6, it affects even C5 and the area between C5 and C6 which mostly is involved in paralysis of legs, wrists and hands. Due to the spread of the tumor it might also cause weakness of shoulder abduction and elbow flexion. It might also cause loss of brachioradialis deep tendon reflex. At the C5 and above, it causes respiratory paralysis along with quadriplegia.
2. Some of the sensations and symptoms faced by Tom is back pain that gradually becomes worst, decreases sensation, paralysis in some of the areas that is controlled by the spinal cord, erectile dysfunction. The pressure on the spinal nerve roots might cause pain, tingling, numbness and the pain may radiate along the nerve of the compressed roots.
3. The spinal cord deficits are present in the compressed nerve roots as it might lead to extreme pain. It is present along the spinal cord from C5 and C6 and the nerve compression makes it even worst.

After surgery

Ans 1) The patient continues to face the tingling and pain for a while even after the surgery. It is difficult for them to walk properly and requires assistance. There is interference in functional mobility.

Ans 2) The recovery requires proper management and therapy. Acute oncological management is required for the complete recovery of the patient. Apart from the physiotherapy is needed to enhance the altered mobility.