Last reviewed:September 2019
Last updated:December  2018



History and exam

Key diagnostic factors

  • motor weakness
  • loss of fine motor coordination
  • spasticity
  • paresthesia, numbness, dysesthesia
  • hyperreflexia and ankle clonus
  • pathologic reflexes
  • contractures
  • loss of perianal sensation, voluntary anal contraction and anal tone
  • autonomic dysreflexia
  • syrinx

Other diagnostic factors

  • central (midline) pain
  • girdle pain
  • musculoskeletal or visceral pain
  • unsteady gait
  • urinary incontinence or retention
  • constipation
  • sexual dysfunction
  • nonspecific malaise
  • radicular pain

Risk factors

  • spinal cord trauma or ischemia
  • higher level spinal cord lesion
  • extremes of age
  • narrow spinal canal
  • male sex

Diagnostic investigations

Investigations to consider

  • MRI spine
  • EMG
  • urodynamic studies
  • bladder ultrasound
  • micturition cystourethrogram
Full details

Treatment algorithm


Clinical Associate Professor of Surgery (Neurosurgery)

Michigan State University School of Medicine

Clinical Associate Professor of Physical Medicine and Rehabilitation

Wayne State University School of Medicine

Surgical Director Intensive Care

Oakwood Southshore Medical Center



KC declares that he has no conflicts of interest.

Dr Kenneth Casey would like to gratefully acknowledge Dr Jwalant S. Mehta, a previous contributor to this topic. JSM declares that he has no competing interests.

Peer reviewersVIEW ALL

Medical Director and Director of Spinal Cord Injury Services

Kessler Institute for Rehabilitation

West Orange


University of Medicine and Dentistry of New Jersey/New Jersey Medical School




SK declares that he has no competing interests.

Consultant in Rehabilitation Medicine

Robert Jones and Agnes Hunt Hospital




DS declares that she has no competing interests.

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