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4/3: Elderly/Neuro Y3/4 - Neuro and Stroke [12] > [18] Spinal Cord Compression > Flashcards

[18] Spinal Cord Compression Flashcards

1
Q

What is spinal cord compression?

A

A medical emergency where the there is compression or displacement of the arterial, venous and CSF spaces, as well as the cord itself

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2
Q

What are the possible causes of spinal cord compression?

A
  • Trauma
  • Tumours
  • Irradiation
  • Prolapsed intervertebral disc
  • Epidural or subdural haematoma
  • Inflammatory disease
  • Spinal infections
  • Cervical spondylitic myelopathy
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3
Q

What types of traumatic incident may cause spinal cord compression?

A
  • Car accidents
  • Falls
  • Sports injuries
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4
Q

How do traumatic injuries lead to spinal cord compression?

A

Vertebral fracture or facet joint dislocation

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5
Q

What types of tumours can cause spinal cord compression?

A

Benign or malignant

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6
Q

What malignancies can cause spinal cord compression?

A
  • Primary bone tumours
  • Metastatic tumours
  • Lymphomas
  • Multiple myeloma
  • Neurofibromata
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7
Q

What primary cancers most commonly metastasise to bone?

A
  • Breast
  • Prostate
  • Lung
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8
Q

When is irradiation (leading to spinal cord compression) often encountered?

A

Radiotherapy

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9
Q

Which intervertebral discs most commonly prolapse to cause spinal cord compression?

A

L4-L5 or L5-S1

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10
Q

What inflammatory disease can especially cause spinal cord compression?

A

Rheumatoid arthritis

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11
Q

What are the subtypes of infective spinal cord compression?

A

Acute and chronic

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12
Q

What is the usual type of causative organism in acute infective spinal cord compression?

A

Bacteria

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13
Q

What are the usual types of causative organism in chronic infective spinal cord compression?

A

TB or fungal

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14
Q

What is cervical spondylitic myelopathy?

A

An aging process leading to narrowing of the spinal canal due to osteophytes, herniated discs and ligamentum flavum hypertrophy

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15
Q

What are the risk factors for spinal cord compression?

A
  • Age 16-30
  • Male
  • Osteoporosis
  • Risk of trauma
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16
Q

Why is osteoporosis a risk factor for spinal cord compression?

A

It is associated with vertebral column compression fractures

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17
Q

What type of trauma related risk factors increase the risk of spinal cord compression?

A
  • High risk occupation

- High-risk recreational activities

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18
Q

Over what period do the symptoms of spinal cord compression develop?

A

Quickly or slowly depending on the cause

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19
Q

What are the common symptoms of spinal cord compression?

A
  • Pain and stiffness in neck, back or lower back
  • Burning pain that spreads to the arms, buttocks or down into the legs (sciatica)
  • Numbness, cramping or weakness in arms, hands or legs
  • Loss of foot sensation
  • ‘Foot drop’
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20
Q

What can foot drop lead to?

A

Limp (high stepping gait)

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21
Q

In addition to the common symptoms of spinal cord compression, what else can develop over time?

A

Motor, sensory, and autonomic dysfunction

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22
Q

What does the clinical features of spinal cord compression depend on?

A

Extent, rate, and site of the spinal cord compression development

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23
Q

What are the red flags suggesting spinal cord compression?

A
  • Insidious progression
  • Neurological symptoms
  • Neurological signs
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24
Q

What neurological symptoms are red flags for spinal cord compression?

A
  • Gait disturbance
  • Clumsy or weak hands
  • Loss of sexual, bladder, or bowel function
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25
Q

What neurological signs are red flags for spinal cord compression?

A
  • Lhermitte’s sign
  • UMN signs in lower limbs
  • LMN signs in upper limbs
  • Sensory changes
26
Q

What is Lhermitte’s sign?

A

Flexion of the neck causing an electric shock-type sensation that radiates down the spine and into the limbs

27
Q

What UMN signs can be seen in the lower limbs in spinal cord compression?

A
  • Babinski’s sign
  • Hyper-reflexia
  • Clonus
  • Spasticity
28
Q

What is Babinski’s sign?

A

Up-going plantar reflex

29
Q

What LMN signs may be seen in the upper limbs in spinal cord compression?

A
  • Atrophy

- Hyporeflexia

30
Q

What sensory changes may be seen in spinal cord compression?

A

Loss of vibration and joint position sense

31
Q

What investigations can be used in assessing spinal cord compression?

A
  • MRI spine
  • Gadolinium-enhance MRI spine
  • Plain spine x-ray
  • CT spine
32
Q

Which of the previously listed imaging modalities is the study of choice for assessing spinal cord compression?

A

MRI spine

33
Q

What may an MRI of the spine show in spinal cord compression?

A
  • Disc displacement
  • Epidural enhancement
  • Mass effect
  • T2 cord signal
34
Q

When may a gadolinium-enhanced MRI be used in spinal cord compression?

A

If there is suspicion of infection (osteomyelitis) or epidural abscess

35
Q

What may also be seen on gadolinium-enhanced MRI in spinal cord compression other than infection?

A

Metastatic disease

36
Q

What can be seen on a plain spine x-ray if the underlying cause of the spinal cord compression is disc compression?

A

Decreased disc space height

37
Q

What can be seen on a plain spine x-ray if the underlying cause of the spinal cord compression is a tumour?

A

Loss of bony detail

38
Q

What can be seen on a plain spine x-ray if the underlying cause of the spinal cord compression is trauma?

A

Misalignment of vertebral elements

39
Q

What can be seen on a plain spine x-ray if the underlying cause of the spinal cord compression is infection?

A
  • Loss of bony detail

- Loss of end-plate definition

40
Q

When might a CT spine be used to assess spinal cord compression?

A
  • MRI unavailable

- Surgical planning

41
Q

What do further investigations (beyond imaging) depend on in spinal cord compression?

A

The suspected underlying cause

42
Q

What further investigations may be required in spinal cord compression?

A
  • FBC
  • ESR and CRP
  • Blood or CSF cultures
  • Tumour biopsy and histopathology
  • Urodynamic studies
  • PET scan of spine
43
Q

When may FBC be abnormal in spinal cord compression?

A

Raised WBC if an infection is the cause

44
Q

When may ESR and CRP be raised in spinal cord compression?

A

Underlying infection or inflammation

45
Q

When may blood or CSF cultures be positive in spinal cord compression?

A
  • Epidural abscess
  • Discitis
  • Osteomyelitis
46
Q

When are urodynamic studies useful in spinal cord compression?

A
  • Evaluate degree of sphincter dysfunction

- Monitor recovery of function post-decompression surgery

47
Q

What are the potential differentials for spinal cord compression?

A
  • Transverse myelitis
  • Guillain-Barre syndrome
  • HIV-related myelopathy
  • Amyotrophic lateral sclerosis (ALS)
  • MS
  • Diabetic neuropathy
  • Polymyositis
  • Hereditary muscular dystrophy
  • Peripheral neuropathy
48
Q

In what position should a patient with spinal cord compression be nursed initially and for how long?

A

Flat, neutral spine alignment until spinal stability and neurological stability are ensured

49
Q

What should be given in spinal cord compression until a definitive treatment plan is made?

A

Dexamethasone

50
Q

What other supportive therapy steps can be used in spinal cord compression?

A
  • Mange postural hypotension
  • Insert catheter
  • Techniques to clear airways
  • VTE prophylaxis
  • Prevention of pressure ulcers
  • Pain control
51
Q

What techniques can be used to clear the airways in spinal cord compression?

A
  • Breathing exercises
  • Assisted coughing
  • Suction
52
Q

How can pain be managed in spinal cord compression?

A
  • Analgesia
  • Palliative radiotherapy
  • Spinal orthoses
  • Vertebroplasty
  • Spinal stabilisation surgery
53
Q

When should a definitive treatment be started in spinal cord compression if one is possible?

A

Before the ability to walk is lost and ideally within 24 hours

54
Q

What definitive treatment options are available for spinal cord compression?

A
  • Surgery

- Radiotherapy

55
Q

What types of surgery can be used to treat spinal cord compression?

A
  • Laminectomy

- Posterior decompression

56
Q

What should be provided to a patient post-discharge with spinal cord compression?

A

Community based rehab and support

57
Q

What do complications of spinal cord compression depend on?

A

The site of compression and severity of dysfunction

58
Q

What are the potential complications of spinal cord compression?

A
  • Pressure sores
  • Hypothermia
  • Lung complications
  • Depression
59
Q

What lung complications can occur as a result of spinal cord compression?

A
  • Aspiration pneumonia
  • Acute respiratory distress syndrome
  • Atelectasis
  • Ventilation-perfusion mismatch
  • Decreased coughing with retention of secretions
60
Q

Why is depression often a complication of spinal cord compression?

A

There may be restriction of ADL’s

4/3: Elderly/Neuro Y3/4 - Neuro and Stroke [12] (33 decks)

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