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4/3: Elderly/Orthopaedics Y3/4 - MSK [11] (check ILOs) > [2] Spinal Cord Compression > Flashcards

[2] Spinal Cord Compression Flashcards

1
Q

What is the importance of acute spinal cord compression (ASCC)?

A

It is a surgical emergency requiring immediate neurosurgical treatment

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2
Q

What does the prognosis of ASCC vary most depending on?

A

Time between diagnosis and treatment

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3
Q

What causes ASCC?

A

Any pathology that leads to compression of the spinal cord compression

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4
Q

What is the most common cause of ASCC?

A

Metastatic spinal cord compression (MSCC)

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5
Q

What are the categories of causes of ASCC?

A

Neoplastic
Traumatic
Infective
Disc prolapses

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6
Q

What primary malignancies most commonly caused metastatic spinal cord compression?

A 
Thyroid
Lung 
Breast 
Renal 
Prostate
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7
Q

What primary tumours can cause ASCC?

A

Primary bone tumours

Haemotological malignancies, such as non-Hodgkins lymphoma and myeloma

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8
Q

What are the traumatic causes of ASCC?

A

Typically a vertebral fracture or facet joint dislocation

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9
Q

What is possible in a vertebral fracture or facet joint dislocation?

A

Complete severance of the cord

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10
Q

How can infections cause ASCC?

A

Can lead to abscess formation and cause compression of the spinal cord

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11
Q

What chronic infections can cause ASCC?

A

Tuberculosis

Fungal infections

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12
Q

Why is disc prolapse a rare cause of spinal cord compression?

A

Because lumbar disc herniation typically causes compression of the cauda equina inferior to the spinal cord

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13
Q

What can lead to an increased risk of developing ASCC?

A

Any pathology that can predispose to a narrowed cord canal

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14
Q

What kinds of pathologies can lead to a narrowed cord canal?

A

Inflammatory conditions

Degenerative conditions

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15
Q

Give two inflammatory conditions that can cause a narrowed spinal cord canal

A

RA

Ankylosing spondylitis

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16
Q

Give two degenerative conditions that can cause a narrowed spinal cord canal

A

Ligamentum flavum hypertrophy

Osteophyte formation, contributing to spinal stenosis

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17
Q

What are the history and examination vital for in suspected spinal cord compression?

A

Differentiating acute spinal cord compression from simple disc herniation

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18
Q

What are the clinical features of ASCC?

A 
Impaired sensation and proprioception
Pain
Weakness
UMN signs 
Autonomic involvement
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19
Q

What effect will ASCC have on sensation and proprioception?

A

It will often be impaired at the dermatomal levels below the cord compression

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20
Q

What aggravates the pain caused by ASCC?

A

Straining, e.g. Coughing and sneezing

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21
Q

Does ASCC cause unilateral or bilateral weakness?

A

Can be either

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22
Q

What proportion of MSCC are non-ambulatory at diagnosis?

A

About 2/3

23
Q

What is the diagnostic importance of UMN signs being present in ASCC?

A

It can differentiate it from peripheral nerve compression or cauda equina syndrome, which has LMN signs

24
Q

Give 4 examples of UMN signs that may be seen in ASCC

A

Hypertonia
Hyperreflexia
Babinski’s sign
Colnus

25
Q

Where are the UMN signs present in ASCC?

A

Below the level of the lesion

26
Q

What tends to happen to reflexes in ASCC?

A

They tend to be absent at the level of the lesion

27
Q

Why do reflexes tend to be absent at the level of the lesion in ASCC?

A

Because the lower motor neurone within the ventral horn is compressed, so produces a lower motor neurone deficit

28
Q

What is the relevance of any autonomic involvement in ASCC

A

It is a late stage, and therefore carries a worse prognosis

29
Q

What clinical features are associated with autonomic involvement in ASCC?

A

Bowel incontinence, or constipation and urinary retention

30
Q

What features may be diagnostically useful in ACSS?

A

May be signs of an underlying cause, e.g. Malignant features such as weight loss and tiredness

31
Q

What lower motor neurone sign is often the initial manifestation of ASCC?

A

Flaccidity

I dont really get this, but the card IS supposed to say LMN

32
Q

What do cord injuries at T12 or above tend to cause over time?

A

Bladder spasticity

33
Q

What are the differential diagnoses for spinal cord compression?

A

Lumbago
Sciatica
Cauda equina syndrome

34
Q

How can lumbago be differentiated from spinal cord compression?

A

Lumbago causes pain solely around the lower lumbar area, with no radiation

35
Q

How will sciatica present?

A

With lower back pain spreading to the buttocks or lower limbs, depending on dermatome affected

36
Q

What are lumbago and sciatica often caused by?

A

A disc herniation pressing on the exiting nerve

37
Q

What is the result of the disc herniation pressing on the exiting nerve in lumbago and sciatica?

A

It produces LMN signs

38
Q

What is cauda equina syndrome typically caused by?

A

Lumbar disc herniation, compressing the cauda equina

39
Q

How does cauda equina syndrome present?

A

LMN signs

Bladder/bowel disturbances

40
Q

What is the gold standard investigation for ASCC?

A

MRI of the whole spine

41
Q

How quickly should an MRI of the whole spine be carried out in suspected ASCC?

A

Within a week if spinal mets are suggested

Within a day if the cord is believed to be compressed

42
Q

Are routine bloods helpful in ASCC?

A

Yes, especially if the underlying cause is not apparent

43
Q

What investigations should be done as a result of the high chance of surgical intervention if ASCC is present?

A

G&S and clotting screen

44
Q

What is involved in the immediate management of ACSS?

A

High dose corticosteroids should be given immediately, alongside a PPI for gastric protection

45
Q

What corticosteroid regime is typically given in ASCC?

A

Typically 16mg dexamethasome PO stat, then 8mg BD thereafter

46
Q

What is the purpose of high dose corticosteroids in ASCC?

A

Improve patients prognosis

47
Q

What should be done following imaging in ASCC?

A

Immediate referral to neurosurgery and an oncological opinion will be sought as required

48
Q

What is the definitive treatment option for MSCC?

A

Surgical compression, if the patient is fit enough for surgery

49
Q

What might be done alongside surgical decompression for MSCC?

A

Radiotherapy and chemotherapy

50
Q

What does the use of radiotherapy and chemotherapy in MCSS depend on?

A

The sensitivity of the tumour

51
Q

What does the prognosis of MCSS depend on?

A

The extent that the disease has progressed before decompression, as well as the underlying cause

52
Q

What is one of the best indicators of prognosis in MCSS?

A

Mobility state at the time of treatment - 90% of ambulatory patients remain mobile, whereas only 1/3 of non-ambulatory patients at presentation will regain the ability walk

53
Q

What is the survival rate for MSCC patient?

A

About 6 months after onset

54
Q

Why is the survival rate of MCSS so short?

A

Due to the nature of metastatic disease, it is likely that the patient will be in an advanced phase of cancer if this is the underlying cause

4/3: Elderly/Orthopaedics Y3/4 - MSK [11] (check ILOs) (38 decks)

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