Ch. 15 - Spinal cord compression

Question 1

What are the 3 types of spinal cord compression?

Answer 1

Extradural, intradural/extramedullary, intramedullary

Question 2

Most common intrathecal tumor

Answer 2

Schwannoma (neurofibroma)

Question 3

Most common causes of malignant spinal cord compression

Answer 3

Lung CA > breast CA > prostate CA > kidney CA > lymphoma > myeloma

Question 4

What is the most common type of spinal cord compression?

Answer 4

Extradural (80%) - most from metastases

Question 5

What are the most common causes of extradural spinal cord compression?

Answer 5

Metastatic tumor, extradural abscess

Question 6

What are the most common causes of intradural/extramedullary spinal cord compression?

Answer 6

Schwannoma > meningioma

Question 7

What are the most common causes of intramedullary spinal cord compression?

Answer 7

Glioma (ependymoma > astrocytoma), syrinx

Question 8

What 2 major presenting features are the hallmarks of spinal cord compression?

Answer 8

1. Pain (common early feature)
2. Neurologic deficit (esp. sensory level)

Question 9

Describe ‘girdle’ pain

Answer 9

Pain radiating around chest wall 2/2 thoracic cord compression, with involvement of thoracic nerve roots

Question 10

Lhermitte’s sign

Answer 10

Flexion or extension of neck causing ‘electric shock’ or tingling radiating down through body to extremities; associated with cervical cord involvement

Question 11

What do the neurological features of spinal cord compression consist of?

Answer 11

Progressive weakness, sensory disturbance, sphincter disturbance

Question 12

Describe the pattern of weakness in spinal cord compression

Answer 12

‘Pyramidal’ pattern with flexor movements most severely affected and extensor movements (e.g. hip extension, knee extension, plantar flexion) preserved

Question 13

What nerve root weakness will be demonstrated by a mass below T1 in the thoracic area?

Answer 13

NO clinically demonstrable weakness!

Question 14

What pattern of weakness is seen with conus medullaris involvement? Cauda equina compression?

Answer 14

Conus medullaris – mixture of LMN and UMN signs

Cauda equina – LMN signs

Question 15

At what level does the T4 dermatome lie? T7? T10?

Answer 15

T4 – nipples

T7 – xiphisternum

T10 – umbilicus

Question 16

Brown-Sequard syndrome

Answer 16

Hemisection causing contralateral impairment of pain and temperature sensation, with ipsilateral pyramidal weakness and impairment of joint position sense, vibration, and fine touch

Question 17

Clinical signs of sphincter disturbance

Answer 17

Enlarged, palpable bladder (2/2 urinary retention), diminished perianal sensation, and decreased anal tone

Question 18

Best imaging modality for spinal cord compression

Answer 18

MRI

Question 19

Tx of spinal cord compression

Answer 19

Urgent decompression except for some malignant tumors (high-dose steroids and radiotherapy)

Question 20

Surgical tx options for malignant spinal cord compression

Answer 20

Decompressive laminectomy (posterior approach) OR vertebrectomy and fusion (anterior approach)

Question 21

Why are glucocorticoids often used prior to spinal cord decompression?

Answer 21

Reduce local edema

Question 22

A poor prognosis for neurological recovery is suggested by how many hours of complete paraplegia?

Answer 22

36 hours

Question 23

‘Dumb-bell’ tumor

Answer 23

Intrathecal tumor (e.g. schwannoma) extending through intervertebral foramen

Question 24

Population most commonly affected by spinal meningiomas

Answer 24

Middle-aged or elderly with marked FEMALE predominance

Question 25

Most common site for spinal meningioma

Answer 25

Thoracic region

Question 26

Most common site for ependymoma

Answer 26

Filum terminale leading to compression of cauda equina

Question 27

Cauda equina compression sxs

Answer 27

Low back and leg pain, progressive leg weakness, saddle anesthesia, sphincter disturbance

Question 28

Spinal cord ependymoma tx? Astrocystoma?

Answer 28

Ependymoma – macroscopic excision Astrocytoma – NOT resectable; radiotherapy only

Question 29

Central posterior cervical disc herniation presentation? Most common levels?

Answer 29

Sudden onset of severe neck pain with rapidly progressive paralysis (LMN features at level of compression and UMN below); usually C5/6 or C6/7

Question 30

Why is the low thoracic region considered a ‘watershed’ area?

Answer 30

T8-L2 often largely supplied by a single unilateral radicular vessel (artery of Adamkiewicz); can contribute to disc degeneration

Question 31

Etiology of spinal epidural abscess?

Answer 31

Hematogenous spread from distant or occult infection OR direct spread from adjacent intervertebral disc or vertebral column (esp. pedicle or neural arch)

Question 32

Most common site of primary infection causing epidural spinal abscess?

Answer 32

Skin/soft tissue \> respiratory tract

Question 33

Most common causative organism of epidural spinal abscess?

Answer 33

Staphylococcus aureus \>\> Streptococcus sp.

Question 34

Tx of epidural abscess?

Answer 34

Urgent laminectomy + complete evacuation of abscess + high-dose abx

Question 35

Pott’s disease

Answer 35

Spinal tuberculosis (osteomyelitis) affecting 2 or more adjacent vertebral bodies with destruction of intervening disc space

Question 36

Spinal AVMs more common in males or females?

Answer 36

Males 4x more likely than females

Question 37

'Steal' phenomenon seen with spinal AVMs

Answer 37

AVM steals blood from normal neural tissue causing local spinal cord hypoxia

Question 38

Subarachnoid hemorrhage associated with sudden severe back pain. What is the diagnosis?

Answer 38

Spinal AVM (15% of patients present with subarachnoid hemorrhage)

Question 39

What causes cervical myelopathy?

Answer 39

Cervical cord compression 2/2 narrow cervical vertebral canal

Question 40

DDx for cervical myelopathy

Answer 40

Spinal tumor, multiple sclerosis, motor neuron disease, syringomyelia, subacute combined degeneration of cord

Question 41

Identify the lesion

Answer 41

Pott's disease

Question 42

Identify the lesion

Answer 42

Epidural abscess

Question 43

Spinal column region most commonly affected by mets?

Answer 43

Thoracic

Question 44

Is meningitis more common with epidural or subdural abscesses?

Answer 44

Subdural