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Neurosurgery > Ch. 15 - Spinal cord compression > Flashcards

Ch. 15 - Spinal cord compression Flashcards

1
Q

What are the 3 types of spinal cord compression?

A

Extradural, intradural/extramedullary, intramedullary

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2
Q

Most common intrathecal tumor

A

Schwannoma (neurofibroma)

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3
Q

Most common causes of malignant spinal cord compression

A

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

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4
Q

What is the most common type of spinal cord compression?

A

Extradural (80%) - most from metastases

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5
Q

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

A

Metastatic tumor, extradural abscess

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6
Q

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

A

Schwannoma > meningioma

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7
Q

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

A

Glioma (ependymoma > astrocytoma), syrinx

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8
Q

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

A
  1. Pain (common early feature)
  2. Neurologic deficit (esp. sensory level)
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9
Q

Describe ‘girdle’ pain

A

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

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10
Q

Lhermitte’s sign

A

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

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11
Q

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

A

Progressive weakness, sensory disturbance, sphincter disturbance

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12
Q

Describe the pattern of weakness in spinal cord compression

A

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

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13
Q

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

A

NO clinically demonstrable weakness!

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14
Q

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

A

Conus medullaris – mixture of LMN and UMN signs

Cauda equina – LMN signs

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15
Q

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

A

T4 – nipples

T7 – xiphisternum

T10 – umbilicus

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16
Q

Brown-Sequard syndrome

A

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

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17
Q

Clinical signs of sphincter disturbance

A

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

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18
Q

Best imaging modality for spinal cord compression

A

MRI

19
Q

Tx of spinal cord compression

A

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

20
Q

Surgical tx options for malignant spinal cord compression

A

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

21
Q

Why are glucocorticoids often used prior to spinal cord decompression?

A

Reduce local edema

22
Q

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

A

36 hours

23
Q

‘Dumb-bell’ tumor

A

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

24
Q

Population most commonly affected by spinal meningiomas

A

Middle-aged or elderly with marked FEMALE predominance

25
Q

Most common site for spinal meningioma

A

Thoracic region

26
Q

Most common site for ependymoma

A

Filum terminale leading to compression of cauda equina

27
Q

Cauda equina compression sxs

A

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

28
Q

Spinal cord ependymoma tx? Astrocystoma?

A

Ependymoma – macroscopic excision

Astrocytoma – NOT resectable; radiotherapy only

29
Q

Central posterior cervical disc herniation presentation? Most common levels?

A

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

30
Q

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

A

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

31
Q

Etiology of spinal epidural abscess?

A

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

32
Q

Most common site of primary infection causing epidural spinal abscess?

A

Skin/soft tissue > respiratory tract

33
Q

Most common causative organism of epidural spinal abscess?

A

Staphylococcus aureus >> Streptococcus sp.

34
Q

Tx of epidural abscess?

A

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

35
Q

Pott’s disease

A

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

36
Q

Spinal AVMs more common in males or females?

A

Males 4x more likely than females

37
Q

‘Steal’ phenomenon seen with spinal AVMs

A

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

38
Q

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

A

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

39
Q

What causes cervical myelopathy?

A

Cervical cord compression 2/2 narrow cervical vertebral canal

40
Q

DDx for cervical myelopathy

A

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

41
Q

Identify the lesion

A

Pott’s disease

42
Q

Identify the lesion

A

Epidural abscess

43
Q

Spinal column region most commonly affected by mets?

A

Thoracic

44
Q

Is meningitis more common with epidural or subdural abscesses?

A

Subdural

Neurosurgery (21 decks)

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