Overview of Cord Compression

Question 1

Where does the conus medullaris end in a foetus, a new-born, and an adult?

Answer 1

1. S2
2. L3
3. L1

Question 2

What is this a presentation of?
Neck stiffness, arm radiculopathy (pain, weakness, numbness), bilateral leg weakness, bladder and anal sphincter involvement. Motor, reflex, and sensory level involvement.

Answer 2

Cord compression

Question 3

In cord compression, what signs are present above and below the level of the compression?

Answer 3

Above - LMN

Below - UMN

Question 4

What are the causes of cord compression?

Answer 4

1. Secondary malignancy (breast, lung, thyroid, prostate, kidney)
2. Degeneration of annulus fibrosis - disc prolapse
3. Haematoma (warfarin)
4. Infection, myeloma
5. Any cause of spinal stenosis

Question 5

How is a suspected cord compression investigated?

Answer 5

1. MRI is definitive imaging
2. Chest x-ray for primary lung metastases
3. FBC, ESR, B12, syphilis, U&Es, LFTs, PSA, serum electrophoresis.

Question 6

What is the treatment for cord compression?

Answer 6

1. Urgent dexamethasone in malignancy

2. More specific treatments - radiotherapy, chemotherapy, decompressive laminectomy.