Spinal Cord Compression

Question 1

What is the main symptom of corticospinal tract compression?

Answer 1

Weakness

Question 2

What is the main symptom of dorsal column compression?

Answer 2

Reduced fine touch, vibration and proprioception

Question 3

What is the main symptom of spinothalamic tract compression?

Answer 3

Reduced pain, temperature, gross touch

Question 4

Do the corticospinal tract, dorsal column and spinothalamic tract produce ipsilateral or contralateral symptoms?

Answer 4

Corticospinal - ipsilateral
Dorsal column - ipsilateral
Spinothalamic - contralateral

Question 5

What are acute causes of spinal cord compression?

Answer 5

Trauma
Malignancy causing pathological fractures
Infection and abscess
Spontaneous haemorrhage

Question 6

What are chronic causes of spinal cord compression?

Answer 6

Malignancy causing bony metastases

Degenerative disease causing spondylosis, osteoarthritis

Question 7

What is the presentation of spinal cord compression?

Answer 7

Neurological deficits - weakness, loss of balance, saddle anaesthesia
Back pain in chronic
- radicular type pain
- often precedes the neurological deficits
- is made worse by coughing
Systemic - urinary retention, constipation

Question 8

What are the different patterns of spinal cord compression?

Answer 8

Complete compression or transection
Brown-Sequard syndrome
Central cord syndrome - central ischaemia

Question 9

What symptoms does complete compression of the spinal cord cause?

Answer 9

Complete loss of neurological function below the level of the spine affected
- sensory and motor
- +/- urinary and bowel disturbance
Spinal shock immediately after compression - hypotonia, areflexia, paralysis
UMN signs in days after the compression - hyperreeflexia, hypertonia, paralysis

Question 10

What is Brown-Sequard syndrome?

Answer 10

Unilateral compression or transection of spinal cord

Question 11

Wha symptoms does Brown-Sequard syndrome cause?

Answer 11

Contralateral - loss of pain, temperature and gross touch

Ipsilateral - weakness, loss of proprioception, vibration, light touch

Question 12

What causes central cord syndrome?

Answer 12

Whiplash injury in elderly patients who have underlying cervical spine stenosis
the whiplash pinches the blood vessels and causes an ischaemia that starts centrally and spreads outwards if blood supply continues to be compromised

Question 13

What 2 tracts are affected in central cord syndrome?

Answer 13

Corticospinal as it lies more medial, especially fibres supplying upper limbs
Spinal as fibres have to cross through the ischaemic zone

Question 14

What is the presentation of central cord syndrome?

Answer 14

Upper limb weakness

Band-like loss of pain, temperature and gross touch on the back in a cape distribution

Question 15

What investigation is done for spinal cord compression?

Answer 15

X-ray or CT

Question 16

What is the management of spinal cord compression?

Answer 16

Immobilisation
Steroids if delay in surgery
Surgical intervention if appropriate
Radiotherapy if surgery not possible or if bony mets

Question 17

When is surgical intervention done?

Answer 17

If a single vertebral region is involved
If no evidence of metastatic disease
If radio-resistant primary tumour
If unknown cause - to get tissue sample