Spinal Cord Compression

Question 1

Corticospinal tracts carry info about primary motor activity. How many neurones in tract?

Answer 1

2 neurone tract - upper motor neurone from motor cortex to anterior grey horn and lower motor neurone is anterior horn cell

Question 2

Where does corticospinal tract decussate?

Answer 2

Upper motor neurone decussates in medulla so ipsilateral

Question 3

What are 4 features of upper motor neurone lesion?

Answer 3

Increased tone,
muscle wasting NOT marked,
no fasciculation,
hyper-reflexia

Question 4

What are 4 features of lower motor neurone lesion?

Answer 4

Decreased tone,
muscle wasting,
fasciculation,
diminished reflexes

Question 5

What are the 2 sensory pathways?

Answer 5

Spinothalamic tracts and dorsal column

Question 6

What sensory info does spinothalamic tract carry?

Answer 6

Pain, temp and coarse touch

Question 7

At what level does spinothalamic tract decussate?

Answer 7

Spinal level so contralateral

Question 8

What sensory info does dorsal column carry?

Answer 8

Fine touch, proprioception and vibration

Question 9

At what level does dorsal column decussate?

Answer 9

Medullary level so ipsilateral

Question 10

List 4 causes of acute spinal cord compression

Answer 10

Trauma
Tumours
Infection - abscess or osteomyelitis and collapse
Spontaneous haemorrhage

Question 11

List 3 causes of chronic cord compression

Answer 11

Degenerative disease - spondylosis
Tumours
Rheumatoid arthritis

Question 12

Most common cause of chronic cord compression is degenerative diseases causing spinal canal stenosis. List 5 ways they can compress

Answer 12

facet hypertrophy
Ligamentum flavum hypertrophy
bone spurs
disc prolapse
Subluxation

Question 13

In complete lesion of cord there are both sensory and motor levels affected. If caused by bony lesion the sensory and motor level injured may not correspond to the bony lesion level, why is this?

Answer 13

Because spinal cord is shorter than the spine

Question 14

How do complete lesions present? (Initially and later)

Answer 14

Initially: flaccid arreflexic paralysis AKA spinal shock
Later: UMN signs

Question 15

What is Brown-Sequard Syndrome?

Answer 15

Cord Hemisection

Question 16

How does Brown-Sequard Syndrome present? (Neuro terms)

Answer 16

Ipsilateral motor level
Ipsilateral dorsal column sensory level
Contralateral spinothalamic sensory level

Question 17

How does Brown-Sequard Syndrome present? (Basic terms)

Answer 17

Loss of motor function on ipsilateral side
Loss of vibration, proprioception and coarse touch??? on ipsilateral side
Loss of pain, temp and fine touch??? on contralateral side

Question 18

What causes central cord syndrome?

Answer 18

Hyperflexion or extension injury to already stenotic neck so often old people with spondylosis

Question 19

4 features of central cord syndrome?

Answer 19

Predominantly distal upper limb weakness, “cape-like” spinothalamic sensory loss, lower limb power preserved, dorsal columns preserved

Question 20

What explains the predominantly upper limb weakness in central cord syndrome?

Answer 20

Upper limb elements of corticospinal tract are on inside and lower limb on outside

Question 21

What is the main difference between acute and chronic spinal cord compression in terms of symptoms?

Answer 21

UMN signs predominate in chronic

Question 22

What are the usual types of extradural tumours compressing spine?

Answer 22

Usually metastasis: lung, breast, kidney, prostate, thyroid or haematological malignancies

Question 23

What are the usually types of intradural tumours that can cause spinal cord compression?

Answer 23

Extramedullary meningioma, schwannoma

Question 24

What are the usual types of intramedullary tumours that can compress spinal cord?

Answer 24

Astrocytoma, ependymoma

Question 25

Tumours can cause both acute and chronic cord compression. How can they cause acute?

Answer 25

By causing vertebral collapse or haemorrhage

Question 26

What types of infection cause spinal cord compression and what is most common bacteria?

Answer 26

Epidural abscess (e.g. bloodborne staph/TB)
Surgery
Trauma
Staph most common

Question 27

What are three types of spinal haemorrhage that can cause cord compression?

Answer 27

Epidural
Intradural
Intramedullary

Question 28

List 4 causes of spinal haemorrhage

Answer 28

Trauma,
Bleeding diatheses,
Anticoagulants,
Arterio-venous malformations

Question 29

What is management for trauma causing spinal cord compression

Answer 29

Immobilise,
Investigate: X-ray/CT, later MRI if no neurological deficit
Decompress + stabilise: surgery, traction, external fixation

Question 30

Outline management options for metastatic tumours causing cord compression

Answer 30

Depends on patient + tumour 
dexamethasone,
radio,
chemo,
Surgical decompression & stabilisation

Question 31

Surgical excision is a management option for primary tumours causing cord compression. True/false?

Answer 31

True

Question 32

Outline management options for infection causing spinal cord compression

Answer 32

Antimicrobial therapy, surgical drainage, stabilisation when required & ideally once infection eradicated

Question 33

If disc is intact and bone is destroyed it’s more likely to be ______ process. If disc is destroyed and bone is intact it’s more likely to be ______ process.

Answer 33

Disc intact bone destroyed - malignant

Disc destroyed and bone intact - infective

Question 34

Outline management for haemorrhage causing cord compression

Answer 34

Reverse anticoagulation,

Surgical decompression if neuro deficit

Question 35

Management for degenerative disease causing cord compression

Answer 35

Decompression +/- stabilisation