Spinal Cord Compression Flashcards
What are causes of spinal cord compression?
- Trauma (age 16-30)
- Vertebral compression fracture
- Intervertebral disc herniation (30-50)
- Primary or metastatic spinal tumour (40-75)
- Infection
What are different types of spinal cord compression?
- acute
- subacute
- chronic
What are RF for spinal cord compression?
- Trauma
2. High risk occupation or sports activity
What are possible symptoms and signs of spinal cord compression?
- Acute/chronic onset and duration of symptoms
- Back pain
- Numbness or paraesthesia’s
- Weakness or paralysis
- Bladder or bowel dysfunction
- Hyper-reflexia
- Sensory loss
- Muscle weakness or wasting
What are DDx for spinal cord compression?
- Transvere myelitis
- Guillain-Barre syndrome (GBS)
- HIV-related myelopathy
- ALS
- MS
- Diabetic neuropathy
- Polymyositis
- Hereditary Muscular dystrophy
- Peripheral neuropathy
What investigations may you do for spinal cord compression?
- MRI spine
- Gadolinium-enhanced MRI spine
- Plain spine X ray
- CT spine
- CT myelography
What may an MRI spine show?
- disc displacement
- epidural enhancement
- mass effect
- T2 cord signal
What can gadolinium enhanced MRI spine?
- infection: epidural space and bone involvement
2. metastatic disease: visualisation of tumour
What would a plain spine X ray show for which type of condition?
- decreased disc space height (disc compression)
- loss of bony detail (tumour, infection)
- misalignment of vertebral elements (trauma)
- loss of end-plate definition (infection)
What is the 1st line management for spinal cord compression unknown cause?
1st line: immobilisation + decompressive/stabilisation surgery
What would you add to the management of spinal cord compression?
- IV corticosteroid e.g. methylprednisolone
- Prevention of DVT
- Maintenance of volume and BP
- Prevention of gastric stress ulcers
What is the 1st line treatment for cauda equina?
decompressive laminectomy
What is the the 1st line treatment of a malignant spinal cord compression?
1st line: Corticosteroids, surgery, radiotherapy
What is the 1st line treatment of epidural abscess?
1st line: antibiotics and surgery
What are possible complications of spinal cord compression?
- Pressure ulcers
- Post-op autonomic dysfunction
- Cardiovascular dyfunction
- DVT
- UTI
- Etc
What is the prognosis of spinal cord compression?
Recurrence rates of malignant spinal cord compression: 7-9%
What is spinal cord compression?
Injury to the spinal cord with neurological symptoms dependent on the site and extent of injury
What are the motor symptoms?
- Limb weakness (hemiplegia/paraplegia)
- UMN symptoms below the level of the lesion
- LMN symptoms at the level of the lesion
What are the sensory symptoms?
- Sensory loss below a specific level
2. Back pain
What are the autonomic symptoms in spinal cord compression?
- Constipation
- Urinary retention
- Erectile dysfunction
What radiological investigations are used?
- Definitive diagnosis – MRI
- May also use CT
- Lateral x-rays of spine for loss of alignment , fractures
What bloods are done?
FBC, U&Es, calcium, ESR, immunoglobulin electrophoresis (multiple myeloma?)
What urine tests are done?
Ø Bence Jones proteins (multiple myeloma?)
What is cauda equina syndrome?
Lumbosacral nerves roots that form the cauda equina in the spinal canal become compressed
