Spinal Cord Compression

Question 1

Definition of spinal cord compression

Answer 1

Injury to the spinal cord with neurological symptoms dependent on the site and extent of the compression

Question 2

Aetiology of spinal cord compression

Answer 2

• Most common causes are SECONDARY TO TUMOUR and TRAUMA:
◦ Metastases: likely from either breast, lung, prostate, brain, thyroid and kidney)
◦ Disc prolapse
◦ Haematoma
◦ Infection: epidural abscess
◦ Direct cord contusion

Question 3

History and examination of spinal cord compression

Answer 3

• Back pain: Common complaint in bone metastasis, may also get nocturnal pain
• Weakness:
• Bilateral leg weakness: depending on level of compression
• Arm weakness: suggests cervical cord lesion
• Normal finding above lesion
• LMN findings at the level of the lesion: wasting, hyporeflexia, hypotonia
• UMN signs below the level of the lesion: upgoing plantars etc
• Can be progressive symptoms
• Sensory loss
• Bladder and anal sphincter involvement: can manifest as hesitancy, frequency and painless retention

Question 4

Investigations for spinal cord compression

Answer 4

• MRI Spine: do not delay imaging, X rays are unreliable
• CXR: to identify any primary lung malignancy
• FBC, LFTs (ALP), calcium, immunoglobulin electrophoresis (multiple myeloma), PSA

Question 5

Treatment of spinal cord compression

Answer 5

• For MALIGNANCY, give urgent dexamethasone (and prophylactic PPI) and consider radiotherapy or chemotherapy
• May need decompressive surgery