Spinal cord compression

Question 1

What is spinal cord compression?

Answer 1

injury to the spinal cord with neurological symptoms dependent on site + extent of injury

Question 2

What are most cases of spinal cord compression caused by?

Answer 2

TRAUMA:
Direct cord contusion  
Compression by bone fragments  
Haematoma  
Acute disk prolapse  
TUMOURS: more frequently METASTASES 
Other causes: spinal abscess, TB (Pott's disease)

Question 3

What is the epidemiology of spinal cord compression?

Answer 3

COMMON
Trauma occurs across all age groups
Malignancy/ disc disease is more common in the ELDERLY

Question 4

List risk factors for spinal cord compression

Answer 4

Trauma
Osteoporosis
Metabolic bone disease
Vertebral disc disease

Question 5

What will a patient have experienced if presenting with spinal cord compression?

Answer 5

Hx trauma

Tumour

Question 6

List 4 symptoms of spinal cord compression

Answer 6

Pain
Weakness
Sensory loss
Disturbance of bowel and bladder function

Question 7

List 7 signs of spinal cord compression

Answer 7

Diaphragmatic breathing
Reduced anal tone
HYPERreflexia
Priapism (persistent + painful erection)
Spinal shock (low BP without tachycardia)
Sensory Loss: at level of the lesion
Motor dysfunction

Question 8

What symptoms may be caused by a large central lumbar disc prolapse?

Answer 8

Bilateral sciatica
Saddle anaesthesia (loss of sensation)
Urinary retention

Question 9

What motor symptoms may be caused by spinal cord compression?

Answer 9

Weakness or paralysis
UMN signs BELOW the level of the lesion
LMN signs AT the level of the lesion

Question 10

What is Brown-Sequard Syndrome?

Answer 10

HEMISECTION of the spinal cord (due to tumour or disc herniation).
Ipsilateral spastic paralysis
Ipsilateral loss of vibration + proprioception
Contralateral pain + temperature sensation loss from from 1-2 segments below the lesion.

Question 11

What are the investigations for spinal cord compression?

Answer 11

MRI spine: disc displacement, epidural enhancement, mass effect
Bloods:
FBC (WCC= infection)
U+Es
Calcium + Immunoglobulin electrophoresis (multiple myeloma)
ESR (infection/ inflammation)
Urine: Bence Jones proteins (multiple myeloma)

Question 12

What is Cauda equine syndrome?

Answer 12

Compression of nerves caudal to the level of spinal cord termination

Question 13

List 3 causes of cauda equine syndrome

Answer 13

Herniation of a lumbar disc (most common) large central lumbar disc herniation at L4/L5 + L5/S1 level
Tumours: mets, lymphomas, spinal tumours.
Trauma.
Infection e.g. epidural abscess

Question 14

List 7 signs and symptoms of caudal equine syndrome

Answer 14

Low back pain + pain in legs
Lower limb motor weakness + sensory deficits: usually asymmetrical with loss of reflexes
Saddle anaesthesia.
Loss of anal tone + sensation.
Urinary dysfunction (retention, difficulty starting or stopping, overflow incontinence, decreased bladder + urethral sensation)
Bowel disturbances: incontinence + constipation.
Sexual dysfunction.

Question 15

What may suggest spinal cord compression rather than cauda equine syndrome?

Answer 15

Increased lower limb reflexes + other UMN signs e.g. extensor plantars indicate spinal cord involvement + excludes CES