Spinal cord compression

Question 1

What is meant by spinal cord compression?

Answer 1

Spinal cord compression (SCC) results from processes that compress or displace arterial, venous, and cerebrospinal fluid spaces, as well as the cord itself/

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

Question 2

What are some of the risk factors for spinal cord compression?

Answer 2

Trauma
Malignancy
Osteoporosis
Metabolic bone disease
Vertebral disc disease

Question 3

What are the different causes of spinal cord compression?

Answer 3

Trauma, vertebral compression fractures (low energy trauma in patients with osteoporosis or osteomyelitis), vertebral metastases (lung, breast or prostate cancer), intervertebral disc disease (herniation), infection

• Acute Onset = trauma or disc herniation
• Chronic Onset = malignancy (vertebral metastases), osteoporosis, osteomyelitis

Question 4

What are the common causes for spinal cord compression in each age group?

Answer 4

16-30 yrs old → Trauma

30-50 yrs old → Disc Disease

40-75 yrs old → Malignancy

Question 5

What are the presenting symptoms of spinal cord compression?

Answer 5

History of trauma or malignancy
Pain
Weakness
Sensory loss
Disturbance of bowel and bladder function

Question 6

Summarise the epidemiology of cord compression

Answer 6

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

Question 7

What signs of spinal cord compression can be found on physical examination?

Answer 7

• UMN signs below level of lesion. LMN signs at level of lesion.
  1. Back Pain → earliest and most common symptom (worse when lying down or coughing = red flag for growth or tumour)
  2. Numbness/Sensory Loss or Paraesthesia
  3. Sensory Loss → at level of lesion
  4. Weakness or Paralysis → bilateral below affected level of spinal cord
  5. Bladder or Bowel Dysfunction → faecal incontinence + urinary retention
  6. Hyper-Reflexia
• Cauda-Equina Syndrome (lumbosacral nerve roots that extend below the spinal cord are compressed) → commonly caused by disc herniation (L4/L5 or L5/S1). Decreased reflexes, saddle anaesthesia, faecal incontinence, urinary incontinence, bilateral sciatica, decreased anal tone

Question 8

What investigations are used to diagnose/ monitor spinal cord compression?

Answer 8

1. Radioloyg:
   - MRI Spine (Whole Spine)→ may see disc displacement or mass effect. Recommended within 24 hours of presentation.
   - Lateral radiographs of spine to look for loss of alignment, fractures etc.
2. Bloods:
   - FBC, U&Es, calcium, ESR, immunoglobulin electrophoresis (multiple myeloma), syphilis serology, LFTs, PSA
3. CXR for primary lung malignancy, TB
4. Urine - look for Bence Jones proteins (multiple myeloma)

Question 9

How is spinal cord compression managed?

Answer 9

Trauma → immobilisation, decompressive surgery, IV corticosteroids

Intervertebral Disc Compression (cauda equina) → decompressive laminectomy (involves removing a small piece of the back part (lamina) of the small bones of the spine (vertebrae). Laminectomy enlarges the spinal canal to relieve pressure on the spinal cord or nerves.)

Malignancy → high-dose oral dexamethasone

Question 10

What are some complications that may arise from spinal cord compression?

Answer 10

Pressure ulcers, UTI, DVT