Spinal Cord Compression Flashcards

1
Q

Definition

A

Spinal cord injury 2’ to external pressure = injury to white matter and grey matter in cord resulting in loss of sensory and motor function

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2
Q

Types of spinal cord compression

A

Acute
Sub-acute
Chronic

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3
Q

When is spinal cord compression classed as cauda equina syndrome

A

L1/L2

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4
Q

Aetiology

A
  • Trauma: car accidents, sport injuries, knife injury
  • Vertebral compression fractures: osteoporosis, osteomalacia, spinal subluxation
  • Intervertebral disc disease: disc herniation, disc protrusion
  • Tumours: metastatic disease, primary sarcoma, CNS tumours
  • Infection: discitis, epidural abscess, TB (Pott’s disease), osteomyelitis
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5
Q

Epidemiology

A
  • Trauma (MC) - 16-30 year olds
  • High risk sporting activity: horse-riding, motor racing, diving
  • High risk occupation: construction, military, firefighting
  • Malignancy: breast, prostate, renal, lung, multiple myeloma mets
  • Age
  • Immunosuppression: osteomyelitis, discitis, epidural abscess
  • IV drug use: osteomyelitis, discitis, epidural abscess
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6
Q

Signs

A

UMN weakness below lesion
- loss of muscle power
- increased tone
- hyperflexia
Sensory deficit: pinprick, fine touch, vibration, temperature, joint-position sense
Spinal shock:
- hypo- or areflexia below the level of injury
- motor paralysis below the level of injury
Neurogenic shock:
- typically cervical/high thoracic injury
- bradycardia
- peripheral vasodilation
- poikilothermia
- decreased cardiac output
- priapism

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7
Q

Symptoms

A
  • Acute onset: more likely trauma or disc herniation
  • Insidious onset: more likely malignancy, osteoporosis
  • Back pain
  • Paresthesia
  • Weakness
  • Bladder or bowel dysfunction
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8
Q

Complete spinal cord injury

A

All motor and sensory function below the SCI level lost
E.g. high cervical cord level
- quadriplegia
- respiratory insufficiency
- loss of bladder and bowel function
- neurogenic shock

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9
Q

Central cord syndrome

A
  • Usually involves cervical spine
  • Weakness in upper extremities > weakness in lower extremities
  • Variable sensory loss below the level of injury
  • Most common pattern of incomplete SCI
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10
Q

Anterior cord syndrome

A
  • Disruption of anterior spinal cord or anterior spinal artery
  • Loss of motor function below the level
  • Loss of pain and temperature sensation (anterior column)
  • Preservation of fine touch and proprioception (posterior column)
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11
Q

Posterior cord syndrome

A
  • Disruption of posterior spinal cord or posterior spinal artery (rare)
  • Motor function retained
  • Loss of fine touch and proprioception (posterior column)
  • Preservation of pain and temperature sensation (anterior column)
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12
Q

Brown-sequard syndrome

A
  • Hemisection lesion of the spinal cord
  • Unilateral spastic paralysis
  • Ipsilateral loss of vibration and proprioception
  • Contralateral loss of pain and temperature sensation
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13
Q

Diagnosis

A

FIRST LINE:
- Full neurological examination: tone, power, sensation, reflexes, proprioception
- GOLD STANDARD = MRI whole spine
= Rarely spinal cord injury without radiographic abnormality (SCIWRA) may occur.
Consider:
- Blood cultures: osteomyelitis suspected
- CSF culture: epidural abscess or CNS infection
- CT thorax, abdomen and pelvis: sus met disease

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14
Q

Treatment MDT support

A
  • VTE prophylaxis: due to reduced mobility
  • Nutritional input: if dysphagia or reduced oral intake
  • Blood pressure support: if neurogenic shock
  • PPI cover : to prevent gastric stress ulceration
  • Ventilatory support: if high cervical lesion affecting respiratory effort
  • Physiotherapy
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15
Q

Acute traumatic SCC Tx

A
  • Immediate immobilisation
  • Surgical spinal cord decompression and stabilisation
  • IV corticosteroids: not always used in traumatic SCC, CI in gunshot injury due to limited evidence
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16
Q

Malignanct SCC Tx

A
  • Dexamethasone: reduce inflammation
  • Radiotherapy: usually performed as a palliative measure in context of metastatic disease
  • Surgery: depending on impact of radiotherapy, age and prognosis
17
Q

Infective spinal cord compression

A

(e.g. epidural abscess)
- IV antibiotics
- Surgery: spinal cord decompression vs CT-guided needle aspiration if antibiotic therapy is insufficient

18
Q

Complications

A
  • Respiratory compromise
  • CV dysfunction: bradycardia , AV block , SVT , cardiac arrest
  • Autonomic dysfunction : orthostatic hypotension, heat intolerance, impaired bladder and bowel control
  • Pressure ulcers: LOM
  • Thromboembolism : reduced mobility
  • UTI : increased risk with impaired bladder emptying
  • Heterotopic ossification
  • Depression
  • Iatrogenic complications : haemorrhage, infection, nerve root injury during operation