Spinal Cord Compression

Question 1

Three types of lesions that compress spinal cord?

Answer 1

• extradural (80%)
• intradural, extramedullary (15%)
• intramedullary (5%)

Question 2

Extradural compression?

Answer 2

• metastatic tumor

- extradural abscess

Question 3

Intradural, extramedullary?

Answer 3

• meningioma

- schwannoma

Question 4

Intramedullary?

Answer 4

• glioma (astro/ependy)

- syrinx

Question 5

Main causes of spinal compression?

Answer 5

• tumor
• degenerative
• infection
• hematoma
• developmental

Question 6

Presentation of spinal compression?

Answer 6

Pain

Neuro deficit

Question 7

Which type of pain is most specific for spinal compression?

Answer 7

girdle pain, aggravated w/ valsalva

Question 8

Describe central pain?

Answer 8

burning quality, diffuse

described with difficulty

Question 9

What is Lhermitte’s sign?

Answer 9

sign of cervical cord involvement

flexion/extension of neck causes electric shock or tingling down the body to extremities.

Question 10

What are the components of neurological deficit 2/2 to spinal compression?

Answer 10

• progressive weakness
• sensory disturbance
• sphincter disturbance

Question 11

Describe progressive weakness?

Answer 11

• compression of corticospinal pathways (UMN signs)

- cauda equina is LMN

Question 12

Describe dermatomal sensory disturbance?

Answer 12

T4 - nipples
T7 - xiphoid
T10 - umbilicus

Question 13

Describe sphincter disturbance?

Answer 13

first difficulty initiating micturation, followed by urinary retention, constipation, fecal incontinence

Question 14

Which malignant tumor is most common that causes extradural spinal cord compression?

Answer 14

• lung

breast, prostate, kidney

Question 15

Schwannoma?

Answer 15

• most common intrathecal tumor
• from posterior nerve roots
• slow growing
• pain and radicular sx
• might see brown-sequard
• excise via laminectomy

Question 16

Spinal meningioma?

Answer 16

• middle aged/elderly/female
• slow growing
• ill defined back pain at night
• MRI w/ gad
• Tx resection of tumor and involved dura

Question 17

Intramedullary tumor?

Answer 17

• ependymoma

- astrocytoma (cant resect astro, radiotherapy)

Question 18

Cervical disk prolapse?

Answer 18

• central posterior disc herniation causes rapidly progressive paralysis with UMN features below the level of compression and LMN features at level

Question 19

Where is thoracic disc prolapse most common?

Answer 19

T8 level
ages 30 - 55 men
tx with excision of disc protrusion

Question 20

What is the blood supply of t8-l2?

Answer 20

artery of adamkiewicz

Question 21

What causes a spinal abscess?

Answer 21

• hematogenous spread OR

- adjacent intervertebral disc infection

Question 22

What is the most common pathogen?

Answer 22

S. aureus

Question 23

What is tx of spinal abscess?

Answer 23

urgent laminectomy or anterior approach

• complete evacuation of abscess
• abx

Question 24

spinal AVM?

Answer 24

• steal phenomenon
• thrombosis
• compressive sx
• chronic increase of venous pressure
• hemorrahage

Question 25

What is steal phenomenon?

Answer 25

steals blood from normal neural tissue and the shunt causes spinal cord hypoxia (avm)