Spinal Cord Compression Flashcards
Categories of lesions which may cause spinal cord compression?
- Extradural
- Intradural / extramedullary
- Intramedullary
Common pathological causes of spinal cord compression?
- Tumour (primary, met)
- Degenerative (disc prolapse, osteoporosis, spondylosis)
- Infection (vert body, disc space, extradural, intramural)
- Haematoma (spontaneous, trauma, AVM)
- Developmental (syrinx, AVM, arachnoid cyst)
What are the major presenting features of spinal cord compression?
- Pain
- Neurological deficit
What is the result of cervical spinal canal stenosis?
Cervical myelopathy due to cord compression
- UL: predominately LMN signs
- LL: UMN (spastic paraparesis)
What is the result of lumbar spinal canal stenosis?
Sciatic and neurogenic claudication due to cauda equina compression
What causes the stenosis of degenerative spinal canal stenosis?
- Spondylosis with hypertrophy and osteophytes of the facet joints
- Hypertrophy of the ligament flavum
- Bulging or prolapsed IV discs and associated osteophytes
- Excessive mobility
- Often congenitally narrow canal
What are the neurological symptoms due to in degenerative spinal canal stenosis?
Neurological symptoms result from:
- direct pressure on neural structures
- Ischaemia of neural structures
What is the result of degenerative spinal canal stenosis (in terms of cell/structure reaction)?
- Degeneration and loss of nerve cells
- Spinal cord cavitation
- Glial cell proliferation
- Demyelination
- Wallerian degeneration of tracts above and below the level of compression
Treatment of degenerative canal stenosis?
- Conservative for mild, non progressive disease of the very elderly / unfit for sure
- Surgery: halt further disability, preventing defects may be irreversible
Posterior surgical approach?
Laminectomy
Anterior surgical approaches?
Discectomy, vertebrectomy
Ddx of intramural, extra medullary lesion?
- Schwannoma
- Myxopapillary ependymoma
- Dermoid or epidermoid cyst
- Mets (rare)
Major sensory levels on trunk?
- T4 = nipple
- T7 = xiphisternum
- T10 = umbilicus
Weakness of cervical / thoracic lesion?
- Progressive spastic paraparesis with UMN weakness
- little or no wasting
- hypertonia
- hyperreflexia
- eventual paraplegia
Brown Sequard syndrome pattern of sensory loss?
Laterally placed mass:
- Contralateral impairment of pain and temp
- Ipsilateral weakness and impairment of proprioception, vibration and light touch
Syringomyelia pattern of sensory loss?
Cape like loss of pain and temp sensation (also in intrinsic lesions of the central spinal cord)
Regions of compression most predisposed to causing sphincter disturbance?
- Occurs with compression at any region
- Particularly conus medularis and cauda equina
First symptoms of sphincter disturbance in spinal cord compression?
-Difficulty initiating urination
–> urinary retention / incontinence
Subsequent constipation and faecal incontinence
Which cancers most commonly cause spinal cord compression?
- Breast Ca
- Lung Ca
- Prostate Ca
- Kidney Ca
- Lymphoma
- Myeloma
Treatment of malignant spinal cord compression?
-Commence dexamethasone
-Palliation / symtpom control
OR
-Radiotherapy
OR
-Surgery
When is radiotherapy preferred Mx of malignant spinal cord compression?
In radiosensitive tumours and only if neurological deficit is mild and non-progressive, without significant neural compression on imaging
When is palliation most appropriate management of malignant spinal cord compression?
If death from primary cancer imminent or if deficit has been present for more than a few days and is fixed
Where is epidural abscess most common i.e. site?
Thoracolumbar region
Origin of spinal abscess?
- Haematogenous spread to disc or epidural space from distant infected site
- Direct spread from adjacent infection including vertebral body, decubitus ulcer, paraspinal or psoas abscess
Why does cord ischaemia occur in spinal abscess?
Results from thrombosis of arteries and veins (may lead to rapid and irreversible neurological deterioration)
How does spinal abscess present?
- Severe local spinal pain
- Rapidly progressive neuro deficit
- Systemic features of infection
Treatment of spinal abscess?
- Emergency investigation and transfer for neurosurgical assessment
- Emergency surgical decompression
- Broad spec ABx until sensitivities known
