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MD2 Surgery and Anaesthesia > Spinal Cord Compression > Flashcards

Spinal Cord Compression Flashcards

1
Q

Why is prompt diagnosis and treatment for spinal cord compression essential?

A

Neurosurgical emergency

Avoid permanent neurological disability

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2
Q

What categories of lesions can compress the spinal cord and the cauda equina?

A 
Extradural = 80%
Intradural/extramedullary = 15%
Intramedullary = 5%
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3
Q

What is the most common intradural lesion causing spinal cord compression?

A

Nerve root lesions

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4
Q

What is an intramedullary lesion?

A

Lesion from inside spinal cord itself

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5
Q

How can you tell if the image a T2 MRI?

A

CSF white

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6
Q

What are the most common pathological causes of spinal cord compression?

A 
Tumour
Degenerative
- Disc prolapse
- Osteoporosis
- Spondylosis
Infection
- Vertebral body
- Disc space
- Extradural
- Intradural
Haematoma
- Spontaneous
- Trauma
- AV malformation
Developmental
- Syrinx
- AV malformation
- Arachnoid cyst
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7
Q

What are the most common extradural causes of spinal cord compression?

A

Metastatic tumour
Abscess
Degenerative spinal disease

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8
Q

What are the most common intradural causes of spinal cord compression?

A

Meningioma
Schwannoma
Myxopapillary ependymoma

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9
Q

What are the most common intramedullary causes of spinal cord compression?

A

Glioma

Syrinx

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10
Q

What are the two major presenting features of spinal cord compression?

A

Pain

Neurological deficit

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11
Q

What does the order of symptom presentation in spinal cord compression suggest about the cause?

A

If presents with pain as 1st symptom, most likely extramedullary
- If pain slow, slow growing
If neurological deficits 1st, most likely intramedullary
If both present at same time, acutely, probably from outside and rapid

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12
Q

What structures are the source of pain in spinal cord compression?

A

Periosteum
Dura
Nerve roots

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13
Q

What structures are the source of neurological deficit in spinal cord compression?

A

Nerve roots

Spinal cord itself

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14
Q

What is the most likely diagnosis in

  • Older patient
  • Neck pain
  • Slow symptom onset
  • No fever
  • No Hx of cancer
A

Degenerative cervical canal stenosis

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15
Q

What are the differential diagnoses for degenerative canal stenosis?

A 
Spinal tumour
- Primary
- Metastatic
Spinal infection
Inflammatory/neurodegenerative disease
- MS
- Motor neuron disease
- Syringomyelia
- Subacute combined degeneration of spinal cord
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16
Q

Where are the most clinically significant places that degenerative spinal canal stenosis can occur?

A

Cervical spine

Lumbar spine

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17
Q

What symptoms does degenerative spinal cervical canal stenosis cause?

A

Cord compression > cervical myelopathy

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18
Q

What symptoms does degenerative spinal lumbar canal stenosis cause?

A

Cauda equina compression > sciatica and neurogenic claudication

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19
Q

What causes degenerative spinal canal stenosis?

A

Spondylosis with hypertrophy and osteophytes of facet joints
Hypertrophy of ligamentum flavum/posterior spinal ligament
Bulging/prolapsed intervertebral discs and associated osteophytes
Excessive mobility
Often on background of congenitally narrow canal

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20
Q

What are the neurological symptoms in degenerative spinal canal stenosis due to?

A

Direct pressure on neural structures

Ischaemia of neural structures

21
Q

What damage does degenerative spinal canal stenosis cause?

A 
Degeneration and loss of nerve cells
Spinal cord cavitation
Glial cell proliferation
Demyelination
Wallerian degeneration of tracts above and below level of compression
22
Q

When is conservative management of degenerative spinal canal stenosis indicated?

A

Mild, non-progressive disease
Very elderly
Unfit for surgery due to comorbidities

23
Q

When is surgical treatment indicated for degenerative canal stenosis?

A

Moderate/severe/progressive disease

24
Q

Why is surgical treatment indicated for degenerative canal stenosis?

A

To stop further disability - presenting neurological deficits may be irreversible

25
Q

What can be removed in surgery for degenerative spinal canal stenosis?

A

Lamina = laminectomy
Disc = discectomy
Vertebral body = vertebrectomy

26
Q

What is the gold standard investigation for cauda equina compression?

A

MRI of lumbosacral spine

27
Q

What are the differential diagnoses for an intradural, extramedullary, well-defined lesion in a young patient?

A

Schwannoma
Myxopapillary ependymoma
Dermoid/epidermoid cyst
Metastasis - rare

28
Q

What sort of pain can occur in spinal cord compression?

A

Diffuse, dull, burning
Sciatica in lower limbs
Brachalgia in upper limbs
“Girdle” pain radiating around chest wall

29
Q

What are the sensory levels on the trunk?

A 
C4 = right above T2
T2 = sternal angle
T4 = nipple level
T7 = xiphisternum
T10 = umbilicus
L1 = inguinal region
30
Q

What is Brown-Sequard syndrome?

A 
Happens when only 1/2 of cord involved
Contralateral impairment of 
- Pain 
- Temperature sensation
Ipsilateral 
- Weakness 
- Impairment of
   - Proprioception
   - Vibration
   - Light touch
31
Q

What is the sensory disturbance in intrinsic lesions of the central spinal cord and syringomyelia?

A

Cape-like loss of pain and temperature

32
Q

What is a syrinx?

A

Dilatation of central canal

33
Q

What is syringomyelia?

A

Cord compression due to syrinx

34
Q

What is the sensory disturbance in lesions of the cauda equina and conus medullaris?

A

Saddle anaesthesia

35
Q

At what spinal level is the conus medullaris?

36
Q

At what spinal level do you not get upper motor neuron signs?

37
Q

When does sphincter disturbance occur?

A

Compression in any region
Particularly compression of
- Conus medullaris
- Cauda equina

38
Q

What symptoms does a sphincter disturbance cause?

A

Urinary hesitancy > urinary retention > urinary incontinence > constipation > faecal incontinence

39
Q

What are the most common causative cancers of malignant spinal cord compression?

A 
Lung carcinoma
Breast carcinoma
Prostate carcinoma
Renal carcinoma
Lymphoma
Myeloma
40
Q

What spinal level is most commonly affected by metastasis?

41
Q

What are the principles of treatment of malignant spinal cord compression?

A

Urgent Ix and Rx to avoid severe permanent disability
- Start dexamethasone
Prompt decision regarding treatment modality
- Palliation/symptom control only
- Radiotherapy
- Surgery

42
Q

In which region of the spine is a spinal abscess most common?

A

Thoraco-lumbar region

43
Q

What can cause a spinal abscess?

A 
Haematogenous spread to
- Disc
- Epidural space
Direct spread from adjacent infection
- Vertebral body
- Decubitus ulcer
- Paraspinal abscess
- Psoas abscess
44
Q

What is the most common causative organism of spinal abscesses?

A

Staph aureus

45
Q

What is the presentation of a spinal abscess?

A

Severe local spinal pain
Rapidly progressive neurological deficit
Systemic features of infection

46
Q

What causes spinal cord compression with a spinal abscess?

A

Inflammatory swelling

Pus

47
Q

What causes spinal cord ischaemia with a spinal abscess?

A

Thrombosis of arteries and veins

48
Q

What are the principles of treatment of a spinal abscess?

A

Emergency Ix and transfer for neurosurgical assessment
Emergency surgical decompression
Broad spectrum Abx until micro-organism isolated and sensitivities known

49
Q

What are yellow flags?

A

Psychosocial reasons that prevent improvement of back pain

MD2 Surgery and Anaesthesia (31 decks)

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