Spinal Cord Compression Flashcards
Why is prompt diagnosis and treatment for spinal cord compression essential?
Neurosurgical emergency
Avoid permanent neurological disability
What categories of lesions can compress the spinal cord and the cauda equina?
Extradural = 80% Intradural/extramedullary = 15% Intramedullary = 5%
What is the most common intradural lesion causing spinal cord compression?
Nerve root lesions
What is an intramedullary lesion?
Lesion from inside spinal cord itself
How can you tell if the image a T2 MRI?
CSF white
What are the most common pathological causes of spinal cord compression?
Tumour Degenerative - Disc prolapse - Osteoporosis - Spondylosis Infection - Vertebral body - Disc space - Extradural - Intradural Haematoma - Spontaneous - Trauma - AV malformation Developmental - Syrinx - AV malformation - Arachnoid cyst
What are the most common extradural causes of spinal cord compression?
Metastatic tumour
Abscess
Degenerative spinal disease
What are the most common intradural causes of spinal cord compression?
Meningioma
Schwannoma
Myxopapillary ependymoma
What are the most common intramedullary causes of spinal cord compression?
Glioma
Syrinx
What are the two major presenting features of spinal cord compression?
Pain
Neurological deficit
What does the order of symptom presentation in spinal cord compression suggest about the cause?
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
What structures are the source of pain in spinal cord compression?
Periosteum
Dura
Nerve roots
What structures are the source of neurological deficit in spinal cord compression?
Nerve roots
Spinal cord itself
What is the most likely diagnosis in
- Older patient
- Neck pain
- Slow symptom onset
- No fever
- No Hx of cancer
Degenerative cervical canal stenosis
What are the differential diagnoses for degenerative canal stenosis?
Spinal tumour - Primary - Metastatic Spinal infection Inflammatory/neurodegenerative disease - MS - Motor neuron disease - Syringomyelia - Subacute combined degeneration of spinal cord
Where are the most clinically significant places that degenerative spinal canal stenosis can occur?
Cervical spine
Lumbar spine
What symptoms does degenerative spinal cervical canal stenosis cause?
Cord compression > cervical myelopathy
What symptoms does degenerative spinal lumbar canal stenosis cause?
Cauda equina compression > sciatica and neurogenic claudication
What causes degenerative spinal canal stenosis?
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
What are the neurological symptoms in degenerative spinal canal stenosis due to?
Direct pressure on neural structures
Ischaemia of neural structures
What damage does degenerative spinal canal stenosis cause?
Degeneration and loss of nerve cells Spinal cord cavitation Glial cell proliferation Demyelination Wallerian degeneration of tracts above and below level of compression
When is conservative management of degenerative spinal canal stenosis indicated?
Mild, non-progressive disease
Very elderly
Unfit for surgery due to comorbidities
When is surgical treatment indicated for degenerative canal stenosis?
Moderate/severe/progressive disease
Why is surgical treatment indicated for degenerative canal stenosis?
To stop further disability - presenting neurological deficits may be irreversible
