Spinal cord compression Flashcards
Go over the anatomy of the spinal cord
What are the key points to remember for the corticospinal tract
- It is a 2 neurone tract - UMN and LMN
- UMN – from motor cortex to anterior grey horn. Decussates at medullary level
- The tract is ipsilateral – because it decussates in the medulla so the tract running down the spinal cord supplies the same side of the body to the side of the spinal cord it is on (note tho that the motor cortex for the corticospinal tract is contralateral)
- Lower motor neurone ( anterior horn cell )
What are the main signs of an UMN lesion ?
- Increased tone
- Muscle wasting NOT marked
- No fasciculation
- Hyper - reflexia
What are the signs of a LMN lesion ?
- Decreased tone
- muscle wasting
- fasciculation
- diminished reflexes
Go over the key points about the spinothalamic tract
- Spinothalamic tracts convey Pain, temperature and crude touch Contralateral – so the tract decussates immediately after it enters the spinal cord which means that e.g. a R hemisection of the cord will cause lack of spinothalamic sensations on the opposite side to the hemisection below that level (refer to pic stuck up on wall)
- Decussates at spinal level
What are the key points to remember about the dorsal column ?
- Tracts convey Fine touch, proprioception, vibration
- Ipsilateral - same idea as corticospinal tract
- Decussate at medullary level
What 2 ways can spinal cord compression be classified ?
- Acute or Chronic
- Complete or Incomplete
What are the causes of acute spinal cord compression ?
- Trauma
- Tumours – haemorrhage or collapse
- Infection
- Spontaneous haemorrhage
What are the causes of chronic spinal cord compression ?
- Degenerative disease – spondylosis
- Tumours
- Rheumatoid Arthritis
What are the 3 main patterns in which spinal cord compression can occur ?
- Cord transaction
- Cord hemisection (brown sequard syndrome)
- Central cord syndrome
Describe the presentation of cord transaction
This is a complete lesion at a level of the spinal cord so all motor and sensory modalities affected
It will result in bilateral sensory deficit of both tracts below the level of the lesion
It will result in UMN lesion signs in terms of the corticospinal tract but this initially presents as spinal shock which causes hyporeflexia/areflexia which then over time develops into UMN signs - hyperreflexia and spasticity etc
Describe the presentation of a spinal cord hemisection (brown sequards syndrome)
Results in below the level of the lesion:
- Ipsilateral (to the lesion i.e lesion on the R so motor deficit affecting R side below this) motor deficit - weakness or paralysis (hemiparaplegia)
- Ipsilateral (to the lesion) deficit in Dorsal Column
- Contralateral (to the lesion) spinothalamic sensory level
Describe the presentation of central cord syndrome
- Hyperflexion or extension injury to already stenotic neck
- Predominantly distal upper limb weakness
- “Cape-like” spinothalamic sensory loss
- Lower limb power preserved
- Dorsal Columns preserved
Appreciate the pic on the ‘cape like’ distribution of loss of spinothalamic sensation in central cord syndrome
What is the main difference between acute and chronic cord compression symptoms ?
Same as acute except upper motor neurone signs predominate in chronic cord compression
What sort of trauma causes spinal cord injuries and what segment of the spinal cord is esp vulnerable ?
- High energy injury
- Especially mobile segments of spine - CERVICAL
How can tumours affect the spinal cord ?
- Can slowly compress
- Can cause acute compression by collapse or haemorrhage
What is spinal stenosis and what can cause it ?
Spinal stenosis is caused by narrowing of the spinal canal or neural foramina producing root ischaemia and neurogenic claudication
Causes:
- osteophyte formation (OA)
- bulging of intervertebral discs
- facet joint hypertrophy
- subluxation
How can infection result in cord compression ?
Epidural abscess formation
What are some of the causes of haemorrhage which can result in cord compression ?
- Epidural
- Subdural
- Intramedullary
- Trauma
- Bleeding diatheses
- Anticoagulants
- Arterio-venous malformations
What do you need to remember about tone and reflexes in acute cord compression?
They are usually reduced (this applies to all 3 cord compression syndromes even though I didn’t mention previously and as the compression syndrome becomes more chronic this is when the UMN symptoms become prevalent)
What is the treatment of trauma causing spinal cord compression ?
- Immobilise - C-spine
- Investigate - X-Ray/CT MRI - MRI is the definitive diagnosis
- Decompress + stabilise - Surgery Traction External fixation
- ?Methylprednisolone - Bolus 24hr infusion
What is the treatment of tumours causing spinal cord compression ?
Metastatic tumours:
- Dexamethasone - give this whilst considering more specific therapy i.e. radio, chemo and surgery
- Then treat with Radiotherapy or Chemotherapy +/- Surgical decompression and stabilisation
If primary tumour:
- Surgical excision
- Think would still give the steroids first whilst deciding
What is the treatment of haemorrhage causing spinal cord compression?
- Reverse anticoagulation
- Surgical decompression
What is the treatment of epidural abscesses causing spinal cord compression ?
- Antimicrobial therapy
- Surgical drainage
- Stabilisation where required
