Spinal Cord Compression Flashcards
What is spinal cord compression
Acute spinal cord compression is caused by pathology that leads to compression of the spinal cord
What are the causes of spinal cord compression?
Neoplastic - Metastatic from thyroid, lung, breast, renal, prostate, primary bone tumours as well as haematological malignancy - non-H lymphoma, myeloma
Traumatic - vertebral fracture or facet joint dislocation
Infective - abscess formation
Disc prolapses - rare as lumbar disc herniation causes compression of cauda equina inferior to the spinal cord
What conditions increase risk of acute spinal cord compression
any pathology that narrows the cord canal (spinal stenosis):
inflammatory conditions - RA, ankylosing spondylitis
Degenerative conditions - ligamentum flavum hypertrophy or osteophyte formation
What are the clinical features of spinal cord compression?
Sensation and proprioception impaired at the dermatomal levels below the cord compression.
Pain, aggravated through straining such as coughing or sneezing.
Weakness - bilateral or unilateral
Upper motor neurone signs - hypertonia, hyperreflexia, Babinski’s sign, clonus (below level of the lesion)
Reflexes tend to be absent at the level of the lesion as the lower motor neurone within the ventral horn is compressed so producing a lower motor neurone deficit.
Autonomic involvement is a late stage
Evidence of underlying cause - weight loss and tiredness in malignancy
What is Babinski’s sign? What is clonus?
Plantar reflex is elicited when the sole of the foot is stimulated with a blunt instrument. Normally, this causes a downward, flexion response of the hallux. An upward extension response is Babinkski sign
Indicates upper motor neurone lesion constituting damage to the corticospinal tract
Note: healthy in newborn
Involuntary rhythmic muscular contractions
Describe some differential diagnoses
Lumbago - pain solely around the lower lumbar area with no radiation
Sciatica - lower back pain, spreading to buttocks or lower limbs depending on dermatome affected
Both caused by disc herniation pressing on exiting nerve producing lower motor neurone signs
Cauda equina syndorme - lumbar disc herniation compressing the cauda equina, presents with lower motor neurone signs and bowel/bladder disturbances.
What investigations should be carried out for ASCC?
MRI of whole spine
Routine blood tests for underlying cause + clotting screen and group and save for surgery
How is spinal cord compression managed?
High dose corticosteroids - dexamethasone + PPI for gastroprotection
Neurosurgery and oncology referral
Decompression surgery is definitive treatment
What does the prognosis of MSCC depend on?
Progress before decompression and underlying cause.
Mobility state at time of treatment
Common mets to bone?
Thyroid, renal, breast, prostate, lung
UMN signs?
Hyperreflexia, hyeprtonia, spastic paralysis, weakness, NO atrophy, positive Babinski sign, NO fasciculation
LMN signs?
Hyporeflexia, hypotonia, flaccid paralysis, weakness, atrophy, fasciculation
