Spinal Cord Compression Flashcards
What are the names of the 3 most important spinal cord tracts?
Corticospinal tracts.
Spinothalamic tracts.
Dorsal columns.
What does the white matter contain?
Nerve fibres
Where do motor tracts sit?
In the lateral white columns
Where does the spinothalamic tract sit?
In the anterolateral white matter
The corticospinal tract is a __ neurone tract
2
Where does the UMN go to and from in the corticospinal tract?
From motor cortex, to anterior grey horn
Where does the UMN decussate in the corticospinal tract?
At the medullary level
Is the CST ipsilateral or contralateral?
Ipsilateral – on the same side as the side of the body it supplies
(because of decussation at medulla)
What is the LMN in the CST?
Anterior horn cell
What signs are associated with an UMN lesions in the motor pathways?
- Increased tone.
- Muscle wasting NOT marked.
- No fasciculation.
- Hyper-reflexia.
If you damage your spinal cord, it is the LMN that tends to be damaged
FALSE - UMN
What signs are associated with a LMN lesion?
- Decreased tone.
- Muscle wasting.
- Fasciculation.
- Diminished reflexes.
What are the spinothalamic tracts responsible for?
Pain, temperature and crude touch
What should you ask when trying to find out about someones spinothalamic tract?
Ask if they can feel cold or hot while in the shower
Is the STT contralateral or ipsilateral?
Contralateral
Where do the STT’s decussate?
At spinal level
What are dorsal columns responsible for?
Fine touch, proprioception, vibration.
How are dorsal columns tested?
Low frequency tuning fork
Are dorsal columns ipsilateral or contralateral?
Ipsilateral
Where do dorsal columns decussate?
At medullary level
Spinal cord compression can be……
Acute OR Chronic
Complete OR Incomplete
What 4 things can acute spinal cord compression be due to?
- Trauma.
- Tumours – haemorrhage or collapse. (most common)
- Infection.
- Spontaneous haemorrhage.
What is the most common cause of acute spinal cord compression?
Tumour - mets
What 3 things can chronic spinal cord compression be due to?
- Degenerative disease – spondylosis.
- Tumours.
- Rheumatoid arthritis
If there is a complete spinal cord transection, what will be affected?
All sensory and motor modalities
Do UMN signs appear in spinal cord transection?
Yes - but later
Initially what happens in spinal cord transection?
There is initially a FLACCID ARREFLEXIC PARALYSIS ‘spinal shock.’
Outline how each of the 3 spinal tracts are affected in Brown-Sequard syndrome.
- IPSILATERAL motor level
- IPSILATERAL dorsal column sensory level
- CONTRALATERAL spinothalamic sensory level
If there is a right hemisection of the spinal cord, what are the clinical features?
- Right-sided paralysis (due to damage to right CST)
- Right-sided loss of fine touch, proprioception, vibration (due to damage to right dorsal column)
- Left-sided loss of pain, temperature and crude touch (due to damage to right STT)
Brown-Sequard Syndrome
Cord hemisection
What does central cord syndrome occur due to?
A hyperflexion or hyperextension injury to an already stenotic neck
Describe how a patient with central cord syndrome presents.
- ‘Cape-like’ spinothalamic sensory loss.
- Lower limb power preserved.
- Dorsal columns preserved.
Describe the process behind central cord syndrome.
Blood supply to the central spinal cord is momentarily interrupted leading to ischaemic spinal cord damage
This wipes out the upper limb fibres (medial) of the CST but not the lower limb fibres (lateral)
If the STT isn’t affected in central cord syndrome, why does numbness occur?
Because although the STT isn’t affected, the crossing over neurone is
What is the presentation of central spinal cord syndrome like?
Same as acute, but upper motor neurone signs predominate
also more gradual and progressive
What type of injury is trauma?
High energy
What parts of the spine are usually affected by trauma?
Mobile segments - especially the spine (cervical)
What are extradural tumours usually?
Mets
What cancers typically metastasise to bone?
Lung, breast, kidney, prostate
What can intradural tumours be again divided into?
Intramedullary OR extramedullary
Give 2 examples of extramedullary intradural tumours
Meningiona
Schwannoma
Give 2 examples of intramedullary intradural tumours
Astrocytoma
Ependymoma
How can tumours cause compression of the spinal cord?
- Either by growing, and slowly compressing
or - Can cause acute compression by collapse or haemorrhage
What can spinal cord stenosis result from?
- Osteophyte formation.
- Bulging of IVD’s.
- Facet joint hypertrophy.
- Subluxation.
What can an epidural abscess arise due to?
- Bloodborne infection.
- Staph.
- Tuberculosis.
What else can lead to spinal cord infection?
Surgery or trauma
Haemorrhage can be either…..
- Epidural.
- Subdural.
- Intramedullary.
What factors can lead to haemorrhage?
Trauma.
Bleeding diatheses.
Anticoagulants.
AVM’s.
How should a haemorrhage, cause by trauma, be managed?
- Immobilise
- Investigate - xray, CT, MRI
- Decompress + stabilise
- Methyprednisolone
What ways can the spinal cord be decompressed?
- surgery
- traction
- external fixation
How are primary spinal tumours managed?
Surgical excision
How are spinal infections treated?
- ABx
- Surgical drainage
- Stabilisation if required
How are spinal haemorrhages treated?
- Reverse anticoagulation
* Surgical decompression
How is degenerative spinal disease managed?
Surgical decompression +/- stabilisation
Acute spinal cord compression is an ____________
EMERGENCY
Outline the treatment of metastatic spinal tumours
- Dexamethasone
- Radiotherapy
- Chemo
- Surgical decompression and stabilisation
Why is radiotherapy the GOLD STANDARD treatment for metastatic spinal tumours?
- Just as good as surgery
- Good for pain relief
- Non-invasive
