Spinal cord compression

Question 1

Most common cause of acute spinal cord compression?

Answer 1

Metastatic SCC

Question 2

Most common primary cancers causing MSCC

Answer 2

Breast 
Prostate 
Thyroid 
Renal 
Luny

Question 3

Traumatic causes of SCC

Answer 3

Vertebral fracture or facet joint dislocation

Question 4

Infectious causes of SCC

Answer 4

TB/ Fungal

Question 5

Risk factors for SCC

ie things leading to a narrow cord canal

Answer 5

Inflammatory conditions e.g. Rheumatoid, Ank spond

Degenerative conditions e.g. spinal cord stenosis

Question 6

Gold standard for suspected SCC

Answer 6

MRI of the whole spine

• within a week if spinal mets suggested
• within a day is believe the cord is compressed

Question 7

Causes of CES

Answer 7

Disc herniation 
Mets 
Trauma 
Infection 
Chronic spinal inflammation e.g. ank spond

Question 8

Classification of CES

Answer 8

1. Cauda Equina Syndrome with retention (CESR) – Presents as back pain with unilateral or bilateral sciatica, lower limb motor weakness, sensory disturbance in the saddle region, loss of anal tone, and loss of urinary control
2. Incomplete Cauda Equina Syndrome (CESI) – As above, however only altered urinary sensation (e.g. loss of desire to void, diminished sensation, poor stream, and need to strain); painful retention may precede painless retention in some cases
3. Suspected Cauda Equina Syndrome (CESS) – Cases of severe back and leg pains with variable neurological symptoms and signs, and a suggestion of sphincter disturbance.

Question 9

CES vs Cord compression

Answer 9

Majority LMN signs

vs UMN signs (though loss of the reflexes at the level of compression)