Spinal cord compression Flashcards
What is the corticospinal tract?
- 2 neurone tract
- Upper motor neuron - from motor cortex to anterior/ventral grey horn
- Decussates at medullary level
- Tract is ipsilateral
- Lower motor neuron
Describe the clinical features of an upper motor neuron lesion
- Increased tone
- Muscle wasting NOT marked
- No fasciculation
- Hyper-reflexia
Describe the clinical features of a lower motor neuron lesion
- Decreased tone
- Muscle wasting
- Fasciculations
- Diminished reflexes
What does the spinothalamic tract control and where does it decussate?
- Pain, temperature and crude touch
- Tract is contralateral
- Decussates at spinal level
What does the dorsal column control and where does it decussate?
- Fine touch, proprioception, vibration
- Ipsilateral tract
- Decussates at medullary level
What are some causes of acute spinal cord compression?
Trauma (high energy), tumours, infection, spontaneous haemorrhage
What are some causes of chronic spinal cord compression?
- Degenerative disease - spondylosis
- Tumours
- Rheumatoid arthritis
How would a complete cord transection present?
- Complete lesion so all motor and sensory modalities affected
- Initially a flaccid arreflexic paralysis (spinal shock)
- Upper motor neuron signs appear later
What is Brown-Sequard syndrome?
- Cord hemisection
- Ipsialteral motor level
- Ipsilateral dorsal column sensory level
- Contralateral spinothalamic sensory level
What is 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
How does chronic spinal cord compression present?
Same as acute except upper motor neurone signs predominate
What segments of the spine are particularly susceptible to injury following high energy trauma?
Mobile segments of the spine - cervical
What are some causes of extradural tumours causing spinal cord compression?
Metastasis - lung, breast, kidney, prostate
What are some causes of intradural tumours causing spinal cord compression?
- Extramedullary -meningioma, Schwannoma
- Intramedullary - astrocytoma, ependymoma
What are the 2 mechanisms of spinal cord compression in tumours?
Can either slowly compress or cause acute compression by collapse or haemorrhage
What is a cause of degenerative disease leading to spinal cord compression?
Spinal canal stenosis - osteophyte formation, bulging of intervertebral discs, facet joint hypertrophy, subluxation
What kind of infections can cause spinal cord compresion?
- Epidural abscess - bloodborne staph, tuberculosis
- Surgery or trauma can lead to infecton
How do you treat spinal cord compression due to trauma?
- Immobilise
- Investigate - x-ray/CT, MRI
- Decompress + stabilise - surgery, traction, external fixation
- Methylprednisolone - bolus, 24 hour infusion
How do you treat spinal cord compression due to a metastatic tumour?
- Depends on patient and tumour
- Dexamethasone
- Radiotherapy
- Chemotherapy
- Surgical decompression and stabilisation
How do you treat spinal cord compression due to a primary tumour?
Surgical excision
How do you treat spinal cord compression due to an infection?
- Antimicrobial therapy
- Surgical drainage
- Stabilisation where required
How do you treat spinal cord compression due to a haemorrhage?
- Reverse anti-coagulation
- Surgical decompression
How do you treat spinal cord compression due to degenerative disease?
Surgical decompression +/- stabilisation
