Spinal Cord Compression Flashcards
describe the corticospinal tract
2 neurone tract
UMN = from motor cortex > anterior grey horn
decussates at medulla
ipsilateral tract
LMN = anterior horn cell > site of action
features of UMN lesion?
increased tone
no real muscle wasting
hyperreflexia
no fasciculation
features of LMN lesion?
decreased tone
muscle wasting
fasciculation
diminished reflexes
describe spinothalamic tract?
carried info on pain, temp and crude touch
contralateral tract
decussates at spinal level
describe dorsal columns
carried info on fine touch, proprioception, vibration
ipsilateral tract
decussates at medulla
which spinal joint is most commonly affected in rheumatoid arthritis?
C1/C2
what is cord transection?
conceptual term meaning spinal cord is injured
can be complete (all motor and sensory modalities below level of injury affected)
can be incomplete (some power/sensation preserved)
how does cord transection present?
hypotension (due to loss of sympathetic outflow below lesion)
initially a flaccid areflexic paralysis/”spinal shock” (no reflexes, floppy paralysis)
classic UMN signs develop later (spastic paralysis, hypereflexes etc)
how does borwn sequard syndrome present?
ipsilateral motor level affected
ipsilateral dorsal column sensor level affected
contralateral spinothalamic sensory level affected
how does central cord syndrome generally present?
usually an elderly person after a fall cant move hands band of numbness/pins and needles over tops of hands distal upper limb weakness cape-like spinothalamic sensory loss normal lower limbs and dorsal column
what usually causes a central cord syndrome?
hyperflexion or extension injury to already stenotic neck
why does ischaemia often occur in central cord syndrome?
pinching of medial spinal cord = most vulnerable part to ischaemia due to blood supply
describe sensory loss in central cord syndrome?
not true sensory loss as there isn’t complete loss of sensation everywhere below injury, only at that level
how does chronic spinal cord compression present?
same as acute but UMN signs predominate
most common areas of spine injured in trauma?
cervical
- most mobile
commonest cause of spinal tumours?
metastases
what causes extradural tumours?
metastases (Lung, breast, kidney, prostate)
what causes intradural tumour?
extramedullary (meningioma, schwannoma)
intramedullary (astrocytoma, ependymoma)
how can tumours damage spinal cord?
can slowly compress
can cause acute compression by collapse or haemorrhage
features of spinal stenosis?
osteophyte formation
bulging of IV discs
facet joint hypertrophy
subluxation
causes of spinal cord infection?
epidural abscess (bloodborne staph, TB) surgery or trauma
what types of bleeding can cause spinal cord compression?
epidural
subdural
intramedullary
causes of bleeding leading to spinal cord compression?
trauma
bleeding diatheses
anticoagulants
AVM
how is spinal cord trauma managed?
immobilise (collar, board, blocks etc)
investigate (CT/X-ray, MRI)
decompress and stabilise (surgery, traction, external fixation)
methylprednisolone (acute inflammation decompression but generally not used due to side effects)
how are metastatic tumours causing spinal cord compression managed?
IV dexamethasone in acute presentation
radiotherapy usually
chemotherapy if chemosensitive (multiple myeloma etc)
surgical decompression and stabilisation if needed but try to avoid
how are primary spinal tumours managed?
mainly excised
how is infection in the spine managed?
antimicrobial therapy
surgical drainage (always drain pus)
stabilisation where required
how is haemorrhage in spinal canal managed?
reverse anticoagulation
surgical decompression
how is degenerative disease managed?
surgical decompression +/- stabilisation
