Spinal cord compression Flashcards
summarise the corticospinal tracts
upper motor neurone- motor cortex to anterior grey horn decussates at medullary level tract is ipsilateral lower motor neurone (anterior horn cell)
descending motor pathway
what are upper motor neurone lesions features
increased tone
muscle wasting NOT marked
no fasciculation
hyper-reflexia
what are the lower motor neurone lesion features
decreased tone
muscle wasting - marked over time
fasciculation
diminished reflexes
summarise the spinothalamic tracts
pain, temp and crude touch
contralateral
decussates at spinal level (segmentally)
summarise the dorsal column
fine touch, proprioception, vibration
tract is ipsilateral
decussate at medullary level
what does complete/ incomplete cord injury mean
complete- loss of power/ sensation
incomplete- some preservation of motor/ sensory function
what can cause acute spinal cord compression
trauma
tumours (haemorrhage or collapse)
infection
spontaneous haemorrhage
what can cause chronic spinal cord compression
degenerative disease (spondylosis) tumours rheumatoid arthritis (erosive synovitis in synovial joints esp C1/2)
what will result from a complete cord transection lesion
all motor and sensory modalities affected
what does a sensory/ motor level mean
after a cord transection a motor/ sensory level means below this there is complete/ partial loss of sensation or power
what type of motor symptoms in a cord transection
initially a flaccd areflexic paralysis ‘spinal shock’
upper motor neurones signs appear later s
what are the features of brown sequard syndrome
(cord hemisection)
- ipsilateral motor level
- ipsilateral dorsal column sensory (fine touch, vibration etc)
- contralateral spinothalamic sensory level
what causes central cord syndrome
hyperflexion or extension injury to already stenotic neck
what are the symptoms of central cord syndrome
predominantly distal upper limb weakness
cape like spinothalamic sensory loss
lower limb power preserved
dorsal columns preserved
why are the hands affected in central cord syndrome
affects central bit of spinal cord as most vulnerable to ischaemia (furthest away from the blood supply)
Most medial part of corticospinal tract carry innervation to hands- why hands get weakness
why do you get spinothalamic symptoms (parasethesia) in central cord syndrome when tracts are lateral in cord
as spinothalamic neurons cross over at the anterior white matter commissure- tract not affected but the area of decussation is- means there is paresthesia only at the level of injury as this tract crosses segmentally = suspended sensory level
what is the presentation of chronic spinal cord compression
same as acute except UMN signs predominate
progressively worsening spastic paralysis
what part of spine is most vulnerable to trauma
cervical
what are the common extradural tumours that compress the cord
usually mets
- lung
- breast
- kidney
- prostate
what are extradural cord tumours
outside dura (within vertebral bones)
what are intradural tumours
within dura
can be extramedullay (outside cord) or intramedullary (within cord)
what types of intradural tumours cause cord compression
extramedullary - meningioma, schwannoma
intramedullary- astrocytoma, ependymoma
how do tumours compress the cord
mass
expand bone
weaken bone- vertebral collapse
heamorrhage
what are the degenerative diseases that can cause spinal cord compression
osteophyte formation
bulging of intervertebral discs
facet joint hypertrophy
subluxation
what infections common cause cord compression and how
cause epidural abscess
usually blood borne staphylococcal
TB in other countries
what is the main symptom of infection causing spinal cord compression
extreme back pain
what is at risk when there is compression at C1/2 level
resp arrest- phrenic nerves
what haemorrhages can cause cord compression
epidural
subdural
intramedullary
what is the treatment for cord compression
immobilise investigate: -CT for trauma -x ray -MRI for tumours
decompress + stabilise:
- surgery
- traction
- external fixation
methylprednisolone (controversial, for trauma)
what drug can you give for mets causing cord compression
IV dexamethasone high dose
what treatment for mets causing cord compression
Depends on Patient and Tumour Dexamethasone IV MR imagine Radiotherapy Chemotherapy Surgical decompression and stabilisation
what treatment for primary tumours causing cord compression
surgical excision
what is the commonest cause of acute spinal cord compression
mets
what treatment for infection cause cord compression
antimicrobials
surgical drainage
stabilisation where required
what treatment for haemorrhage causing cord compression
reverse anticoagulation
surgical decompression
what treatment for degenerative diseases causing cord compression
surgical decompression +/- stabilisation
is acute cord compression an emergency
YES
does chronic cord compression need rapid treatment
yes- prevents further deterioration- important to do while patient is still ambulant and independent
