Spinal cord compression

Question 1

summarise the corticospinal tracts

Answer 1

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

Question 2

what are upper motor neurone lesions features

Answer 2

increased tone
muscle wasting NOT marked
no fasciculation
hyper-reflexia

Question 3

what are the lower motor neurone lesion features

Answer 3

decreased tone
muscle wasting - marked over time
fasciculation
diminished reflexes

Question 4

summarise the spinothalamic tracts

Answer 4

pain, temp and crude touch
contralateral
decussates at spinal level (segmentally)

Question 5

summarise the dorsal column

Answer 5

fine touch, proprioception, vibration
tract is ipsilateral
decussate at medullary level

Question 6

what does complete/ incomplete cord injury mean

Answer 6

complete- loss of power/ sensation

incomplete- some preservation of motor/ sensory function

Question 7

what can cause acute spinal cord compression

Answer 7

trauma
tumours (haemorrhage or collapse)
infection
spontaneous haemorrhage

Question 8

what can cause chronic spinal cord compression

Answer 8

degenerative disease (spondylosis) 
tumours 
rheumatoid arthritis (erosive synovitis in synovial joints esp C1/2)

Question 9

what will result from a complete cord transection lesion

Answer 9

all motor and sensory modalities affected

Question 10

what does a sensory/ motor level mean

Answer 10

after a cord transection a motor/ sensory level means below this there is complete/ partial loss of sensation or power

Question 11

what type of motor symptoms in a cord transection

Answer 11

initially a flaccd areflexic paralysis ‘spinal shock’

upper motor neurones signs appear later s

Question 12

what are the features of brown sequard syndrome

Answer 12

(cord hemisection)

• ipsilateral motor level
• ipsilateral dorsal column sensory (fine touch, vibration etc)
• contralateral spinothalamic sensory level

Question 13

what causes central cord syndrome

Answer 13

hyperflexion or extension injury to already stenotic neck

Question 14

what are the symptoms of central cord syndrome

Answer 14

predominantly distal upper limb weakness
cape like spinothalamic sensory loss
lower limb power preserved
dorsal columns preserved

Question 15

why are the hands affected in central cord syndrome

Answer 15

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

Question 16

why do you get spinothalamic symptoms (parasethesia) in central cord syndrome when tracts are lateral in cord

Answer 16

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

Question 17

what is the presentation of chronic spinal cord compression

Answer 17

same as acute except UMN signs predominate

progressively worsening spastic paralysis

Question 18

what part of spine is most vulnerable to trauma

Answer 18

cervical

Question 19

what are the common extradural tumours that compress the cord

Answer 19

usually mets

• lung
• breast
• kidney
• prostate

Question 20

what are extradural cord tumours

Answer 20

outside dura (within vertebral bones)

Question 21

what are intradural tumours

Answer 21

within dura

can be extramedullay (outside cord) or intramedullary (within cord)

Question 22

what types of intradural tumours cause cord compression

Answer 22

extramedullary - meningioma, schwannoma

intramedullary- astrocytoma, ependymoma

Question 23

how do tumours compress the cord

Answer 23

mass
expand bone
weaken bone- vertebral collapse
heamorrhage

Question 24

what are the degenerative diseases that can cause spinal cord compression

Answer 24

osteophyte formation
bulging of intervertebral discs
facet joint hypertrophy
subluxation

Question 25

what infections common cause cord compression and how

Answer 25

cause epidural abscess
usually blood borne staphylococcal
TB in other countries

Question 26

what is the main symptom of infection causing spinal cord compression

Answer 26

extreme back pain

Question 27

what is at risk when there is compression at C1/2 level

Answer 27

resp arrest- phrenic nerves

Question 28

what haemorrhages can cause cord compression

Answer 28

epidural
subdural
intramedullary

Question 29

what is the treatment for cord compression

Answer 29

immobilise 
investigate:
-CT for trauma
-x ray 
-MRI for tumours 

decompress + stabilise:

• surgery
• traction
• external fixation

methylprednisolone (controversial, for trauma)

Question 30

what drug can you give for mets causing cord compression

Answer 30

IV dexamethasone high dose

Question 31

what treatment for mets causing cord compression

Answer 31

Depends on Patient and Tumour
Dexamethasone IV
MR imagine 
Radiotherapy
Chemotherapy
Surgical decompression and stabilisation

Question 32

what treatment for primary tumours causing cord compression

Answer 32

surgical excision

Question 33

what is the commonest cause of acute spinal cord compression

Answer 33

mets

Question 34

what treatment for infection cause cord compression

Answer 34

antimicrobials
surgical drainage
stabilisation where required

Question 35

what treatment for haemorrhage causing cord compression

Answer 35

reverse anticoagulation

surgical decompression

Question 36

what treatment for degenerative diseases causing cord compression

Answer 36

surgical decompression +/- stabilisation

Question 37

is acute cord compression an emergency

Answer 37

YES

Question 38

does chronic cord compression need rapid treatment

Answer 38

yes- prevents further deterioration- important to do while patient is still ambulant and independent