Spinal cord compression Flashcards
where is the DCML located in the spinal cord
posteriorly/dorsal
functions of DCML
fine touch
proprioception
vibration
where do fibres of the DCML cross over
cross over to the contralateral side at the medulla
where is the STT located in the spinal cord
anterolateral
functions of STT
pain
temperature
deep pressure
where do fibres of the STT cross over
segmentally at the spinal level it enters
where is the CST located in the spinal cord
laterally
function of CST
fine movement
where do fibres of the CST cross over
cross over at the medullary pyramids
where is the UMN found
motor cortex to anterior grey horn
where is the LMN found
anterior horn cell to muscle
how can spinal cord compression be classified
acute vs chronic
complete vs incomplete
causes of acute SCC
trauma
tumour
haemorrhage
infection
causes of chronic SCC
degenerative
tumour
rheumatoid arthritis
at what vertebral levels can rheumatoid arthritis cause SCC
C1/2 synovial joint
how does a complete acute SCC present
all motor and sensory modalities are affected
how does an incomplete acute SCC present
partial preservation of power and sensation
what is spinal shock
temporary hypo/areflexia, flaccid paralysis and autonomic dysfunction
hypo/hypertension occurs in spinal shock
hypotension from lost vasomotor tone in blood vessels
what is Brown Séquard syndrome
hemisection of the spinal cord
features of Brown Séquard syndrome
ipsilateral DCML and CST loss
contralateral STT loss
causes of cord hemisection
knife injury
demyelination
what causes central cord syndrome
hyperflexion or extension injury to an already stenotic neck
presentation of central cord syndrome
distal upper limb weakness
cape like STT sensory loss
what is preserved in central cord syndrome
DCML
lower limb power
how does chronic SCC present
same as acute SCC but with UMN signs predominating
tumour causes of SCC
meningioma
metastases
astrocytoma
schwannoma
degenerative causes of SCC
osteophytes
bulging discs
facet joint hypertrophy
subluxation
haemorrhagic causes of SCC
epidural
subdural
intramedullary
infectious causes of SCC
epidural abscess
TB
management of trauma to the spine
immobilise spinal column with blocks
Imaging - Xray, CT, MRI
decompress and stabilise
steroids sometimes used
management of malignant SCC
dexamethasone IV
radiotherapy
chemo is appropriate
rarely operate
management of infectious SCC
antimicrobial therapy
surgical drainage
management of haemorrhagic causes of SCC
reverse anticoagulation
surgical decompression
management of degenerative causes of SCC
surgical decompression +- stabilisation
what is syringomyelia
fluid filled cavity/cyst in the spinal cord associated with Chiari malformation
what is acute degenerative cervical myelopathy
degenerative condition with compression of the spinal cord
what kind of SCC does syringomyelia cause
central cord syndrome
pathology/causes of degenerative cervical myelopathy
osteophytes degenerative cervical spondylosis ligament hypertophy stenosis tumour epidural abscess
symptoms of degenerative cervical myelopathy
neck pain and stiffness clumsiness and weakness occipital headaches gait instability paraesthesias of extremities
management of degenerative cervical myelopathy
surgical decompression
what is Hoffman’s sign
presence of UMN lesion from spinal cord compression
flicking of middle distal phalynx causes overflexion of index finger and thumb
what is subacute combined degeneration of the cord
degeneration of the posterior and lateral columns of the spinal cord due to a B12 deficiency
