Spinal cord compression

Question 1

what is spinal cord compression?

Answer 1

A surgical emergency requiring immediate neurosurgical treatment

Question 2

what can cause compression?

Answer 2

• neoplastic, can get metasteses e.g thyroid, lung, breast, prostate, renal.
• traumatic, usually vertebral fracture of facet joint dislocation
• infective, resulting in abscess formation can cause compression
• disc prolapse, a rare cause as lumbar disc herniation usually causes CES

Question 3

what are the clinical features of spinal cord compression?

Answer 3

• sensation and proprioception will be impared at dermatomal levels below compression
• bi/unilateral weakness
• upper motor neurone signs present below level of lesion e.g hypertonia, hyperreflexia, babinski’s sign, clonus
• autonomic involvement is late stage ad carriers worse prognosis. clinical features include bowel incontinence, constipation, retention. may be evidence of underlying cause

Question 4

what investigations are done?

Answer 4

MRI whole spine

routine bloods to see if there is an underlying cause

do a group and save as surgery is likely as well as a coag clotting screen

Question 5

what is the management?

Answer 5

• high dose corticosterioids e.g dexamethosone
• PPI for gastric protection
• refer to neurosurgery and may been oncological opinion
• surgery is definitive if patient is fit enough