Spinal Cord Compression

Question 1

Define spinal cord compression

Answer 1

Spinal cord compression (SCC) results from processes that compress the spinal cord or blood vessels/ CSF spaces.

Question 2

What are the causes/risk factors of spinal cord compression?

Answer 2

Trauma:  
• Accidents 
• Falls
• GSW 
• Surgery/ Injections 

Vertebral Compression: 
• Osteoporosis 
• Steroids 
• Osteomalacia 
• Osteomyelitis 

Intervertebral Disc Disease:
• Herniation: Rupture of the nucleus pulposis.

Tumours (85% Metastatic): 
• Sarcomas 
• CNS Tumours 
• Multiple Myeloma 
• Metastases: 
• Lung, Breast, Prostate, Renal 

Infections:
• Discitis
• TB –Pott’s Disease
• Epidural Abscess

_E__

Question 3

What are the symptoms of spinal cord compression?

Answer 3

• Back Pain
• Altered sensations/ paraesthesia below the level of compression
• Weakness:
- Hemiplegia or hemiparesis, sparring the face in compressions higher up in the spine.
- Paraplegia and paraparesis, in compressions lower down in the spine.
- Tetraplegia and tetraparesis if the compression is affecting both sides of the cord.
• Autonomic Symptoms:
- Constipation
- Urinary retention
- Cold, shivering and drowsiness
- Erectile dysfunction
- Syncope
• Acute symptoms are more suggestive of trauma or disc herniation.
• Chronic onset symptoms is suggestive of malignancy, osteoporosis or osteomyelitis.

Question 4

What are the signs of spinal cord compression?

Answer 4

Following a history of acute spinal trauma and while examination is undertaken, the patient should be immobilised with a cervical collar and backboard/head strap.
• Tone: Flaccidity in an acute presentation due to spinal shock. After a few weeks, there will be hypotonia.
• Power: Motor loss and weakness is a common presentation in people with cord compression.
• Reflexes: Lost initially due to spinal shock. In a more chronic cause, where a UMN lesion develops, hyperreflexia will develop (usually after a few weeks).
• Co-ordination: Usually intact as the cerebellum is working well.
• Sensation: Pinprick and vibration are tested from caudally, moving raustrally. This can be useful to detect a sensory level –thus determining the level of compression.
• Horner’s syndrome may be seen with higher transections due to loss of descending sympathetic pathways from the hypothalamus.
• Neurogenic Shock: Usually follows cervical or high thoracic injury. Patients show hypotension, bradycardia, warm, dry extremities, peripheral vasodilation, venous pooling, poikilothermia, priapism, and decreased cardiac output.

Question 5

What investigations are carried out for spinal cord compression?

Answer 5

• Spine X-Ray - decreased disc space height (disc compression), loss of bony detail (tumour, infection), misalignment of vertebral elements (trauma), loss of end-plate definition (infection).
• MRI Spine - disc displacement, epidural enhancement, mass effect, T2 cord signal.
- Infection: epidural space and bone involvement; Metastatic disease: visualisation of tumour.
• FBC - raised WBC count with neutrophilia seen in infection
• ESR/CRP - elevated in infection & inflammation.
• Blood/ CSF Culture - positive in epidural abscess, discitis, or osteomyelitis
• PET Scan - hypermetabolism ‘hot spots’ in areas pf metastases.