Spinal Cord Compression

Question 1

Define:

Answer 1

Pressure injury to the spinal cord with neuro symptoms dependent on the site and the extent of the injury

Question 2

Define Cauda equina syndrome:

Answer 2

symptoms due to damage to the bundle of nerves below the end of the spinal cord (L2 onwards)

Question 3

Define Conus Medullaris syndrome:

Answer 3

• The conus medullaris is the tapered, lower end of the spinal cord occurring at L1/L2. Conus medullaris syndrome is caused by an injury to the conus medullaris

Question 4

Aetiology:

Answer 4

Mainly trauma and tumours.

Trauma leads to:

• Direct cord compression
• Haematoma
• Compression by the bone fragments
• Acute disc prolapse

Tumours are mainly metastases from: breast, lung, prostate, thyroid and kidneys

Other causes: Pott’s disease in TB, ankolysing spondolyitis, myleoma, spinal abscess, lumbar disc disease

Question 5

Risk factors:

Answer 5

Trauma 
Malignancy 
Osteoporosis 
Metabolic bone disease 
Vertebral disc disease

Question 6

Symptoms:

Answer 6

Hx of tumours or trauma 
Pain
Bladder and bowel disturbances 
Weakness
Sensory loss

Question 7

Signs of cord compression:

Answer 7

At the site of the lesion you find LMN effects, below there is UMN but above there is no changes.

Diaphragmatic breathing

Sensory loss below the lesion

Weakness or paralysis

Reduced anal tone

Priapism

Hyporeflexia

Spinal shock

Question 8

Signs of cauda equina:

Answer 8

This is a LMN weakness

Loss of sensation in the saddle area

Back pain (sciatic)

Reduced sphincter tone - bladder and bowel incontinence

Asymmetrical, atrophic, areflexic paralysis of the legs.

erectile dysfunction

Question 9

Signs of Conus medularis syndrome:

Answer 9

Mixed UMN and LMN

Early urinary retention and constipation

Back pain

erectile dysfunction

Question 10

Investigations:

Answer 10

MRI

Lateral imaging of the spine to see alignment

FBC, U+Es, syphilis serology, LFTs, ESR, calcium, PSA

Urine for bence jones proteins and immunoglobulin electrophoresis for multiple myleoma

CXR - for lung mets and TB