Spinal Cord Compression

Question 1

What can cause acute spinal cord compression?

Answer 1

Trauma
Tumours
Infection
Spontaneous haemorrhage

Question 2

What usually causes chronic spinal cord compression?

Answer 2

Degenerative disease – spondylosis
Tumours
Rheumatoid Arthritis

Question 3

What is meant by incomplete cord transection?

Answer 3

Preservation of some power and sensation

Question 4

What part of the spinal cord is normally affected in rheumatoid arthritis?

Answer 4

C1/2 joint as this has the most synovium

=> loss of the synovium can cause vertebrae to move over each other and compress spinal cord

Question 5

What symptoms occur in a sensory level cord transection?

Answer 5

All sensation below that level of the spinal cord is lost

Question 6

What symptoms occur in a motor level cord transection?

Answer 6

All motor function below the level of the compression is affected.

If the level that is affected carries out movements with other levels ABOVE it, then these movements can still be done but will be weaker

Question 7

What is spinal shock after an acute injury?

Answer 7

• Flacid paralysis of the body due to depolarisation right down the spinal cord
• As muscles are flacid and lose all tone, all reflexes are also lost

Question 8

Why is hypotension after acute spinal cord injury also considered “spinal shock”?

Answer 8

Thoracolumbar outflow of sympathetics is affected by injury

=> BP cannot be maintained and pt becomes hypotensive

Question 9

Describe the type of cord injury seen in Brown-Sequard syndrome?

Answer 9

Hemisection of cord

=> ONE SIDE ONLY IS CUT

Question 10

What symptoms are seen in Brown-Sequard Syndrome?

Answer 10

Ipsilateral fine touch/vibration loss (dorsal column)
Ipsilateral weakness (corticospinal tract)
Contralateral loss of pain/temp sensation (spinothalamic)

Question 11

What type of injury usually causes a central cord syndrome?

Answer 11

Hyperflexion or extension injury to already stenotic neck

Question 12

What type of patient usually presents with a central cord syndrome?

Answer 12

Older patient after a fall

Question 13

What symptoms indicate a central cord syndrome?

Answer 13

Distal upper limb weakness (as motor control of hands = most medial => falls within centre part of cord that is damaged)

“Cape-like” spinothalamic sensory loss over back and shoulders

Question 14

Do upper or lower motor neuron signs predominate in a chronic spinal cord compression?

Answer 14

UPPER motor neuron signs predominate

usually in lower limbs

Question 15

What segment of the spine is most likely to get injured during trauma?

Answer 15

Cervical spine (most mobile)

Question 16

What type or tumour most commonly compresses the spinal cord?

Answer 16

Extradural
=> Metastases to bone
(from breast, lung, kidney, prostate)

Question 17

What types of tumour can arise inside the dura (intradural) and cause spinal cord compression?

Answer 17

Extramedullary => inside meninges but outside spinal cord

• Meningioma
• Schwannoma
  - Intramedullary => tumour OF THE SPINAL CORD
• Astrocytoma
• Ependymoma (cells lining spinal canal)

Question 18

Explain how tumours can cause acute and chronic compression of the spinal cord

Answer 18

Can slowly compress => chronic

Can cause acute compression by collapse or haemorrhage

Question 19

What degenerative changes in the spinal cord can cause spinal canal stenosis?

Answer 19

• osteophyte formation - bulging of intervertebral discs - facet joint hypertrophy - subluxation (due to joint incompetence letting bones move)

Question 20

How are spinal cord compressions due to trauma investigated and treated?

Answer 20

Ix = CT (standard), MRI for potential tumour

Tx = Surgery - decompress (traction) and stabilise (external/internal fixation)

Question 21

Why is traction used as a form of decompression in treating traumatic spinal cord injury?

Answer 21

Traction causes any subluxations to slip back into almost normal position
=> easier to fixate

Question 22

Methylprednisolone does not have much added benefit in treating spinal cord trauma patients. TRUE/FALSE?

Answer 22

TRUE

- no clear benefit, but drug is sometimes given as a last resort

Question 23

How are metastatic tumours compressing the spinal cord treated?

Answer 23

Dexamethasone IV (allows time to carry out investigations)

• Radiotherapy
• Chemotherapy (if chemosensitive e.g. myeloma)
• Surgical decompression and stabilisation IF REQUIRED

Question 24

When would surgical decompression and stabilisation NOT be performed in patients with metastases compressing their spinal cord?

Answer 24

If the cancer was so advanced that their prognosis is poor regardless

No surgery means they can spend their time at home with family, rather than in hospital suffering surgical complications

Question 25

How are primary tumours compressing the spinal cord treated?

Answer 25

Surgical excision

Question 26

How is an infection, which is causing spinal cord compression, treated?

Answer 26

Antimicrobial therapy
Surgical drainage
Stabilisation where required

Question 27

How are haemorrhages causing spinal cord compression treated?

Answer 27

Reverse anticoagulation

Surgical decompression

Question 28

How is degenerative disease which is compressing the spinal cord treated?

Answer 28

Surgical decompression +/- stabilisation

Question 29

What group of patients are likely to demonstrate a Brown-Sequard syndrome and why?

Answer 29

Patients with MS or other demyelinating disorders as the plaque formation is often asymmetrical on spinal cord