Spinal cord compression

Question 1

What determines the clinical features of a spinal cord compression?

Answer 1

The location of the compression

Question 2

Give three things that spinal cord compression can be a result of?

Answer 2

• Spondylosis (degeneration of the spine)
• Disc prolapse
• Spondylolisthesis (one vertebra slips forward on another)
• Spinal tumours - Secondary malignancy typically from (Thyroid, Lung, Breast, Kidney, Prostate)
• Spinal stenosis
• Spinal abscess
• Spinal Tuberculosis

Question 3

What are the risk factors of spinal cord compression?

Answer 3

• Osteoporosis
• Trauma
• Tumour
• Rheumatoid arthritis - Atlanto-axial instability
• Ankylosing spondylitis

Question 4

What would the signs at the level of the lesion be?

Answer 4

• Localised back pain, nerve root pain, which is typically sharp, shooting, burning and radiating in character.
• There may be numbness
• Paraesthesia
• Also lower motor neuron signs

Question 5

What would the signs below the lesion in a spinal cord compression be?

Answer 5

• Upper motor neuron symptoms and signs.
• Therefore, knowledge of the cross-sectional anatomy of the cord at different levels is essential and also knowledge of the different dermatomes and myotomes.

Question 6

What investigations would you do in suspected spinal cord compression?

Answer 6

• MRI
• Biopsy or exploration of any mass
• Chest X-ray may be required to look for primary lung cancers

Question 7

What pharmacological treatments can be given in spinal cord compression?

Answer 7

• Dexamethasone if there is a malignancy - red oedema around lesion
• Chemotherapy
• Radiotherapy

Question 8

What surgical treatment can be used in spinal cord compression?

Answer 8

Decompressive laminectomy