Spinal Cord Compression

Question 1

What is the definition of Spinal Cord Compression?

Answer 1

Injury to the spinal cord with neurological symptoms dependent on the site and extent of the injury

Question 2

What is the aetiology involved with spinal cord compression?

Answer 2

• Majority of cases = trauma and tumors
• Trauma can lead to cord compression via direct cord contusion, compression by bone fragments, haematoma ad acute disk prolapse
• Tumours are more freq. metastases
• Other causes include spinal abscess, TB (Pott’s disease)

Question 3

What are the risk factors involved with spinal cord compression?

Answer 3

Trauma

Osteoporosis

Metabolic bone disease

Vertebral disc disease

Question 4

What is the epidemiology of spinal cord compression

Answer 4

COMMON

Trauma occurs across all age groups

Malignancy/disc disease is more common in the ELDERLY

Question 5

What are the presenting symptoms of spinal cord compression?

Answer 5

History of trauma or malignancy

Pain

Weakness

Sensory loss

Disturbance of bowel and bladder function

A large central lumbar disc prolapse may cause:

• Bilateral sciatica
• Saddle anaesthesia (loss of sensation in the area of the buttocks that is covered by a bike seat)
• Urinary retention

Question 6

What are the signs of spinal cord compression upon physical examination?

Answer 6

Diaphragmatic breathing

Reduced anal tone

HYPOreflexia

Priapism (persistent and painful erection)

Spinal shock (low blood pressure without tachycardia)

Sensory Loss - at level of the lesion

Motor  
Weakness or paralysis  
Downward plantars (in acute phase)  
UMN signs below the level of the lesion 
LMN signs at the level of the lesion  

Brown-Sequard Syndrome - seen with hemisection of the spinal cord

Question 7

What are the appropriate examinations for spinal cord compression?

Answer 7

• > Radiology:
• Lateral radiographs of spine to look for loss of alignment, fractures etc.
• MRI or CT
• > Bloods - FBC, U&Es, calcium, ESR, immunoglobulin electrophoresis (multiple myeloma)
• > Urine - look for Bence Jones proteins (multiple myeloma)