Spinal Cord Compression Flashcards
What are the signs of a upper motor neuron lesion?
- increased tone
- muscle wasting not marked
- no fasciculations
- hyper-reflexia
What are the signs of a lower motor neuron lesion?
- decreased tone
- muscle wasting
- fasciculations
- diminished reflexes
How can spinal cord compression be categorised?
Acute/chronic
Complete/incomplete
What are the causes of acute spinal cord compression?
Trauma, tumours, infection, spontaneous haemorrhage
Define sensory level
Lowest level that has normal pinprick and touch sensation
Define motor level
Lowest key muscle function with a grade <3 on muscle testing
What is Brown Sequard Syndrome?
Cord hemisection, ipsilateral motor level and dorsal column sensory level but contralateral spinothalamic level
Who does central cord syndrome commonly affect?
In elderly patients hyperflexion or extension injury in stenotic neck
How does central cord compression present?
Distal upper limb weakness, cape-like spinothalamic sensory loss but dorsal column and lower limbs are preserved
What is special about the corticospinal tract?
It is layered and the upper limb area is more medial to the lower limb
What signs are predominant in chronic cord compression?
UNM signs
State the types of trauma that cause cord compression
Vehicle/heights usually cervical or lumbar
Where do extradural tumours tend to come from?
Metastases - lung, breast, prostate, kidney, thyroid, haematological - plasmocytoma
What are the three positions of a tumour in the spinal cord?
- extradural
- intradural, extramedullary (in the meninges)
- intradural, intramedullary (on the spinal cord)
What types of tumour are often intradural extramedullary?
Meningioma
Schwannoma
What types of tumour are often intramedullary?
Astrocytoma, ependymoma
State the degenerative causes of cord compression
Osteophytes
Bulging discs
Facet joint hypertrophy
Subluxation
How is compression due to trauma treated?
CT/MRI, decompress and stabilise by traction or fixation
How is compression due to tumours treated?
Dexamethasone can help protect neurons
Primary - surgical excision
Mets - radiotherapy, chemotherapy, palliative surgery
How is compression due to infection treated?
Antimicrobial treatment
Drainage
Stabilisation may help eliminate micro-movement in wound healing
How is compression due to haemorrhage treated?
Reverse anticoagulation and surgical decompression
How is compression due to degenerative disease treated?
Surgical decompression
Stabilisation
What causes anterior cord syndrome?
Infarction by anterior spinal artery
How does anterior cord syndrome present?
Paralysis, loss of pain and temperature but preserved proprioception
How does cervical myelopathy present?
UMN signs in lower limbs
Imbalance, gait disturbance, clumsy, incontinence, pain, legs jump at night
What signs will be positive in cervical myelopathy?
Babinski
Hoffmans
How is cervical myelopathy investigated and treated?
MRI
Surgical decompression
