Spinal Cord Compression

Question 1

Spinal Cord Compression Aetiology

Answer 1

• Trauma (fracture, transection, BS)
• Tumours
• Prolapsed intervertebral discs, cauda equina
• Epidural/subdural haematoma
• Inflammatory disease
• Infection
• Cervical spondylitic myelopathy

Question 2

Red Flags That Suggest Spinal Cord Compression

Answer 2

• Insidious progression
• Neurological symptoms: gait disturbance, clumsy hands, loss of sexual, bladder or bowel function
• Neurological signs: Lhermitte’s, UMN signs (Babinski’s up going…), lower motor neurone signs (atrophy…), sensory changes

Question 3

Spinal Cord Compression Presentation

Answer 3

• Motor, sensory and autonomic dysfunction can occur
• Fatigue and disturbance of gait
• Cervical lesions can cause quadriplegic, need for ventilation if about C3, C4, C5
• Thoracic lesions produce paraplegia
• Lumbar lesions can affect L4, L5 and sacral nerve roots
• Sensory symptoms
• Reflexes increased below, absent at level, normal above level of compression
• Sphincter disturbances

Question 4

Spinal Cord Compression Investigations

Answer 4

-MRI spine

Question 5

Spinal Cord Compression Due to Metastasis Most Common Cancers, Management

Answer 5

• Breast, prostate, lung
• Dexamethasone with PPI
• Management may be with surgery or radiotherapy

Question 6

Spinal Cord Compression Trauma Management

Answer 6

• Immobilisation + surgery

- Manage hypotension

Question 7

Spinal Cord Compression Cauda Equina Management

Answer 7

• Decompressive laminectomy

- Manage hypotension