Spinal Cord Compression

Question 1

what is the clinical features of complete spinal cord transection?

Answer 1

All sensory modalities and reflexes impaired below level of severance: pinprick loss most valuable Flaccid, paraplegia or tetraplegia
Fasciculations
Urinary or rectal sphincter dysfunction
Sweating, piloerection diminished below lesions
Genital reflexes lost, priapism

Question 2

what are the clinical features of central cord syndrome?

Answer 2

Vest-like loss of pain and temperature
Initial sparing of proprioception
Sacral sensation spared
Paraparesis or tetraparesis

Question 3

what are the clinical features of cord hemisection?

Answer 3

• Ipsilateral upper motor neuron paralysis and loss of proprioception (dorsal column) below the lesion.
• Contralateral loss of pain and temperature sensation beginning at 1 or 2 segments below the lesion.

Question 4

what are the clinical features of anterior cord syndrome?

Answer 4

· Pain and temperature loss below lesion
· Proprioception spared
· Flaccid, areflexia
· Paraparesis or tetraparesis
· Fasciculations
· Urinary or rectal sphincter dysfunction
· Dysautonomia absent

Question 5

what are the features of UMN symptoms in cord hemisection?

Answer 5

o signs maximal on side of lesion.
o Weakness in a ‘pyramidal’ distribution
 arms – extensors predominantly affected
 legs – flexors predominantly affected.
o Increased tone, clonus – increased reflexes
o Extensor plantar response

Question 6

what are the causes of central cord syndrome?

Answer 6

Acute extension or flexion injury to already stenotic neck or syringomyelia or tumour

Question 7

why is upper limb weakness more common than lower limb in central cord syndrome?

Answer 7

the fibres supplying the upper limbs in the lateral corticospinal tracts are more medial to the fibres supplying the lower limbs, hence a lesion in the central cord is more likely to damage the upper limb fibres

Question 8

what tracts are affected as the lesion expands in central cord syndrome?

Answer 8

anterior horn cells are also involved and a l.m.n weakness occurs

Question 9

what happens when corticospinal tracts are involved in central cord syndrome?

Answer 9

u.m.n signs and symptoms in the limbs below the level of lesion

Question 10

what are the acute causes of spinal cord compression?

Answer 10

Trauma, tumours, infection, spontaneous haemorrhage

Question 11

what are the types of spinal cord trauma?

Answer 11

Vertical Compression = burst fracture (stable)
Hinge Injury – weight falling on back or blow to the head (stable or unstable)
Shearing Injury – fall from height or RTA (unstable)
Hyperextension injury – rupture of anterior longitudinal ligament (stable in flexion)

Question 12

what are the clinical features of spinal cord compression caused by trauma?

Answer 12

tenderness over spinous process, paraspinal swelling or a gap between the spinous process
neurogenic paradoxical ventilation
bilateral absence of limb reflexes in flaccid limbs, unresponsive to painful stimuli indicates spinal cord damage
painless urinary retention or priapism

Question 13

how is spinal cord trauma diagnosed?

Answer 13

 X Rays – lateral view and AP (if in doubt take oblique)
 CT Scanning
 MRI

Question 14

how is spinal cord trauma managed?

Answer 14

unstable lesions require either operative fixation or immobilisation
METHYLPREDNISOLONE – bolus, 24hr infusion

Question 15

how is spinal cord trauma of odontoids managed?

Answer 15

immobilisation to avoid non-union = Halo (posterior C1, C2 fusion if non-union)

Question 16

how is spinal cord trauma of cervical spine managed?

Answer 16

• if cord damage – traction (tongs/callipers inserted into skull)
• if cord intact + stable = cervical collar
• If cord intact + unstable = operative fixation or 12 weeks skull traction or halo

Question 17

how is spinal cord trauma of thoracic spine managed?

Answer 17

• stable – normal activity after pain subsides

* unstable – no treatment other than for paraplegia

Question 18

how is spinal cord trauma of thoracolumbar region managed?

Answer 18

• stable = mobilise
• unstable – operative reduction and fixation (anterior and/or posterior e.g. Hartshill rectangle or screw/rod construct)
• Unstable – conservative – without paraplegia = brace, with paraplegia = bed rest

Question 19

how do tumours cause spinal cord compression?

Answer 19

collapse or haemorrhage

Question 20

what are the causes of spinal cord compression via infection?

Answer 20

o surgery or trauma

o epidural abscess

Question 21

what are the common organisms involved in spinal cord infection?

Answer 21

• staph aureus most common

* ALSO, TB

Question 22

how does TB spread in the spine?

Answer 22

lower thoracic spine effected and initially affects the intravertebral discs and spreads to vertebral bodies

Question 23

how does infection generally spread in spine?

Answer 23

Haematogenous spread or from vertebral osteomyelitis

Question 24

what are the clinical features of epidural abscess of spine?

Answer 24

• mimics extradural tumour or haematoma with bilateral leg weakness, sensory level and urinary retention
• very severe pain and tenderness
• toxaemia; pyrexia, malaise, increased pulse rate
• rigidity of neck and spinal column with marked resistance to flexion
• if TB – classic symptoms often absent

Question 25

how are epidural abscess of spine diagnosed?

Answer 25

• X-ray, MRI

* CSF, leucocytosis, blood cultures

Question 26

what is the management of epidural spinal abscess?

Answer 26

• antimicrobial therapy, surgical drainage, stabilisation where required

Question 27

what are causes of spontaneous haemorrhage?

Answer 27

Epidural, Subdural, Intramedullary, Trauma, Bleeding diatheses, Anticoagulants, AVM

Question 28

what are the causes of spinal cord infarction?

Answer 28

• small vessel disease – diabetes, vasculitis, neurosyphilis, endarteritis
• large vessel disease – atheromatous, embolic, thrombotic, Dissection, hypotension

Question 29

what are the clinical features of anterior spinal cord infarction?

Answer 29

DEPENDENT ON level, radicular pain at onset, sudden para/quadplegia, flaccid limbs → spastic, areflexia → hyper-reflexia and extensor plantar responses, preserved vibration and proprioception, urinary retention

Question 30

what are the clinical features of posterior spinal cord infarction?

Answer 30

loss of tendon reflexes/motor weakness, loss of proprioception

Question 31

what is the management of spinal cord infarction?

Answer 31

reverse anticoagulation, surgical decompression

Question 32

what are the causes of chronic spinal cord compression?

Answer 32

degenerative disease (spondylosis)
tumours
RA

Question 33

what are the causes of spinal cord stenosis?

Answer 33

osteophyte formation
bulging of intervertebral discs
facet joint hypertrophy
subluxation

Question 34

what are the clinical features of cervical spinal prolapse?

Answer 34

LMN, arm pain, dermatomes, myotomes

Question 35

what are the clinical features of thoracic spinal prolapse?

Answer 35

o rare
o thoracic pain
o usually central causing myeolopathy

Question 36

what are the clinical features of lumbar disc prolapse?

Answer 36

mechanical (spinal movements restricted, scoliosis present, lumbar lordosis lost), unable to straight leg raise, neurological deficit, numbness of parenthesis in distribution

Question 37

what is the pathophysiology of lumbar disc prolapse?

Answer 37

tear in annulus fibrosis leads to soft nucleus herniating causing irritation + compression to SC. Most common to herniate posterolateral. LMN

Question 38

what is the management of degenerative spinal stenosis?

Answer 38

surgical decompression +/- stabilisation

Question 39

what are the types of extradural spinal cord tumours?

Answer 39

usually metastasis of lung, breast, kidney, prostate

Question 40

what are the types of intradural spinal cord tumours?

Answer 40

• extramedullary – meningioma, schwannoma

* intramedullary – astrocytoma, ependymoma

Question 41

what are the clinical features of spinal tumours?

Answer 41

bone pain and tenderness, preceding limb and autonomic dysfunction

Question 42

what investigations are used to diagnose spinal tumours?

Answer 42

X-ray, MRI, PET Scan

Question 43

what is the management of metastatic spinal tumours?

Answer 43

depends on patient and tumour, dexamethasone, radiotherapy, chemotherapy, surgical decompression and stabilisation

Question 44

what is the management of primary spinal tumours?

Answer 44

surgical excision