Spinal Cord Compression Flashcards
what is the clinical features of complete spinal cord transection?
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
what are the clinical features of central cord syndrome?
Vest-like loss of pain and temperature
Initial sparing of proprioception
Sacral sensation spared
Paraparesis or tetraparesis
what are the clinical features of cord hemisection?
- 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.
what are the clinical features of anterior cord syndrome?
· Pain and temperature loss below lesion
· Proprioception spared
· Flaccid, areflexia
· Paraparesis or tetraparesis
· Fasciculations
· Urinary or rectal sphincter dysfunction
· Dysautonomia absent
what are the features of UMN symptoms in cord hemisection?
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
what are the causes of central cord syndrome?
Acute extension or flexion injury to already stenotic neck or syringomyelia or tumour
why is upper limb weakness more common than lower limb in central cord syndrome?
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
what tracts are affected as the lesion expands in central cord syndrome?
anterior horn cells are also involved and a l.m.n weakness occurs
what happens when corticospinal tracts are involved in central cord syndrome?
u.m.n signs and symptoms in the limbs below the level of lesion
what are the acute causes of spinal cord compression?
Trauma, tumours, infection, spontaneous haemorrhage
what are the types of spinal cord trauma?
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)
what are the clinical features of spinal cord compression caused by trauma?
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
how is spinal cord trauma diagnosed?
X Rays – lateral view and AP (if in doubt take oblique)
CT Scanning
MRI
how is spinal cord trauma managed?
unstable lesions require either operative fixation or immobilisation
METHYLPREDNISOLONE – bolus, 24hr infusion
how is spinal cord trauma of odontoids managed?
immobilisation to avoid non-union = Halo (posterior C1, C2 fusion if non-union)
how is spinal cord trauma of cervical spine managed?
- 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
how is spinal cord trauma of thoracic spine managed?
- stable – normal activity after pain subsides
* unstable – no treatment other than for paraplegia
how is spinal cord trauma of thoracolumbar region managed?
- 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
how do tumours cause spinal cord compression?
collapse or haemorrhage
what are the causes of spinal cord compression via infection?
o surgery or trauma
o epidural abscess
what are the common organisms involved in spinal cord infection?
- staph aureus most common
* ALSO, TB
how does TB spread in the spine?
lower thoracic spine effected and initially affects the intravertebral discs and spreads to vertebral bodies
how does infection generally spread in spine?
Haematogenous spread or from vertebral osteomyelitis
what are the clinical features of epidural abscess of spine?
- 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
how are epidural abscess of spine diagnosed?
- X-ray, MRI
* CSF, leucocytosis, blood cultures
what is the management of epidural spinal abscess?
• antimicrobial therapy, surgical drainage, stabilisation where required
what are causes of spontaneous haemorrhage?
Epidural, Subdural, Intramedullary, Trauma, Bleeding diatheses, Anticoagulants, AVM
what are the causes of spinal cord infarction?
- small vessel disease – diabetes, vasculitis, neurosyphilis, endarteritis
- large vessel disease – atheromatous, embolic, thrombotic, Dissection, hypotension
what are the clinical features of anterior spinal cord infarction?
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
what are the clinical features of posterior spinal cord infarction?
loss of tendon reflexes/motor weakness, loss of proprioception
what is the management of spinal cord infarction?
reverse anticoagulation, surgical decompression
what are the causes of chronic spinal cord compression?
degenerative disease (spondylosis)
tumours
RA
what are the causes of spinal cord stenosis?
osteophyte formation
bulging of intervertebral discs
facet joint hypertrophy
subluxation
what are the clinical features of cervical spinal prolapse?
LMN, arm pain, dermatomes, myotomes
what are the clinical features of thoracic spinal prolapse?
o rare
o thoracic pain
o usually central causing myeolopathy
what are the clinical features of lumbar disc prolapse?
mechanical (spinal movements restricted, scoliosis present, lumbar lordosis lost), unable to straight leg raise, neurological deficit, numbness of parenthesis in distribution
what is the pathophysiology of lumbar disc prolapse?
tear in annulus fibrosis leads to soft nucleus herniating causing irritation + compression to SC. Most common to herniate posterolateral. LMN
what is the management of degenerative spinal stenosis?
surgical decompression +/- stabilisation
what are the types of extradural spinal cord tumours?
usually metastasis of lung, breast, kidney, prostate
what are the types of intradural spinal cord tumours?
- extramedullary – meningioma, schwannoma
* intramedullary – astrocytoma, ependymoma
what are the clinical features of spinal tumours?
bone pain and tenderness, preceding limb and autonomic dysfunction
what investigations are used to diagnose spinal tumours?
X-ray, MRI, PET Scan
what is the management of metastatic spinal tumours?
depends on patient and tumour, dexamethasone, radiotherapy, chemotherapy, surgical decompression and stabilisation
what is the management of primary spinal tumours?
surgical excision
