spinal cord compression Flashcards
definition of cord compression
injury to the spinal cord with neurological sx that depend on the site and extent of injury
aetiology of cord compression
trauma and tumours are most common causes
- trauma can cause direct cord contusion or compression by bone fragments, haematoma or acute disk prolapse
- tumours can be primary, more commonly are mets (breast, lung, prostate, kidney, thyroid, melanoma) = collapse or compression of a vertebral body
vascular malformationeg cavernous haemangiomas
infection - spinal abscess
TB (Pott’s disease)
cervical disc prolapse
haematoma - warfarin
atlanto-axial subluxation
myeloma
associations and RF of cord compression
sig spinal cord injury is associated with severe trauma, often with head injuries
in the presence of a tumour or vascular malformation, relatively minor trauma can cause severe sx
predisposing factors
- osteoporosis
- metabolic bone disease
- vertebral disk disease
epidemiology of cord compression
common
trauma at any age
malignancy and disc disease - more common in older pop
sx of cord compression
Hx of injury or trauma
back pain - nocturnal and with straining
bilateral leg weakness (arm weakness less severe and suggests cervical lesion)
limb weakness
sensory loss
difficulty walking
clumsy
disturbance of bowel/bladder func - bladder and anal sphincter involvement is late - hesitency and frequency and then painless retention
large central lumbar disk prolapse may cause bilateral sciatica, saddle anaesthesia and urinary retention
may be a hx of malignancy
ask about nocturnal pain and pain with straining
worry if cervical/thoracic pain
signs of cord compression
diaphragmatic breathing
reduced anal tone
hyporeflexia
priapism
spinal shock - low BP w/o tachycardia
look for sensory, reflex and motor level
- normal above
- sensory signs at level of lesion
- UMN below (except in acute) - spastic weakness, upgoing plantars
motor signs
Brown-Sequard syndrome
motor signs of cord compression
weakness/paralysis (LMN signs), downward plantar in acute phase and at level of spinal cord injury
UMN signs and upward plantar reflexes seen in the later phase below the level of the spinal cord injury
brown-sequard syndrome
seen in hemisection of the spinal cord
below level of lesion - ipsilateral spastic paralysis and loss of postural sense and contralateral loss of pain and thermal sense#
(spinothalamic dessucates at level of exit)
pathology of cord compression
spinal cord exits the skull at the foramen magnum and ends at L1
8 cervival, 12 thoracic, 5 lumbar, 5 sacral and 1 coccygeal pairs of spinal nerves
the lumbar, sacral and coccygeal roots form the cauda equina
role of C5
shoulder abduction - deltoid
role of C6
forearm flexion - biceps
role of C7
forearm extension - triceps
role of C8
wrist/finger flexion
role of T1
finger abduction
role of L2
hip flexion - iliopsoas
role of L3
knee extension - quadriceps
role of L4
ankle dorsiflexion (tibialis anterior)
role of S1
ankle plantar flexion - gastrocnemius
Ix for cord compression
radiology:
- AP and lateral XR of cervical (also peg view), thoracic, or lumbar spine - look for loss of alignment, loss of height or wedging due to compression fracture, detatched fragments
- emergency MRI or CT necessary
blood - FBC, UE, Ca, ESR, immunoglobin electrophoresis, B12, syphilis serology, PSA
urine - Bence Jones protein (indicative of multiple myeloma)
biopsy or surgical exploration may be needed to idnetify nature of a mass
CXR - primary lung malignancy, lung secondaries, TB
ddx for cord compression
transverse myelitis
MS
carcinomatous meningitis
cord vasculitus (PAN, syphilis)
spinal artery thrombosis or aneurysm
trauma
Guillain-Barre syndrome
sx with cauda equina and conus medullaris lesions
leg weakness is flaccid and areflexic (not spastic and hyperreflexic as is the case with lesions higher up)
alternating or bilateral root pain in legs
saddle anaesthesia (perianal) - lack of sensitivity in S3-S5 around anus, genitalia, and inner thighs
loss of anal tone on PR
bladder +- bowel incontinence
causes of cauda equina and conus medullaris lesions
same as lesions higher
congenital lumbar disk disease adn lumbosacral nerve lesions
signs of conus medullaris lesions
mixed UMN and LMN signs
leg weakness
early urinary retention and constipation
back pain
sacral sensory disturbance
erectile dysfunction
cauda equina lesions signs
back pain
radicular pain down the legs
asymmetrical
atrophic
areflexic paralysis of legs
sensory loss in a root distribution
reduced sphincter tone - do PR
saddle anaesthesia
