spinal cord compression Flashcards
compare the features of cauda equina and spinal cord compression?
Define spinal cord compression?
• Injury to the spinal cord with neurological symptoms dependent on the site and extent of the injury
~ acute cord compression is an emergency
what are the causes of spinal cord compression?
trauma leads to compression by:
- direct cord contusion
- compression by bone fragments
- haematoma
- acute disc
tumours more frequently METASTASES
Other causes: spinal abscess, TB (Pott’s disease), spinal vasc malformations
what are the risk factors for spinal cord compression?
o Trauma
o Osteoporosis
o Metabolic bone disease
o Vertebral disc disease
summarise the epidemiology of spinal cord compression?
- COMMON
- Trauma occurs across all age groups
- Malignancy/disc disease is more common in the ELDERLY
what are the presenting symptoms of cord compression?
- History of trauma or malignancy
- Pain
- Weakness
- Sensory loss *
- Disturbance of bowel and bladder function *
* NOTE: URGENT – NEED TO GET THEM TO HOSPITAL ASAP
what are the signs of spinal cord compression?
- History of trauma or malignancy
- Pain
- Weakness
- Sensory loss *
- Disturbance of bowel and bladder function
URGENT – NEED TO GET THEM TO HOSPITAL ASAP
what are the symptoms of cauda equina syndrome?
large central lumbar prolapse =? CAUDA EQUINA SYNDROME
- Bilateral sciatica
- Saddle anaesthesia (loss of sensation in the area of the buttocks that is covered by a bike seat)
- Urinary retention
Need urgent same day assessment by spinal surgeon, imaging and then surgical decompression as appropriate – this must be done within hours and even waiting until the next day may allow irreversible damage and paralysis to occur
what are the signs of cauda equina syndrome on physical examination?
Flaccid paraparesis
Urinary retention/ incontinence
Reduced anal tone
Saddle anaesthesia - can’t feel anything when they wipe
Impaired knee, ankle, bulbocavernous reflexes
May be asymmetrical
what are the signs of brown sequard syndrome on physical examination?
seen with hemisection of the spinal cord – weakness of ipsilateral leg and numbness of contralateral leg
what are the signs of spinal cord compression on physical examination?
- Diaphragmatic breathing
- Reduced anal tone
- HYPOreflexia
- Priapism (persistent and painful erection)
- Spinal shock (low blood pressure without tachycardia)
- Sensory Loss - at level of the lesion
Motor
- Weakness or paralysis
- Downward plantars (in acute phase)
- UMN signs below the level of the lesion
- LMN signs at the level of the lesion
what are the red flag signs of spinal cord compression?
- Thoracic pain.
- Age of onset less than 20 or more than 55 years.
- Loss of control of the bowel or bladder.
- Weakness or numbness in a leg or arm.
- Foot drop, disturbed gait.
- High fever.
- Saddle anaesthesia (numbness of the anus, perineum or genitals).
- History of carcinoma.
- Structural deformity.
symptoms could indicate spinal cord compression, possible cauda equina syndrome or the presence of a tumour (FLAWS) or infection.
what are the appopriate investigations for spinal cord compression?
Radiology
- Lateral radiographs of spine to look for loss of alignment, fractures etc.
- MRI(can see canal changes e.g. narrowing) or CT
Bloods - FBC, U&Es, calcium, ESR, immunoglobulin electrophoresis (multiple myeloma)
Urine - look for Bence Jones proteins (multiple myeloma)
what are the differences in reflexes between cauda equinal syndrome and
Cauda equina compression causes flaccid paralysis with loss of reflexes.
Cord compression usually causes spastic paralysis with brisk reflexes
what is brown sequard syndrome ( BSS)?
rare neurological condition characterized by a hemicord lesion in the spinal cord which results in weakness or paralysis (hemiparaplegia) and light touch/proprioception on ipsilateral side side of the body and a loss of pain and temp on the contra lateral side
