Spinal Cord Compression and Cauda Equina Flashcards
What is the most common cause of spinal cord compression
Metastatic cord compression is the most common aetiology
What are the risk factors for a spinal cord compression?
Inflammatory disorders such as RA or Ankylosing spondylitis
Spinal stenosis
Ligamentum flavum hypertrophy
Metastatic cancers especially myeloma
What are the causes of spinal cord compression
Neoplastic – most common from thyroid, lung, breast, renal and prostate
Traumatic – vertebral fracture or facet joint dislocation or haematoma
Infective – spinal epidural abscess formation or chronic such as TB or fungal
Disc Prolapse – rare as lumbar usually compresses spinal nerve roots or cauda equina
What differentials should be considered alongside spinal cord compression?
Differentials – Transverse myelitis, MS, carcinomatous meningitis, spinal artery thrombosis or aneurysm and Guillain barre syndrome.
Describe the common presentation of spinal cord compression
Preceding back pain
Bilateral weakness with UMN signs below the level and LMN at the level
Sensory loss below the lesion
Autonomic involvement is a later stage sign – bowl and bladder retention
How should suspected spinal cord compression be investigated?
Emergency MRI of whole spine
CXR looking for lung malignancy or TB
How is spinal cord compression managed?
High dose corticosteroids
PPI for gastric protection
Referral for Neurosurgery
Radiotherapy
If Epidural abscess must be surgically decompressed and given antibiotics
What is cauda equine syndrome?
Surgical emergency due to compression of the cauda equina. Peak age of 40-50. 4 in 10,000 back pain patients will be diagnosed with cauda equina
Describe the common causes of cauda equina syndrome
Disc herniation (most common L5/S1 and L4/L5)
Trauma
Neoplasm
Infection (TB)
Iatrogenic (haematoma secondary to spinal analgesia)
Describe the presentation of cauda equine syndrome
Back pain and radicular pain down the leg
Areflexic, atrophic paralysis of the legs, sensory loss in a root distribution and reduced sphincter tone
Lower motor neurone signs and symptoms e.g. flaccid and areflexic
Perianal paraesthesia and bladder and bowl dysfunction
Impotence
Describe the presentation of conus medullaris syndrome
Mixed UMN and LMN signs, leg weakness
Early urinary retention and constipation
Back pain and sacral sensory disturbance and erectile dysfunction
How should cauda equina syndrome be investigated?
DRE
Post void bladder scan
Whole spine MRI emergency
CXR for lung malignancy or TB
What is the difference between complete cauda equina and incomplete cauda equina syndrome
Complete – urinary retention
Incomplete – difficulty voiding
How is cauda equina syndrome managed?
High dose Steroids (dexamethasone)
Immobilisations
Neurosurgical intervention for surgical decompression
If neoplasm, then radiotherapy and/or chemotherapy.
What is subacute combined degeneration of the cord
This occurs due to Vitamin B12 deficiency causing neurological symptoms due to symmetrical degeneration of the dorsal and corticospinal tracts. Can be caused by giving folate before B12 is okay.
