Spinal Cord Compression (cauda equina)

Question 1

Definition

Answer 1

Injury to the spinal cord with neurological symptoms dependent on the site and extent of the injury

Question 2

Aetiology

Answer 2

• MOST CASES: trauma and tumours

• Trauma can lead to compression by:
o Direct cord contusion
o Compression by bone fragments
o Haematoma
o Acute disk prolapse

• Tumours are more frequently METASTASES
• Other causes: spinal abscess, TB (Pott’s disease)

Question 3

Risk factors

Answer 3

o Trauma
o Osteoporosis
o Metabolic bone disease
o Vertebral disc disease

Question 4

Epidemiology

Answer 4

• COMMON
• Trauma occurs across all age groups
• Malignancy/disc disease is more common in the ELDERLY

Question 5

Presenting symptoms

Answer 5

• History of trauma or malignancy
• Pain
• Weakness
• Sensory loss
• Disturbance of bowel and bladder function

• A large central lumbar disc prolapse may cause:
o Bilateral sciatica
o Saddle anaesthesia (loss of sensation in the area of the buttocks that is covered by a bike seat)
o Urinary retention

Question 6

Signs on physical examination

Answer 6

• 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
o Weakness or paralysis
o Downward plantars (in acute phase)
o UMN signs below the level of the lesion
o LMN signs at the level of the lesion

• Brown-Sequard Syndrome - seen with hemisection of the spinal cord

Question 7

Investigations

Answer 7

• Radiology
o Lateral radiographs of spine to look for loss of alignment, fractures etc.
o MRI or CT

• Bloods - FBC, U&Es, calcium, ESR, immunoglobulin electrophoresis (multiple myeloma)
• Urine - look for Bence Jones proteins (multiple myeloma)