Spinal cord compression/ CES

Question 1

What is spinal cord compression?

Answer 1

Results from processes that compress of displace arterial, venous and cerebrospinal fluid space as well as cord itself.

Question 2

Causes of spinal cord compression?

Answer 2

Spine trauma
Vertebral compression fracture
intervertebral disc herniation
Primary or metastatic spinal tumour
Infection

Question 3

What are the RF for spinal cord compression?

Answer 3

Age, between 16-30years
Male
Trauma
Tumour
Osteroporosis
High risk occupation: construction, agriculture, seamen
High risk recreational activity
IVDU
Immunosupression

Question 4

How does spinal cord compression present?

Answer 4

UMN signs
Back pain
Bladder and bowel dysfunction
Numbness/parasthesias
Paralysis/weakness
Sensory loss
Loss of tone below level of suspected injury (spinal shock)

Question 5

How does dorsal column lesion present?

Answer 5

Loss of vibration and propioception

Question 6

How does spinothalamic tract lesion present?

Answer 6

Loss of pain, crude touch sensation and temperature

Question 7

How does brown- sequard syndrome present?

Answer 7

Hemisection of the spinal cord
Ipsilateral paralysis
Ipsilateral loss of proprioception and fine discrimination
Contralateral loss of pain and temp

Question 8

Investigations in Spinal cord compression?

Answer 8

WHOLE MRI spine within 48 hours- disc displacement, epidural enhancement, mass effect, T2 cord signal
Gadolinium- enhanced MRI spine- Infection: epidural space and bone involvement, Met disease: tumour
Plain spine xray: decreased disc space height (disc compression), loss of bony detail (tumour, infection), misalignment of vertebral elements (trauma), loss of end-plate definition (infection)
CT spine
CT myelography

Question 9

Management of spinal cord compression

Answer 9

Treat underlying cause
Decompression if needed
Neoplastic: in patients where clinical suspicion is high or tumour visualised, administration of dexamethasone 16 mg daily in divided doses (with PPI cover) is indicated.

Question 10

What is cauda equine syndrome?

Answer 10

Lumbosacral nerve roots that extend below the spinal cord are compressed

Question 11

Causes of CES?

Answer 11

Most common cause: central disc prolapse- L4/5 or L5/S1
Other causes:
Tumours
Infection- abscess or discitis
Trauma
Haematoma

Question 12

Presentation of CES?

Answer 12

Lower back pain
Bilateral sciatica
Reduced sensation/pins and needles in perianal area
Decrease anal tone
Urinary dysfunction

Question 13

Investigation in CES

Answer 13

Urget WHOLE spine MRI

Question 14

Management of CES

Answer 14

Surgical decompression within 48 hours

Question 15

Ddx of spinal cord compression?

Answer 15

Transverse myelitis
Guillain Barre syndrome
MS
Diabetic neuropathy
Peripheral neuropathy
HIV related myelopathy