Spinal cord compression (incl. cauda equina) Flashcards
Describe the dermatomes of the lower limbs.
What are the most common causes of spinal cord compression?
- Trauma - leading cause of acute SCC (e.g. falls, RTA)
- Vertebral compression fractures - weakened bone fractures with low-level trauma
- Intervertebral disc disease
- Tumours
- Infection - discitis, TB, epidural abscess
How does intervertebral disc disease cause spinal cord compression?
Disc herniation = rupture of nucleus pulposus –> through fibres of annulus fibrosis –> into intervertebral space –> compresses nerve roots
Symptoms = paraesthesia, pain, power reduced indicative of lumbar radiculopathy/sciatica
List 3 types of tumours which can cause SCC.
- Primary sarcoma
- CNS tumours e.g. ependymoma, meningioma, glioma
- Multiple myeloma
- Metastatic breast, prostate, renal, small cell lung cancers
List 3 causes of acute compression of cauda equina.
- Bony metastasis
- Myeloma
- Epidural abscess
- Disc prolapse
- Epidural haematoma
- Primary sacral tumour e.g. chordoma
What is TB causing spinal compression called?
Pott’s disease of the spine
List 5 red flag symptoms for lower back pain, suggesting SCC.
- Bilateral sciatica
- Bladder dysfunction
- Perineal paraesthesia
- Gait disturbance
- Lower limb weakness
- Erectile dysfunction
What are the motor, sensory and autonomic symptoms of incomplete spinal cord compression?
Sensory - altered sensation below certain level/ hemisensory loss
Motor - hemiplegia/paresis (sparing face) [or para or tetra]
Autonomic
- constipation
- urinary retention
- dizziness (due to hypotension)
- cold, shivering, drowsiness (due to hypothermia)
- ED
- abdominal pain and distension (due to ileud)
- syncope (due to bradycardia)
PAIN is also common - often sharp, radicular pain.
Which 4 tumours commonly metastasise to the spine and can contribute to SCC?
- Small cell lung cancer
- Non-small cell lung cancer
- Breast cancer
- Prostate cancer
- Renal cancer
What are the signs and symptoms of cauda equina syndrome? What is a common cause of cauda equina syndrome?
Commonly due to disc compression and stenosis of the spinal canal.
Symptoms:
- Low back pain
- Bilateral sciatica
- Bladder retention/incontinence
- Saddle anaesthesia (perineal)
- Leg weakness
Signs:
- Sensory loss in lumbosacral distribution
- Reduced tone in legs (flaccid)
- Reduced power in legs
- Reduced reflexes (!!)
- Anal sphincter tone loss
List 2 differences between the examination of cauda equina compression and cord compression.
BOTH cause power loss and sensory loss
- Cauda equina causes flaccid paralysis and loss of reflexes
- SCC causes spastic paralysis and brisk reflexes
What are the early signs of spinal shock and how do these progress in SCC?
Spinal shock - areflexia and hyporeflexia
This is later replaced by increased tone, hyper-reflexia and +ve Babinski
NB: bilateral signs are uncommon in disc herniation.
What causes Brown-Sequard’s syndrome? What are the clinical signs/symptoms?
BSS = hemisection lesion of the spinal cord and most commonly seen after trauma
Signs/symptoms:
- Ipsilateral below level of lesion:
- segmental anaesthesia
- paralysis
- loss of vibration
- loss of proprioception
- hyper reflexia
- Contralateral below level of lesion:
- loss of pain
- loss of temperature sensation
How is cauda equina syndrome managed?
Urgent spinal surgical admission same day - must be done within hours and even waiting until the next day may allow irreversible damage and paralysis to occur.
What is the difference between anterior and posterior cord syndrome?
Anterior cord syndrome - anterior spinal tracts affected, including vestibulospinal tract –> loss of pain/temperature sensation + paralysis below level of lesion (spares touch, proprioception, vibration)
Posterior cord syndrome (rare) - posterior spinal tracts affected usually due to posterior spinal artery occlusion –> loss of pain, position, vibration below level of lesion.
What are the causes of spinal cord compression?
- Trauma e.g. car accident, falls, diving
- Vertebral compression fracture
- Intervertebral disc herniation
- rupture of the nucleus pulposus in the intervertebral space, through the fibres of the annulus fibrosis
- Primary or secondary metastatic spinal tumour
- Infection e.g. discitis, TB (Pott’s), epidural abscess
This can include metastatic infiltration to the vertebral column causing instability or pathological fractures as well as direct pressure from malignancy to the spinal cord.
