Spinal Cord Disease - Cord Compression

Question 1

Importance of Spinal Cord Compression.

Answer 1

Medical Emergency - Delays = Irreversible Neurological Dysfunction.

Question 2

Aetiology of Spinal Cord Compression.

Answer 2

Processes that compress or displace arterial, venous and CSF spaces as well as the cord itself.

Question 3

Causes of Spinal Cord Compression (5).

Answer 3

1. Trauma - External Lesion e.g. Bone Fragments.
2. Neoplasia - Tumour.
3. Infection (e.g. TB) - Abscess.
4. Disc Prolapse.
5. Epidural Haemoatoma.
6. Osteoarthritis, Scoliosis.

Question 4

Clinical Presentation of Spinal Cord Compression.

Answer 4

Acute/Sub-Acute UMN Signs and Sensory Disturbances Below Level of Lesion.

Question 5

Clinical Features of Spinal Cord Compression (5).

Answer 5

1. Deep and Localised Back Pain (Band-Like around Dermatome) - Earliest Symptom.
2. Stabbing Radicular Sensory Disturbance at Level of Lesion (Down Dermatome and Sensory Level).
3. Lower Limb Weakness/Stiffness.
4. Bladder/Bowel Involvement (Late Sign = Irreversible Damage).
5. Hyperreflexia below Level and Arrefleixa at Level.

Question 6

Neurological Signs and Lesion Level (2).

Answer 6

1. Lesions Above L1 - UMN signs in Legs and Sensory Level.

2. Lesions Below L1 - LMN signs in Legs and Perianal Numbness.

Question 7

Key Features of the Back Pain.

Answer 7

1. Deep and Localised.
2. Band-Like Around Dermatome.
3. Earliest Symptom.
4. Worse on Coughing/Straining.

Question 8

Investigations of Spinal Cord Compression.

Answer 8

1. Urgent WHOLE Spine MRI (within 24 Hours of Presentation).

Question 9

Management of Spinal Cord Compression.

Answer 9

1. Aim : Surgical Decompression within 48 Hours (Urgent Referral to Neurosurgery).
2. Malignancy : 16mg PO Dexamethasone Daily in Divided Doses with PPI Cover.