Spinal Cord Diseases: Traumatic, Vascular, and Neoplastic Disorders

Question 1

What’s the main cause of injury for trauma, vascular and neoplastic spinal disorder?

Answer 1

• Vascular compromise
• progressive damage over the the next 3-7 days

Question 2

How does vascular compromise lead to spinal cord disorder?

Answer 2

Lack of blood flow = lack of oxygen and glucose
- depolarization of neurons and axons
- leads to build up to Ca2+
- activation of autodestructive enzymes: calpains, caspase, and xanthine oxidase

Question 3

Are vascular spinal diseases painful?

Answer 3

When it happens, yes. If there is a delay to the vet, the pain may not be present anymore

Question 4

How does patient with vascular spinal injury present?

Answer 4

• dysfunction is highly lateralized
• NOT painful
• will need MRI to confirm

Question 5

What is the prognosis for recovery for patients with vascular spinal injury?

Answer 5

• good if it doesn’t involve the LMN (ie., not at C6-T2, L4 -S3)
• also depends on the severity of the injury
• if extremely severe, patient usually can’t survive
• If LMN region affected, may need prolonged recovery or failure to recover

Question 6

Describe fibrocartilaginous embolism (FCE).

Answer 6

• occlusion of the spinal artery by chondroid material –> like a “stroke”
• so downstream spinal cord become devitalized and necrotic within hours –> mild worsening of clinical signs
• classic FCE = small, localized
• may resolve spontaneously (considerable improvement noted in 48h); up to 3m for full recovery
• lesion in C1-C5 or T4-L3 = good prognosis
• sacral involvement = troublesome due to fecal/ urinary incontinence

Question 7

What other vascular spinal cord injuries are possible?

Answer 7

• Blood vessel rupture/ hematomyelia: if large, require immediate surgical decompression
• extradural hematoma
• vascular anomalies
• systemic disease that leads to hypocoagulable state: hemophilia, von Willebrand’s, vasculitis

Question 8

Where is the most common location for spinal tumours?

Answer 8

extradural > intradural/extramedullary > intramedullary

Question 9

What type of spinal cancer is commonly found in the extradural location?

Answer 9

OSA, HSA, STS, LSA, MM etc
- very painful

Question 10

What type of spinal cancer is commonly found in the intradural/ extramedullary location?

Answer 10

• in subarachnoid space
• meningioma (esp C1-C2; Boxer), nerve sheath tumours (esp @ intumescences)
• tend to be slow growing

Question 11

What type of spinal cancer is commonly found in the intramedullary location?

Answer 11

• rare
• glial cells or neurons
• astrocytoma and ependymoma
• can be well encapsulated or highly invasive
• nephroblastoma
• slowly progressive