NEURO - Spinal cord compression Flashcards Preview

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Flashcards in NEURO - Spinal cord compression Deck (16):
1

(3) types of locations of compressing lesion in the spine

Extradural (80%)

Intradural / extramedullary (15%)

Intramedullary (5%)

2

The most common pathological causes of spinal cord compression

–Tumour
•Primary, metastatic

–Degenerative
•Disc prolapse, osteoporosis, spondylosis

–Infection
•Vertebral body, disc space, extradural, intradural

–Haematoma
•Spontaneous, trauma, AVM

–Developmental
•Syrinx, AVM, arachnoid cyst

3

Most common compressions of spinal cord
- extradural
- intradural, extramedullary
- intramedullary

–Extradural compression: by metastatic tumour, abscess or degenerative spinal disease

–Intradural, extramedullary compression: by a meningioma, schwannoma or myxopapillary ependymoma

–Intramedullary compression: by a glioma (astrocytoma or ependymoma) or a syrinx

4

2 Px of compressions of spinal cord

–Pain
–Neurological deficit

5

Describe “cervical myelopathy”

–Predominantly lower motor neuron signs in the upper limbs
–Spastic paraparesis (upper motor neuron) in the lower limbs

In an older patient with neck pain, slow symptom onset, no fever and no history of cancer, this is most likely to be due to degenerative cervical canal stenosis

6

Px of lumbar spinal canal stenosis

sciatica and neurogenic claudication due to cauda equina compression

7

Causes of spinal canal stenosis

–Spondylosis with hypertrophy and osteophytes of the facet joints
–Hypertrophy of ligamentum flavum
–Bulging or prolapsed intervertebral discs and associated osteophytes
–Excessive mobility
–Often on a background of a congenitally narrow canal

8

Neurological symptoms in spinal canal stenosis result from:

–Direct pressure on the neural structures
–Ischaemia of the neural structures

9

Rx of degenerative canal stenosis

•Conservative management may be indicated for
–Mild, non-progressive disease
–The very elderly (>80)
–Those unfit for surgery due to co-morbidities

•Surgical treatment indicated for moderate, severe or progressive disease
- posterior approach: laminectomy
- anterior approach: discectomy, vertebrectomy

10

DDx of Intradural, extramedullary, well-defined lesion in a young patient

•Schwannoma
•Myxopapillary ependymoma
•Dermoid or epidermoid cyst
•Metastasis (rare)

11

Describe sphincter disturbance

–Occurs with compression in any region, but particularly the conus medullaris and cauda equina
–Difficulty initiating urination is usually the first symptom followed be urinary retention or incontinence
–Subsequent constipation and faecal incontinence

12

Common causative cancers of malignant spinal cord compression & most common spinal level affected

Lung, breast, prostate, kidney, lymphoma, myeloma

Thoracic spine

13

Rx of malignant spinal cord compression

•Commence dexamethasone

–Palliation/symptom control only
•If death from primary cancer is imminent or if deficit has been present for more than a few days and is fixed

–Radiotherapy
•In radiosensitive tumours and only if neurological deficit is mild and non-progressive, without significant neural compression on imaging
•After surgical decompression

–Surgery

14

Describe spinal abscess
- common site
- causes

thoraco-lumbar region

Haematogenous spread to disc/epidural space from distant infected site

Direct spread from adjacent infection (v. body, decubitus ulcer, paraspinal/psoas abscess)

Staph aureus most common (45-70%)

15

Px of spinal abscess

–Severe local spinal pain
–Rapidly progressive neurological deficit
–Systemic features of infection

Spinal cord compression due to inflammatory swelling and pus
–Most commonly extradural

Rapid & irreversible neurological deterioration: cord ischaemia from thrombosis of arteries or veins

16

Rx of spinal abscess

•Emergency surgical decompression
•Broad spectrum antibiotics until micro-organism isolated and sensitivities known

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