Spinal Cord Compression

Question 1

Definition

Answer 1

Compression of spinal cord from C1 - L1-2

Question 2

Main Tracts

Answer 2

Dorsal column-medial lemniscus pathway (DCML) - ascending; dorsal root -> medulla then decussates
- fine touch
- 2 point discrimination
- proprioception (sensory)
Spinothalamic - ascending; decussates 1-2 spinal levels above dorsal entry
- PAIN (sensory)
Corticospinal
- descending UMN, decussates at medulla to ventral root
- (motor)

Question 3

Spinal cord lesions

Answer 3

IPSILATERAL = SENSORY
CONTRALATERAL = MOTOR

Question 4

Reflexes

Answer 4

L3/4 = knee jerk
L5 = big toe jerk
S1 = ankle jerk

Question 5

Causes of spinal cord compression

Answer 5

Vertebral body neoplasms
MC = lung, breast, RCC, melanoma
Spinal pathology = disc prolapse/herniation

Question 6

Signs and symptoms

Answer 6

Progressive leg weakness with UMN SIGNS (e.g. Contralateral hype-reflexia, babinski +ve, spasticity
Sensory loss below lesion
- as ascending tracts send info up
Sphincter involvement uncommon (late - v.bad sign

Question 7

Dx

Answer 7

MRI CORD ASAP (risk of SC permanent damage if not asap)
CXR if malignancy suspected

Question 8

Tx

Answer 8

NEUROSURGERY (laminectomy, micro-discectomy)