Spinal Cord Compression Flashcards Preview

MD2 Surgery and Anaesthesia > Spinal Cord Compression > Flashcards

Flashcards in Spinal Cord Compression Deck (49):
1

Why is prompt diagnosis and treatment for spinal cord compression essential?

Neurosurgical emergency
Avoid permanent neurological disability

2

What categories of lesions can compress the spinal cord and the cauda equina?

Extradural = 80%
Intradural/extramedullary = 15%
Intramedullary = 5%

3

What is the most common intradural lesion causing spinal cord compression?

Nerve root lesions

4

What is an intramedullary lesion?

Lesion from inside spinal cord itself

5

How can you tell if the image a T2 MRI?

CSF white

6

What are the most common pathological causes of spinal cord compression?

Tumour
Degenerative
- Disc prolapse
- Osteoporosis
- Spondylosis
Infection
- Vertebral body
- Disc space
- Extradural
- Intradural
Haematoma
- Spontaneous
- Trauma
- AV malformation
Developmental
- Syrinx
- AV malformation
- Arachnoid cyst

7

What are the most common extradural causes of spinal cord compression?

Metastatic tumour
Abscess
Degenerative spinal disease

8

What are the most common intradural causes of spinal cord compression?

Meningioma
Schwannoma
Myxopapillary ependymoma

9

What are the most common intramedullary causes of spinal cord compression?

Glioma
Syrinx

10

What are the two major presenting features of spinal cord compression?

Pain
Neurological deficit

11

What does the order of symptom presentation in spinal cord compression suggest about the cause?

If presents with pain as 1st symptom, most likely extramedullary
- If pain slow, slow growing
If neurological deficits 1st, most likely intramedullary
If both present at same time, acutely, probably from outside and rapid

12

What structures are the source of pain in spinal cord compression?

Periosteum
Dura
Nerve roots

13

What structures are the source of neurological deficit in spinal cord compression?

Nerve roots
Spinal cord itself

14

What is the most likely diagnosis in
- Older patient
- Neck pain
- Slow symptom onset
- No fever
- No Hx of cancer

Degenerative cervical canal stenosis

15

What are the differential diagnoses for degenerative canal stenosis?

Spinal tumour
- Primary
- Metastatic
Spinal infection
Inflammatory/neurodegenerative disease
- MS
- Motor neuron disease
- Syringomyelia
- Subacute combined degeneration of spinal cord

16

Where are the most clinically significant places that degenerative spinal canal stenosis can occur?

Cervical spine
Lumbar spine

17

What symptoms does degenerative spinal cervical canal stenosis cause?

Cord compression > cervical myelopathy

18

What symptoms does degenerative spinal lumbar canal stenosis cause?

Cauda equina compression > sciatica and neurogenic claudication

19

What causes degenerative spinal canal stenosis?

Spondylosis with hypertrophy and osteophytes of facet joints
Hypertrophy of ligamentum flavum/posterior spinal ligament
Bulging/prolapsed intervertebral discs and associated osteophytes
Excessive mobility
Often on background of congenitally narrow canal

20

What are the neurological symptoms in degenerative spinal canal stenosis due to?

Direct pressure on neural structures
Ischaemia of neural structures

21

What damage does degenerative spinal canal stenosis cause?

Degeneration and loss of nerve cells
Spinal cord cavitation
Glial cell proliferation
Demyelination
Wallerian degeneration of tracts above and below level of compression

22

When is conservative management of degenerative spinal canal stenosis indicated?

Mild, non-progressive disease
Very elderly
Unfit for surgery due to comorbidities

23

When is surgical treatment indicated for degenerative canal stenosis?

Moderate/severe/progressive disease

24

Why is surgical treatment indicated for degenerative canal stenosis?

To stop further disability - presenting neurological deficits may be irreversible

25

What can be removed in surgery for degenerative spinal canal stenosis?

Lamina = laminectomy
Disc = discectomy
Vertebral body = vertebrectomy

26

What is the gold standard investigation for cauda equina compression?

MRI of lumbosacral spine

27

What are the differential diagnoses for an intradural, extramedullary, well-defined lesion in a young patient?

Schwannoma
Myxopapillary ependymoma
Dermoid/epidermoid cyst
Metastasis - rare

28

What sort of pain can occur in spinal cord compression?

Diffuse, dull, burning
Sciatica in lower limbs
Brachalgia in upper limbs
"Girdle" pain radiating around chest wall

29

What are the sensory levels on the trunk?

C4 = right above T2
T2 = sternal angle
T4 = nipple level
T7 = xiphisternum
T10 = umbilicus
L1 = inguinal region

30

What is Brown-Sequard syndrome?

Happens when only 1/2 of cord involved
Contralateral impairment of
- Pain
- Temperature sensation
Ipsilateral
- Weakness
- Impairment of
- Proprioception
- Vibration
- Light touch

31

What is the sensory disturbance in intrinsic lesions of the central spinal cord and syringomyelia?

Cape-like loss of pain and temperature

32

What is a syrinx?

Dilatation of central canal

33

What is syringomyelia?

Cord compression due to syrinx

34

What is the sensory disturbance in lesions of the cauda equina and conus medullaris?

Saddle anaesthesia

35

At what spinal level is the conus medullaris?

L1/L2

36

At what spinal level do you not get upper motor neuron signs?

Below L2

37

When does sphincter disturbance occur?

Compression in any region
Particularly compression of
- Conus medullaris
- Cauda equina

38

What symptoms does a sphincter disturbance cause?

Urinary hesitancy > urinary retention > urinary incontinence > constipation > faecal incontinence

39

What are the most common causative cancers of malignant spinal cord compression?

Lung carcinoma
Breast carcinoma
Prostate carcinoma
Renal carcinoma
Lymphoma
Myeloma

40

What spinal level is most commonly affected by metastasis?

Thoracic

41

What are the principles of treatment of malignant spinal cord compression?

Urgent Ix and Rx to avoid severe permanent disability
- Start dexamethasone
Prompt decision regarding treatment modality
- Palliation/symptom control only
- Radiotherapy
- Surgery

42

In which region of the spine is a spinal abscess most common?

Thoraco-lumbar region

43

What can cause a spinal abscess?

Haematogenous spread to
- Disc
- Epidural space
Direct spread from adjacent infection
- Vertebral body
- Decubitus ulcer
- Paraspinal abscess
- Psoas abscess

44

What is the most common causative organism of spinal abscesses?

Staph aureus

45

What is the presentation of a spinal abscess?

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

46

What causes spinal cord compression with a spinal abscess?

Inflammatory swelling
Pus

47

What causes spinal cord ischaemia with a spinal abscess?

Thrombosis of arteries and veins

48

What are the principles of treatment of a spinal abscess?

Emergency Ix and transfer for neurosurgical assessment
Emergency surgical decompression
Broad spectrum Abx until micro-organism isolated and sensitivities known

49

What are yellow flags?

Psychosocial reasons that prevent improvement of back pain