Flashcards in Spinal Cord Compression Deck (49):
Why is prompt diagnosis and treatment for spinal cord compression essential?
Avoid permanent neurological disability
What categories of lesions can compress the spinal cord and the cauda equina?
Extradural = 80%
Intradural/extramedullary = 15%
Intramedullary = 5%
What is the most common intradural lesion causing spinal cord compression?
Nerve root lesions
What is an intramedullary lesion?
Lesion from inside spinal cord itself
How can you tell if the image a T2 MRI?
What are the most common pathological causes of spinal cord compression?
- Disc prolapse
- Vertebral body
- Disc space
- AV malformation
- AV malformation
- Arachnoid cyst
What are the most common extradural causes of spinal cord compression?
Degenerative spinal disease
What are the most common intradural causes of spinal cord compression?
What are the most common intramedullary causes of spinal cord compression?
What are the two major presenting features of spinal cord compression?
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
What structures are the source of pain in spinal cord compression?
What structures are the source of neurological deficit in spinal cord compression?
Spinal cord itself
What is the most likely diagnosis in
- Older patient
- Neck pain
- Slow symptom onset
- No fever
- No Hx of cancer
Degenerative cervical canal stenosis
What are the differential diagnoses for degenerative canal stenosis?
- Motor neuron disease
- Subacute combined degeneration of spinal cord
Where are the most clinically significant places that degenerative spinal canal stenosis can occur?
What symptoms does degenerative spinal cervical canal stenosis cause?
Cord compression > cervical myelopathy
What symptoms does degenerative spinal lumbar canal stenosis cause?
Cauda equina compression > sciatica and neurogenic claudication
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
Often on background of congenitally narrow canal
What are the neurological symptoms in degenerative spinal canal stenosis due to?
Direct pressure on neural structures
Ischaemia of neural structures
What damage does degenerative spinal canal stenosis cause?
Degeneration and loss of nerve cells
Spinal cord cavitation
Glial cell proliferation
Wallerian degeneration of tracts above and below level of compression
When is conservative management of degenerative spinal canal stenosis indicated?
Mild, non-progressive disease
Unfit for surgery due to comorbidities
When is surgical treatment indicated for degenerative canal stenosis?
Why is surgical treatment indicated for degenerative canal stenosis?
To stop further disability - presenting neurological deficits may be irreversible
What can be removed in surgery for degenerative spinal canal stenosis?
Lamina = laminectomy
Disc = discectomy
Vertebral body = vertebrectomy
What is the gold standard investigation for cauda equina compression?
MRI of lumbosacral spine
What are the differential diagnoses for an intradural, extramedullary, well-defined lesion in a young patient?
Metastasis - rare
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
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
What is Brown-Sequard syndrome?
Happens when only 1/2 of cord involved
Contralateral impairment of
- Temperature sensation
- Impairment of
- Light touch
What is the sensory disturbance in intrinsic lesions of the central spinal cord and syringomyelia?
Cape-like loss of pain and temperature
What is a syrinx?
Dilatation of central canal
What is syringomyelia?
Cord compression due to syrinx
What is the sensory disturbance in lesions of the cauda equina and conus medullaris?
At what spinal level is the conus medullaris?
At what spinal level do you not get upper motor neuron signs?
When does sphincter disturbance occur?
Compression in any region
Particularly compression of
- Conus medullaris
- Cauda equina
What symptoms does a sphincter disturbance cause?
Urinary hesitancy > urinary retention > urinary incontinence > constipation > faecal incontinence
What are the most common causative cancers of malignant spinal cord compression?
What spinal level is most commonly affected by metastasis?
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
In which region of the spine is a spinal abscess most common?
What can cause a spinal abscess?
Haematogenous spread to
- Epidural space
Direct spread from adjacent infection
- Vertebral body
- Decubitus ulcer
- Paraspinal abscess
- Psoas abscess
What is the most common causative organism of spinal abscesses?
What is the presentation of a spinal abscess?
Severe local spinal pain
Rapidly progressive neurological deficit
Systemic features of infection
What causes spinal cord compression with a spinal abscess?
What causes spinal cord ischaemia with a spinal abscess?
Thrombosis of arteries and veins
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