Spinal Cord Compression

Question 1

What are the names of the 3 most important spinal cord tracts?

Answer 1

Corticospinal tracts.
Spinothalamic tracts.
Dorsal columns.

Question 2

What does the white matter contain?

Answer 2

Nerve fibres

Question 3

Where do motor tracts sit?

Answer 3

In the lateral white columns

Question 4

Where does the spinothalamic tract sit?

Answer 4

In the anterolateral white matter

Question 5

The corticospinal tract is a __ neurone tract

Answer 5

2

Question 6

Where does the UMN go to and from in the corticospinal tract?

Answer 6

From motor cortex, to anterior grey horn

Question 7

Where does the UMN decussate in the corticospinal tract?

Answer 7

At the medullary level

Question 8

Is the CST ipsilateral or contralateral?

Answer 8

Ipsilateral – on the same side as the side of the body it supplies

(because of decussation at medulla)

Question 9

What is the LMN in the CST?

Answer 9

Anterior horn cell

Question 10

What signs are associated with an UMN lesions in the motor pathways?

Answer 10

• Increased tone.
• Muscle wasting NOT marked.
• No fasciculation.
• Hyper-reflexia.

Question 11

If you damage your spinal cord, it is the LMN that tends to be damaged

Answer 11

FALSE - UMN

Question 12

What signs are associated with a LMN lesion?

Answer 12

• Decreased tone.
• Muscle wasting.
• Fasciculation.
• Diminished reflexes.

Question 13

What are the spinothalamic tracts responsible for?

Answer 13

Pain, temperature and crude touch

Question 14

What should you ask when trying to find out about someones spinothalamic tract?

Answer 14

Ask if they can feel cold or hot while in the shower

Question 15

Is the STT contralateral or ipsilateral?

Answer 15

Contralateral

Question 16

Where do the STT’s decussate?

Answer 16

At spinal level

Question 17

What are dorsal columns responsible for?

Answer 17

Fine touch, proprioception, vibration.

Question 18

How are dorsal columns tested?

Answer 18

Low frequency tuning fork

Question 19

Are dorsal columns ipsilateral or contralateral?

Answer 19

Ipsilateral

Question 20

Where do dorsal columns decussate?

Answer 20

At medullary level

Question 21

Spinal cord compression can be……

Answer 21

Acute OR Chronic

Complete OR Incomplete

Question 22

What 4 things can acute spinal cord compression be due to?

Answer 22

• Trauma.
• Tumours – haemorrhage or collapse. (most common)
• Infection.
• Spontaneous haemorrhage.

Question 23

What is the most common cause of acute spinal cord compression?

Answer 23

Tumour - mets

Question 24

What 3 things can chronic spinal cord compression be due to?

Answer 24

• Degenerative disease – spondylosis.
• Tumours.
• Rheumatoid arthritis

Question 25

If there is a complete spinal cord transection, what will be affected?

Answer 25

All sensory and motor modalities

Question 26

Do UMN signs appear in spinal cord transection?

Answer 26

Yes - but later

Question 27

Initially what happens in spinal cord transection?

Answer 27

There is initially a FLACCID ARREFLEXIC PARALYSIS  ‘spinal shock.’

Question 28

Outline how each of the 3 spinal tracts are affected in Brown-Sequard syndrome.

Answer 28

* IPSILATERAL motor level * IPSILATERAL dorsal column sensory level * CONTRALATERAL spinothalamic sensory level

Question 29

If there is a right hemisection of the spinal cord, what are the clinical features?

Answer 29

* Right-sided paralysis (due to damage to right CST) * Right-sided loss of fine touch, proprioception, vibration (due to damage to right dorsal column) * Left-sided loss of pain, temperature and crude touch (due to damage to right STT)

Question 30

Brown-Sequard Syndrome

Answer 30

Cord hemisection

Question 31

What does central cord syndrome occur due to?

Answer 31

A hyperflexion or hyperextension injury to an already stenotic neck

Question 32

Describe how a patient with central cord syndrome presents.

Answer 32

* ‘Cape-like’ spinothalamic sensory loss. * Lower limb power preserved. * Dorsal columns preserved.

Question 33

Describe the process behind central cord syndrome.

Answer 33

Blood supply to the central spinal cord is momentarily interrupted leading to ischaemic spinal cord damage This wipes out the upper limb fibres (medial) of the CST but not the lower limb fibres (lateral)

Question 34

If the STT isn't affected in central cord syndrome, why does numbness occur?

Answer 34

Because although the STT isn’t affected, the crossing over neurone is

Question 35

What is the presentation of central spinal cord syndrome like?

Answer 35

Same as acute, but upper motor neurone signs predominate | also more gradual and progressive

Question 36

What type of injury is trauma?

Answer 36

High energy

Question 37

What parts of the spine are usually affected by trauma?

Answer 37

Mobile segments - especially the spine (cervical)

Question 38

What are extradural tumours usually?

Answer 38

Mets

Question 39

What cancers typically metastasise to bone?

Answer 39

Lung, breast, kidney, prostate

Question 40

What can intradural tumours be again divided into?

Answer 40

Intramedullary OR extramedullary

Question 41

Give 2 examples of extramedullary intradural tumours

Answer 41

Meningiona | Schwannoma

Question 42

Give 2 examples of intramedullary intradural tumours

Answer 42

Astrocytoma | Ependymoma

Question 43

How can tumours cause compression of the spinal cord?

Answer 43

* Either by growing, and slowly compressing or * Can cause acute compression by collapse or haemorrhage

Question 44

What can spinal cord stenosis result from?

Answer 44

* Osteophyte formation. * Bulging of IVD’s. * Facet joint hypertrophy. * Subluxation.

Question 45

What can an epidural abscess arise due to?

Answer 45

* Bloodborne infection. - Staph. * Tuberculosis.

Question 46

What else can lead to spinal cord infection?

Answer 46

Surgery or trauma

Question 47

Haemorrhage can be either.....

Answer 47

* Epidural. * Subdural. * Intramedullary.

Question 48

What factors can lead to haemorrhage?

Answer 48

Trauma. Bleeding diatheses. Anticoagulants. AVM’s.

Question 49

How should a haemorrhage, cause by trauma, be managed?

Answer 49

1. Immobilise 2. Investigate - xray, CT, MRI 3. Decompress + stabilise 4. Methyprednisolone

Question 50

What ways can the spinal cord be decompressed?

Answer 50

* surgery * traction * external fixation

Question 51

How are primary spinal tumours managed?

Answer 51

Surgical excision

Question 52

How are spinal infections treated?

Answer 52

* ABx * Surgical drainage * Stabilisation if required

Question 53

How are spinal haemorrhages treated?

Answer 53

* Reverse anticoagulation | * Surgical decompression

Question 54

How is degenerative spinal disease managed?

Answer 54

Surgical decompression +/- stabilisation

Question 55

Acute spinal cord compression is an ____________

Answer 55

EMERGENCY

Question 56

Outline the treatment of metastatic spinal tumours

Answer 56

* Dexamethasone * Radiotherapy * Chemo * Surgical decompression and stabilisation

Question 57

Why is radiotherapy the GOLD STANDARD treatment for metastatic spinal tumours?

Answer 57

* Just as good as surgery * Good for pain relief * Non-invasive