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Spinal cord compression

Definition and Epidemiology

  • Spinal cord compression is a medical emergency where the spinal cord is compressed, leading to neurological dysfunction.
  • Causes include traumatic injury, malignancy (primary or metastatic), infection (e.g., abscess), degenerative spinal disease, and herniated intervertebral discs.
  • Early recognition and treatment are crucial to prevent permanent neurological damage.

Pathophysiology

  • Compression of the spinal cord can result from extradural (outside the dura mater), intradural-extramedullary (within the dura but outside the cord), or intramedullary (within the cord) lesions.
  • This compression leads to ischemia and subsequent neuronal injury in the spinal cord.
  • The level of compression determines the clinical presentation and severity of symptoms.

Clinical Features

  • Pain localized to the level of spinal compression, often exacerbated by movement.
  • Neurological deficits depending on the level of compression: weakness, numbness, bladder and bowel dysfunction.
  • Upper motor neuron signs below the level of compression: hyperreflexia, spasticity, positive Babinski sign.
  • In cervical spine compression, all four limbs may be affected (quadriplegia), while in thoracic or lumbar compression, only lower limbs are involved (paraplegia).

Diagnosis

  • Clinical suspicion based on history and physical examination.
  • MRI is the imaging modality of choice for detailed visualization of the spinal cord and surrounding structures.
  • CT scan may be used if MRI is not available.
  • Additional investigations to identify the underlying cause (e.g., tumor markers, infection workup).

Management

  • Immediate referral to a specialist (neurosurgery or orthopedics) for surgical evaluation.
  • High-dose corticosteroids may be used acutely to reduce spinal cord edema (controversial due to potential side effects).
  • Surgical intervention (decompression laminectomy, removal of tumor/abscess) is often necessary.
  • Non-surgical management includes radiotherapy for certain tumors and antibiotics for infections.

Complications

  • Permanent neurological deficits, including paralysis and sensory loss.
  • Chronic pain.
  • Bladder and bowel dysfunction.
  • Secondary complications due to immobility (pressure sores, deep vein thrombosis).

Prognosis

  • Depends on the cause, level, and duration of compression, and the rapidity of intervention.
  • Early detection and treatment generally lead to better outcomes.

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