🏥 Stations

🧠 Qbank

📖 Book

😃 More

💳 Pricing

🔒 Dashboard

📖 OSCE Learning

🔒 OSCE Stations

🔒 Qbank

🔐 Membership
Share your insights

Help us by sharing what content you've recieved in your exams


Spinal cord compression

Medicine > Neurosciences

Background Knowledge 🧠

Definition

  • Spinal cord compression is a medical emergency where the spinal cord is compressed, leading to neurological dysfunction.

Causes

  • Traumatic injury.
  • Malignancy (primary or metastatic).
  • Infection (e.g., abscess).
  • Degenerative spinal disease.
  • Herniated intervertebral discs.

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 ischaemia and subsequent neuronal injury in the spinal cord.
  • The level of compression determines the clinical presentation and severity of symptoms.

Clinical Features 🌡️

Clinical Presentation

  • Pain localised 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).

Investigations 🧪

Investigations

  • Clinical suspicion based on history and physical examination.
  • MRI is the imaging modality of choice for detailed visualisation 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., tumour markers, infection workup).

Management 🥼

Management

  • Immediate referral to a specialist (neurosurgery or orthopaedics) for surgical evaluation.
  • High-dose corticosteroids may be used acutely to reduce spinal cord oedema (controversial due to potential side effects).
  • Surgical intervention (decompression laminectomy, removal of tumour/abscess) is often necessary.
  • Non-surgical management includes radiotherapy for certain tumours 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 are crucial to prevent permanent neurological damage, and can generally lead to better outcomes.

Key Points

  • Spinal cord compression is a medical emergency where the spinal cord is compressed, leading to neurological dysfunction according to the level of compression.
  • Early detection and treatment are crucial to prevent permanent neurological damage.
  • Diagnosis is primarily through clinical history and examination, with imaging to visualise the spinal cord compression.
  • Management includes immediate referral to a specialist (neurosurgery or orthopaedics), often requiring surgery and sometimes high-dose corticosteroids are required to reduce spinal cord oedema.

No comments yet 😉

Leave a Reply

Neurosciences