Spinal Cord Compression Notes
Physiology and anatomy
- The spinal cord runs from C1 (junction with the medulla), to about L1, where it becomes the cauda equina.
o Note that it terminates lower down in children – the spinal cord cannot grow as well as the rest of the body!
- The spinal cord gets its blood supply mainly from the vertebral arteries.
Spinal Cord Compression
Clinical features
- Spastic paraparesis / tetraparesis
- Radicular pain at the level of the compression
- Sensory loss below the level of the compression
Causes
- Degenerative disc lesions, e.g. Herniated disc
- Degenerative vertebral lesions, e.g. Osteoporosis
- TB
o The most common cause of spinal cord compression in countries where TB is common
o There is destruction of both the disc and the vertebra
o Paralysis can occur – in which case it is called Pott’s Paraplegia
- Epidural abscess
- Vertebral neoplasms:
o Myeloma
o Metastasis
§ Bone, Bronchus, Prostate, Lymphoma, Thyroid
o Menningioma
o Neurofibroma
o Ependymoma
o Glioma
o Lipoma
o Teratoma
o Symptoms will occur gradually over months, perhaps even years with slow growing tumours (e.g. glioma). There will usually be root pain and an obvious sensory level.
- Epidural haemorrhage
- Paget’s disease
Example:
- Spinal cord compression at T4
o Pain radiates around the thorax, typically worse on coughing
o Spastic paraparesis develops slowly of the following hours days or weeks depending on the underlying pathology
o Numbness from the feet to the level affected
o Urinary Retention
o Constipation
Treatment
- It is a medical emergency
- Can be difficult to differentiate a chronic from an acute cause, particularly if pain and sensory level are ambiguous.
Notes by Tom Leach
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