Spinal Cord Compression

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