A concise lecture note on Spinal cord compress

1. SPINAL CORD COMPRESSION
DR CHUKWUMA O.N.G
Internal Medicine Department NDU

2. OUTLINE
• Introduction
• Etiology
• Clinical Features
• Investigations
• Management
• References

3. INTRODUCTION
• The spinal cord extends from C1, the junction
with the medulla, to the lower vertebral body
of L1, where it becomes the conus medullaris
• It is located inside the vertebral canal, which is
formed by the foramina of 7 cervical, 12
thoracic, 5 lumbar and 5 sacral vertebrae,
which together form the spine
• Blood supply is from the anterior spinal artery
and a plexus on the posterior cord

4. • Spinal cord is composed of the following 31
segments:
 8 cervical (C) segments
12 thoracic (T) segments
5 lumbar (L) segments
5 sacral (S) segments
1 coccygeal (Co) segment

5. • Spinal cord compression is one of the more
common neurological emergencies
encountered in clinical practice
• Injuries and disorders can put pressure on the
spinal cord, causing back or neck pain,
tingling, muscle weakness, and other
symptoms

6. • A space-occupying lesion within the spinal
canal may damage nerve tissue either directly
by pressure or indirectly by interference with
blood supply
• Edema from venous obstruction impairs
neuronal function, and ischemia from arterial
obstruction may lead to necrosis of the spinal
cord

7. • The early stages of damage are reversible but
severely damaged neurons do not recover;
hence the importance of early diagnosis and
treatment
• The principal features of chronic and subacute
cord compression are spastic paraparesis or
tetraparesis, radicular pain at the level of
compression, and sensory loss below the
compression

8. AETIOLOGY
• Spinal cord tumors
 Extramedullary e.g meningioma or
neurofibroma
 Intamedullary e.g ependymoma, glioma
• Vertebral body destruction by bone
metastases e.g prostate primary
• Epidural hemorrhage/hematoma

9. • Disc and vertebral lesions
Chronic degenerative and acute central disc
prolapse
Trauma
• Inflammatory
 Epidural abscess
Tuberculosis
Granulomatous

10. Disc and Vertebral Lesions
• Central cervical disc and thoracic disc
protrusion causes cord compression
• Chronic compression due to cervical
spondylotic myelopathy is frequently seen in
clinical practice and is the most common
cause of a spastic paraparesis in an elderly
person

11. Trauma
• Stabilize the neck and back, and move patient
with extreme caution in trauma.
• Any trauma to the back is potentially serious
and the patient should be immobilized until
the extent of the injury can be determined

12. Spinal Cord Tumors
• Extramedullary tumors, such as meningiomas and
neurofibromas, cause cord compression gradually
over weeks to months, often with root pain and a
sensory level
• Vertebral body destruction by bony metastases,
such as in prostate or breast cancer, is a common
cause of spinal cord compression.
• Intramedullary tumors (e.g. ependymomas) are
less common and typically progress slowly,
sometimes over many years.
• Sensory disturbances similar to syringomyelia
may develop

13. Tuberculosis
• Spinal tuberculosis is the most common cause
of cord compression in countries where the
disease is common.
• There is destruction of vertebral bodies and
disc spaces, with local spread of infection.
• Cord compression and paraparesis follow,
culminating in paralysis: Pott's paraplegia.

14. Epidural Hemorrhage and Hematoma
• These are rare sequelae of anticoagulant
therapy, bleeding disorders or trauma, and
can follow LP when clotting is abnormal.
• A rapidly progressive cord or cauda equina
lesion develops.

15. CLINICAL FEATURES
• The onset of symptoms of spinal cord
compression is usually slow but can be acute
as a result of trauma or metastases
• The signs vary according to the level of the
cord compression and the structures involved

16. SYMPTOMS OF SPINAL CORD
COMPRESSION
Pain
• Localized over the spine or in a root
distribution, which may be aggravated by
coughing, sneezing or straining
Sensory
• Paraesthesia, numbness or cold sensations,
especially in the lower limbs, which spread
proximally, often to a level on the trunk

17. Motor
• Weakness, heaviness or stiffness of the limbs,
most commonly the legs
Sphincters
• Urgency or hesitancy of micturition, leading
eventually to urinary retention

18. SIGNS OF SPINAL CORD
COMPRESSION
Cervical, above C5
• Upper motor neuron signs and sensory loss in all four
limbs
• Diaphragm weakness (phrenic nerve)
Cervical, C5-T1
• Lower motor neuron signs and segmental sensory loss
in the arms; and upper motor neuron signs in the legs
• Respiratory (intercostal) muscle weakness

19. Thoracic Cord
• Spastic paraplegia with a sensory level on the trunk
• Weakness of legs, sacral loss of sensation and extensor
plantar responses
Cauda Equina
• Spinal cord ends approximately at the T12/L1 spinal
level and spinal lesions below this level can cause
lower motor neuron signs only by affecting the cauda
equina

20. INVESTIGATIONS
• Magnetic resonance imaging
• Plain X-rays of the spine
• Chest X-ray
• Cerebrospinal fluid analysis
• Serum Vitamin B12

21. MANAGEMENT
• Acute spinal cord compression is a medical
emergency.
• Surgical exploration is frequently necessary; if
decompression is not performed promptly,
irreversible cord damage ensues.
• Extradural compression due to malignancy is
the most common cause of spinal cord
compression in developed countries and has a
poor prognosis

22. • Useful function can be regained if treatment,
such as radiotherapy, is initiated within 24
hours of the onset of severe weakness or
sphincter dysfunction; management should
involve close cooperation with both the
oncologists and neurosurgeons
• Spinal cord compression due to tuberculosis is
common in some areas of the world and may
require surgical treatment

23. • This should be followed by appropriate anti-
tuberculous chemotherapy for an extended
period
• Traumatic lesions of the vertebral column
require specialized neurosurgical treatment

24. THANK
YOU

25. REFERENCES
• Kumar & Clark’s Clinical Medicine 9th edition
• Davidson’s Principles and Practice of Medicine
24th edition
• Medscape