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1. SPINAL CORD COMPRESSION

2. Spinal cord compression develops when the spinal cord is
compressed by bone fragments from a vertebral fracture,
a tumor, abscess, ruptured intervertebral disc or other lesion. It is
regarded as a medical emergency independent of its cause, and
requires swift diagnosis and treatment to prevent long-term
disability due to irreversible spinal cord injury.

3. ETIOLOGY
 Vertebral Fracture
 Abscess formation in disc
 Ruptured intervertebral disc

4. The causes of spinal cord compression include the following:
Certain degenerative diseases, such as arthritis, can lead to
spinal cord compression. A ruptured disk may lead to spinal cord
compression. Injury to the spinal cord or the area around the cord
can lead to swelling, which can cause compression.

5. CLINICAL MANIFESTATIONS
 Back pain
 Paralysis of limbs below the level of compression
 Decreased sensation below the level of compression
 Urinary and fecal incontinence and urinary retention
 Most common symptoms is stiffness or pain in the back or the
neck.
 Numbness or weakness in the legs, hands, and arms

6. DIAGNOSIS
 Diagnosis is by x-rays but preferably MRI of the whole
spin
 plain spine x-ray
 CT spine
 Blood or cerebrospinal fluid cultures
 Tumor biopsy and histopathology

7.  Dexamethasone (a potent glucocorticoid) in doses of 16 mg/day
may reduce edema around the lesion and protect the cord from
injury. It may be given orally or intravenously for this indication
 Anti-inflammatory medications may help decrease swelling and
reduce pain
 Physiotherapy, Exercise will strengthen the abdominal and leg
muscles
 Home care, such as applying ice packs and heating pads,- can
help relieve pain.
TREATMENT

8. Surgery is indicated in localized compression as long as there is
some hope of regaining function. It is also occasionally indicated in
patients with little hope of regaining function but with
uncontrolled pain. Postoperative radiation is delivered within 2–3
weeks of surgical decompression. Emergency radiation therapy is
the main treatment for malignant spinal cord compression. It is
very effective as pain control and local disease control.

9. SPINAL DISC HERNIATION (DISK PROLAPSE)

10. Herniated = from “hernia,” a part of the body that
bulges out through an abnormal opening
Disc = the disk-shaped cushions between the bones of
the spine
Spinal disc herniation, also known as a slipped disc,
is a medical condition affecting the spine in which a
tear in the outer, fibrous ring of an intervertebral disc
allows the soft, central portion to bulge out beyond
the damaged outer rings.

11. CAUSES OF SPINAL DISC HERNIATION
 Degenerative disorder : Degenerative disk disease is when
normal changes that take place in the disks of the spine cause
pain.
 Prolonged pressure on nerve ending of vertebral disc:
caused by a tumor or cyst that presses on the sciatic nerve or
its roots.
 Trauma (falls, accidents, and repeated minor stresses such as
heavy lifting, prolonged sitting)
 Advancing age

12. CLINICAL MANIFESTATION
 Pain : Pain can be sharp or burning
 Weakness: Feeling of instability while ambulating can also be seen in
patients with disk herniation.

13. DIAGNOSTIC EVALUATION
During the physical exam, doctor will check the back for tenderness.
He or she may ask to lie flat and move the legs into various positions
to help determine the cause of pain. The doctor may also perform a
neurological exam, to check :
•Reflexes
•Muscle strength
•Walking ability
•Ability to feel light touches, pinpricks or vibration

14. •X-rays. Plain X-rays don't detect herniated disks, but they
may be performed to rule out other causes of back pain,
such as an infection, tumor, spinal alignment issues or a
broken bone.
• Computerized tomography (CT scan). A CT scanner
takes a series of X-rays from many different directions and
then combines them to create cross-sectional images of the

15. •Magnetic resonance imaging (MRI). Radio waves and a strong
magnetic field are used to create images of body's internal structures.
This test can be used to confirm the location of the herniated disk and to
see which nerves are affected.
•Myelogram. A dye is injected into the spinal fluid, and then X-rays are
taken. This test can show pressure on the spinal cord or nerves due to
multiple herniated disks or other conditions.

16. Medical management
•Over-the-counter pain medications. If pain is mild to moderate,
doctor may tell to take an over-the-counter pain medication, such as
ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, others).
•Narcotics. If the pain doesn't improve with over-the-counter
medications, doctor might prescribe narcotics, such as codeine or an
oxycodone-acetaminophen combination (Percocet, OxyContin, others),
for a short time. Sedation, nausea, confusion and constipation are
possible side effects from these drugs.

17. •Anticonvulsants. Drugs originally designed to control seizures also
may be helpful in the treatment of the radiating nerve pain often
associated with a herniated disk.
•Muscle relaxers. Muscle relaxants may be prescribed if the patient
have muscle spasms. Sedation and dizziness are common side effects
of these medications.

18. •Cortisone injections. Inflammation-suppressing corticosteroids may
be given by injection directly into the area around the spinal nerves.
Spinal imaging can help guide the needle more safely. Occasionally a
course of oral steroids may be tried to reduce swelling and
inflammation.
• Physiotherapy may be decrease or minimize the pain
• Hot or cold application to affected area
• Cervical collar or cervical traction is widely used

19. Surgery for herniated disk
Laminotomy/laminectomy
In a laminotomy, a surgeon makes an opening in the vertebral
arch (lamina) to relieve pressure on the nerve roots. This
procedure is performed through a small incision, sometimes with
the aid of a microscope. If necessary, the lamina can be removed.
This is called a laminectomy.

20. Diskectomy/microdiskectomy
Diskectomy is the most common surgery used for herniated disk in
the lumbar region. In this procedure, the portion of the disk that is
causing the pressure on the nerve root is removed. In some cases,
the entire disk is removed.

21. The surgeon will access the disk through an incision in the back (or
neck). When possible, the surgeon will use a smaller incision and
special instruments to achieve the same results. This newer, less
invasive procedure is called microdiscectomy

22. COMPLICATION
 Permanent neurological dysfunction
 Chronic pain with associated psychological issue
 Cauda equina syndrome