Spinal Chord Compression

Question 1

What is the cauda equina?

Answer 1

Free nerve pairs within the vertebral foramen which only carries nerve pairs (no spinal chord)

Carries: 2-5th Lumbar + S and Coccyngeal nerve pairs

Question 2

Where does the cauda equina start?

Answer 2

At Level L1/2

Question 3

What is the cauda equina syndrome?

Answer 3

Compression of the cauda equina

• = compression of Lumbar/Sacral nerve routes

Question 4

What is a typical presentation of a patient with cauda equina syndrome?

Answer 4

• increasing backpain
• bilateral sciatica
• sensory loss in a lumbosacral distribution
  
  • saddle anaesthesia
  • erectile dysfunction
• and flaccid, weakened lower limbs with reduced reflexes
  
  • gait disturbance
• urinariy symptoms
• external anal sphincter
  
  • incontinence

Question 5

What are possible causes for cauda-equina syndrome?

Answer 5

• Bony metastasis
• Myeloma
• Epidural abscess
• Disc prolapse
• Epidural haematoma
• Primary sacral tumour e.g. chordoma

Question 6

What is the appropriate treatment for a patient with suspected cauda-equina syndrome?

Answer 6

Arrange urgent spinal surgical admission that day

• to prevent paralysis or irreversible damage

Question 7

Which lower limb signs may help differentiate compression of the cauda equina rather than the cord itself?

Answer 7

Arreflexia

Reduced tone

Cord compression usually causes spastic paralysis with brisk reflexe

Question 8

What are things you should always include in your backpain history (to exclude red flags)?

Answer 8

1. Trauma/Spinal Fractures
   
   • point tenderness over a vertebral body
   • sudden onset of servere spinal central pain
2. Cancer
   
   • over 50, FH, weight loss, malaise, gradual onset of weight loss, no improvement after 4-6 weeks
3. Infection
   
   • fever, diabetes, IVDU, immuno-suppression (HIV)