Spinal Cord Compression

Question 1

What is spinal cord compression (SCC)?

Answer 1

A form of myelopathy caused by pressure on the spinal cord by various causes

Question 2

What type of lesion does SCC cause?

Answer 2

Upper motor neurone lesion

Question 3

What are the typical symptoms of spinal cord compression?

Answer 3

• Severe back pain
• Difficulty walking
• Weakness below the level compressed
• Numbness below the level compressed
• Urinary or faecal incontinence
• Urinary retention
• Constipation

Question 4

What are signs seen below the level of the lesion in SCC?

Answer 4

• Hypertonia
• Hyperreflexia
• Clonus
• Upgoing plantars
• Sensory loss

Question 5

Which condition presents similarly to spinal cord compression and is characterized by inflammation of the cord?

Answer 5

Transverse Myelitis

Question 6

What distinguishes Cauda Equina Syndrome from SCC?

Answer 6

Cauda Equina Syndrome shows lower motor neurone signs and is typically caused by lumbar disc herniation

Question 7

What investigation is key for diagnosing spinal cord compression?

Answer 7

MRI of the whole spine

Question 8

How quickly should an MRI be performed in suspected malignancy-related spinal cord compression (MSCC)?

Answer 8

Within 24 hours

Question 9

What should be done if urinary retention is suspected in a patient with SCC?

Answer 9

Do a bladder scan

Question 10

What initial treatment is recommended for patients with suspected MSCC?

Answer 10

High-dose steroids (usually 16mg dexamethasone)

Question 11

What medication should be given to prevent peptic ulceration caused by steroids in MSCC patients?

Answer 11

A proton pump inhibitor (PPI)

Question 12

What are key management steps for a patient with spinal cord compression?

Answer 12

• Immobilise the patient
• Regular repositioning
• Analgesia for pain
• VTE prophylaxis
• Catheterise if in urinary retention

Question 13

True or False: Patients unsuitable for surgery may receive radiotherapy for spinal metastases.

Answer 13

True

Question 14

What should be monitored in patients receiving steroids for MSCC?

Answer 14

Blood glucose for hyperglycaemia

Question 15

What is the role of oncology input in the management of SCC?

Answer 15

Key for diagnosis in patients without a known malignancy and for ongoing management

Question 16

Fill in the blank: Spinal braces may be used in patients not suitable for surgery to help with _______.

Answer 16

pain management and spinal stability

Question 17

How to manage malignant spinal cord compression?

Answer 17

IV dexamethasone