Spinal Cord Compression

Question 1

What are the main categories of spinal cord compression causes?

Answer 1

Extradural, intradural extramedullary, and intradural intramedullary.

Question 2

What are common extradural causes of spinal cord compression

Answer 2

Tumours (metastases, primary bone tumours)
• Infections (TB, pyogenic, parasitic)
• Disc herniation
• Trauma

Question 3

What are common intradural extramedullary causes of spinal cord compression?

Answer 3

• Tumours (neurofibroma, meningioma)
  • Cysts (arachnoid, cysticercosis)
  • Dysraphism

Question 4

What are common intradural intramedullary causes of spinal cord compression?

Answer 4

Tumours (astrocytoma, ependymoma, haemangioblastoma)
• Syrinx
• Trauma (cord contusion, acute haematomyelia)
• Inclusions

Question 5

What are the most common secondary (metastatic) tumours causing spinal compression in adults?

Answer 5

Lung, breast, prostate, thyroid, kidney, melanoma, lymphoma, and leukaemia.

Question 6

What are the most common secondary (metastatic) tumours causing spinal compression in children?

Answer 6

Neuroblastoma and nephroblastoma (Wilms tumour).

Question 7

What factors influence the pathophysiology of spinal cord compression?

Answer 7

• Speed of compression
  • Consistency of mass (soft disc vs bone fragment)
  • Vascular compromise
  • Demyelination
  • Infarction

Question 8

What types of pain can occur in spinal cord compression?

Answer 8

Local pain (at the level of lesion)
• Radicular pain (nerve root involvement)
• Central pain (cord itself).

Question 9

What types of weakness are seen in spinal cord compression?

Answer 9

Weakness of lower and/or upper limbs, depending on the level of compression.

Question 10

Which sensory modalities are commonly disturbed in spinal cord compression?

Answer 10

Spinothalamic tract (pain and temperature)
• Dorsal columns (light touch, vibration, proprioception).

Question 11

How is sphincter function affected in spinal cord compression?

Answer 11

Bladder involvement: UMN or LMN type dysfunction
• Rectum: impaired control or constipation depending on level/type of injury.

Question 12

What upper motor neuron (UMN) signs are seen in spinal cord compression?

Answer 12

Spasticity, hyperreflexia, clonus, and positive Babinski sign (extensor plantar response)

Question 13

What lower motor neuron (LMN) signs may be present in spinal cord compression?

Answer 13

Flaccid paralysis, muscle wasting, fasciculations, and hyporeflexia/areflexia (at the level of lesion).

Question 14

What sensory signs are seen in spinal cord compression?

Answer 14

Loss of pain, temperature, touch, vibration, or proprioception depending on which tracts are affected (spinothalamic vs dorsal column), often with a sensory level.

Question 15

What is transverse cord syndrome?

Answer 15

Complete loss of motor, sensory, and autonomic function below the lesion, often due to trauma, infarction, or transverse myelitis.

Question 16

What is posterior cord syndrome

Answer 16

Loss of light touch, vibration, and proprioception (dorsal columns), with preserved motor and pain/temperature. Often due to B12 deficiency or tabes dorsalis.

Question 17

What is Brown-Séquard syndrome?

Answer 17

Ipsilateral motor weakness and loss of proprioception, with contralateral pain and temperature loss. Typically due to penetrating trauma or tumours.

Question 18

What is central cord syndrome?

Answer 18

Cape-like loss of pain and temperature across shoulders/arms, LMN weakness at lesion level (hand wasting), and UMN spasticity below. Causes: syringomyelia, trauma, tumours.

Question 19

What is anterior cord syndrome?

Answer 19

Loss of motor, pain, and temperature below the lesion, with preserved light touch and proprioception. Causes: anterior spinal artery thrombosis, trauma, disc prolapse.

Question 20

How does conus medullaris syndrome present?

Answer 20

Symmetrical lower limb weakness, early bladder/bowel dysfunction, mixed UMN + LMN signs, and saddle anaesthesia.

Question 21

How does cauda equina syndrome present?

Answer 21

Asymmetrical lower limb weakness, radicular pain, areflexia, late bladder/bowel involvement, and saddle anaesthesia.

Question 22

What basic imaging investigations are used in spinal cord compression?

Answer 22

X-ray, MRI (gold standard), myelogram, CT scan, and isotope bone scan.

Question 23

Which blood tests are useful in spinal cord compression evaluation?

Answer 23

FBC, ESR, and serum electrophoresis (to look for malignancy, infection, or inflammation).

Question 24

Which urine test is important in suspected malignant spinal cord compression?

Answer 24

Urine for Bence-Jones proteins, which indicate malignant B-cell proliferation (e.g., multiple myeloma).

Question 25

What is the role of needle biopsy in spinal cord compression?

Answer 25

To obtain a specimen for histology and MCS (microscopy, culture, sensitivity).

Question 26

What are the surgical principles of treatment in spinal cord compression?

Answer 26

- Timely decompression (posterior, anterior, or lateral approaches) • Obtain specimen for histology/MCS • Restore spinal stability

Question 27

What adjuvant therapies are used after surgery in spinal cord compression?

Answer 27

Radiotherapy, chemotherapy, and treatment of infections.

Question 28

What factors influence prognosis in spinal cord compression?

Answer 28

- Speed of compression (slower compression = better outcome) • Complete lesion lasting > 24 hours → poor prognosis • Biology of the lesion (e.g., aggressive tumour vs benign cause).

Question 29

Why is a complete lesion > 24 hours a poor prognostic sign?

Answer 29

Because it usually indicates irreversible cord damage.

Question 30

What are the main components of rehabilitation after spinal cord compression?

Answer 30

Pain control • Physiotherapy (mobility, muscle strength, spasticity management) • Occupational therapy (adaptation to daily activities) • Vocational/occupation support (returning to work or alternative employment).