Three types of lesions that compress spinal cord?
- extradural (80%)
- intradural, extramedullary (15%)
- intramedullary (5%)
Extradural compression?
- metastatic tumor
- extradural abscess
Intradural, extramedullary?
- meningioma
- schwannoma
Intramedullary?
- glioma (astro/ependy)
- syrinx
Main causes of spinal compression?
- tumor
- degenerative
- infection
- hematoma
- developmental
Presentation of spinal compression?
Pain
Neuro deficit
Which type of pain is most specific for spinal compression?
girdle pain, aggravated w/ valsalva
Describe central pain?
burning quality, diffuse
described with difficulty
What is Lhermitte’s sign?
sign of cervical cord involvement
flexion/extension of neck causes electric shock or tingling down the body to extremities.
What are the components of neurological deficit 2/2 to spinal compression?
- progressive weakness
- sensory disturbance
- sphincter disturbance
Describe progressive weakness?
- compression of corticospinal pathways (UMN signs)
- cauda equina is LMN
Describe dermatomal sensory disturbance?
T4 - nipples
T7 - xiphoid
T10 - umbilicus
Describe sphincter disturbance?
first difficulty initiating micturation, followed by urinary retention, constipation, fecal incontinence
Which malignant tumor is most common that causes extradural spinal cord compression?
- lung
breast, prostate, kidney
Schwannoma?
- most common intrathecal tumor
- from posterior nerve roots
- slow growing
- pain and radicular sx
- might see brown-sequard
- excise via laminectomy
Spinal meningioma?
- middle aged/elderly/female
- slow growing
- ill defined back pain at night
- MRI w/ gad
- Tx resection of tumor and involved dura
Intramedullary tumor?
- ependymoma
- astrocytoma (cant resect astro, radiotherapy)
Cervical disk prolapse?
- central posterior disc herniation causes rapidly progressive paralysis with UMN features below the level of compression and LMN features at level
Where is thoracic disc prolapse most common?
T8 level
ages 30 - 55 men
tx with excision of disc protrusion
What is the blood supply of t8-l2?
artery of adamkiewicz
What causes a spinal abscess?
- hematogenous spread OR
- adjacent intervertebral disc infection
What is the most common pathogen?
S. aureus
What is tx of spinal abscess?
urgent laminectomy or anterior approach
- complete evacuation of abscess
- abx
spinal AVM?
- steal phenomenon
- thrombosis
- compressive sx
- chronic increase of venous pressure
- hemorrahage
