Spinal cord compression

Question 1

Corticospinal tracts

• how many neurones? what are these called and what is there pathway?
• on what side of the body does it travel?

Answer 1

-2 neurone tract
Upper motor neurone (motor cortex to ant grey horn, decussates at medullary level)
Lower motor neurone
(anterior horn cell)

-ipsilateral

Question 2

Spinothalamic tracts

• function?
• travels on what side of body?
• decussates where?

Answer 2

• pain, temp and crude touch
• contralateral
• spinal level

Question 3

Dorsal columns

• function?
• travels on what side of body?
• decussates where?

Answer 3

• fine touch, proprioception, vibration
• ipsilateral
• Decussate at medullary level

Question 4

Spinal cord compression

-types? (2,2)

Answer 4

Acute/chronic

Compete/incomplete

Question 5

Acute Spinal cord compression

• causes? (4)
• presentation of:
  1. cord transection
  2. Brown-sequard syndrome
  3. central cord syndrome- why?

Answer 5

-trauma
tumours- haemorrhage or collapse
infection
Spontaneous haemorrhage

-1.complete lesion- all sensory and motor modalities affected
initially spinal shock= flaccid arreflexic paralysis, PMN signs later, also hypotension

2. ipsilateral motor level & dorsal column sensory level but contralateral spinothalamic sensory level
3. hyeprflexion or extensions injury to already stenotic neck
   predominantly distal upper limb weakness
   Cape like spinothalamic sensory loss
   lower limb and dorsal columns preserved
   Because:
   existing stenosis means chronic cord compression and with the extra movement of the neck the cord is compressed and becomes ischaemic for a while, deeper parts get ischaemic first as they are furthest from the blood supply so effects upper limb as it is the medial part of the corticospinal tract

Question 6

Chronic Spinal cord compression

• causes? (3)
• presentation?

Answer 6

-degenerative disease-spondylosis
tumours
RA

-mainly upper motor neurone signs as gradual progression

Question 7

Spinal cord compression

-causes?

Answer 7

Trauma
(high energy injury, particularly cervical)

Tumour
Extradural- mets from lung, breast, kidney, prostate

Intradural- extra medullary (meningioma/shwannoma)
Intrmedullary (astrocytoma, ependymoma)

Degenerative disease:
spinal canal stenosis causes by: osteophyte formation, bulging of intervertebral discs, facet joint hypertrophy, subluxation

Infection
epidural abscess dur to stap/TB via surgery/trauma

haemorrhage
Epidural, subdural, intramedullary
or due to trauma

Question 8

Treatment:

• Trauma?
• tumours?
• infection?
• haemorrhage?
• degenerative disease?

Answer 8

-immoblise
investigate (X ray, CT, MRI)
methylprednisolone bolus
Decompress + stabilise

-depends, dexamethasone, radiotherapy, chemo, surgical decompression and stabilisation
excision if primary

-antimicrobial therapy
surgical drainage
stabilisation where required

• reverse anticoagulation and surgical decompression
• surgical decompression +/- stabilisation