Spinal Cord Compression

Question 1

The upper motor neurone of the corticospinal tract runs from where?

Answer 1

Motor cortex to anterior grey horn and decussates at medullary level.

Question 2

What signs are suggestive of an UMN lesion?

Answer 2

• Increased tone.
• Muscle wasting NOT marked.
• No fasciculations.
• Hyper-reflexia.

Question 3

What is a fasciculation?

Answer 3

Brief spontaneous contraction affecting a small number of muscle fibres, often causing a brief flicker of movement under the skin.

Question 4

What signs are suggestive of a LMN lesion?

Answer 4

• Decreased tone.
• Muscle wasting.
• Fasciculation.
• Diminished reflexes.

Question 5

Describe function of spinothalamic tracts.

Answer 5

SENSORY PATHWAY.

• Pain, temperature and crude touch.
• Contralateral.
• Decussates at spinal level.

Question 6

Describe function of dorsal columns.

Answer 6

SENSORY PATHWAY

• Fine touch, proprioception, vibration.
• Ipsilateral.
• Decussate at medullary level.

Question 7

Describe broad categories of spinal cord compression.

Answer 7

• Acute or chronic.

- Complete or incomplete.

Question 8

What may cause acute spinal cord compression?

Answer 8

• Trauma.
• Tumours: haemorrhage or collapse.
• Infection.
• Spontaneous haemorrhage.

Question 9

What may cause chronic spinal cord compression?

Answer 9

• Degenerative disease e.g. spondylosis.
• Tumours.
• Rheumatoid arthritis.

Question 10

Describe spinal cord transection?

Answer 10

A complete lesion affecting all motor and sensory modalities.

Question 11

What is the initial effect of a spinal cord transection?

Answer 11

• Flaccid arreflexic paralysis: “spinal shock”.

UMN signs appear later.

Question 12

What is Brown-Sequard syndrome?

Answer 12

• Ipsilateral motor level.
• Ipsilateral dorsal column sensory level.
• Contralateral spinothalamic sensory level.

Question 13

What is central cord syndrome?

Answer 13

Hyperflexion or extension injury to an already stenotic neck.

Question 14

How does central cord syndrome present?

Answer 14

• Predominantly as distal upper limb weakness.
• “Cape-like” spinothalamic sensory loss.

Lower limb power is preserved.
Dorsal column is preserved.

Question 15

How does chronic spinal cord compression present?

Answer 15

Predominant UMN signs.

Question 16

What may cause traumatic spinal cord compression?

Answer 16

• High energy injury. Esp. in mobile spine segments e.g. cervical.

Question 17

What extradural tumours that commonly cause spinal cord compression?

Answer 17

Usually metastases from lung, breast, kidney, prostate.

Question 18

What intradural tumours commonly cause spinal cord compression?

Answer 18

Extramedullary meningioma, Schwannoma.

Intramedullary astrocytoma, ependymoma.

Question 19

How do tumours cause spinal cord compression?

Answer 19

• Slowly compress.

- Cause acute compression by collapse or haemorrhage.

Question 20

Spinal canal stenosis is a degenerative, displaying what features?

Answer 20

• Osteophyte formation.
• Bulging of intervertebral discs.
• Facet joint hypertrophy.
• Subluxation.

Question 21

What are causes of infection within the spinal cord?

Answer 21

• Epidural abscess: bloodborne, Staph., TB.

- Surgery or trauma.

Question 22

How is haemorrhage within the spinal cord managed?

Answer 22

• Immobilise.
• Investigate.
• Decompress and stabilise.
• Methylprednisolone?

Question 23

How is haemorrhage of spinal cord decompressed and stabilised?

Answer 23

• Surgery, traction and external fixation.

Question 24

How is methylprednisolone administered in spinal cord haemorrhage?

Answer 24

Bolus 24 hour infusion.

Question 25

How is spinal cord haemorrhage investigated?

Answer 25

X-ray, CT or MRI.

Question 26

Although treatment for metastatic tumours of the spinal cord is dependent on patient and tumour, what is the general management plan?

Answer 26

- Dexamethasone. - Radiotherapy. - Chemotherapy. - Surgical decompression and stabilisation.

Question 27

How are primary tumours of the spinal cord managed?

Answer 27

Surgical excision.

Question 28

How is infection of the spinal cord managed?

Answer 28

- Antimicrobial therapy. - Surgical drainage. - Stabilisation where required.

Question 29

How is haemorrhage of spinal cord managed?

Answer 29

- Reverse anti-coagulation. | - Surgical decompression.

Question 30

How is degenerative disease of the spinal cord managed?

Answer 30

Surgical decompression +/- stabilisation.

Question 31

Is spinal cord compression an emergency or not?

Answer 31

Acute compression is an emergency. Chronic compression requires rapid treatment.

Question 32

What is the aim of treatment in spinal cord compression?

Answer 32

Usually only prevents further deterioration.