Transcript Spinal Cord Compression

Spinal Cord Compression
Chris Lim
Consultant Neurosurgeon
Ninewells Hospital and Medical School
Spinal Cord Anatomy

Corticospinal Tracts (motor)

Spinothalamic Tracts (sensory)

Dorsal Columns (sensory)
Corticospinal tracts

2 neurone tracts (one synapse)

Upper motor neurone – from motor cortex to
anterior grey horn. Decussates at medullary
level

Lower motor neurone ( anterior horn cell to
muscles)
Motor Pathways

Upper motor neurone lesion
Increased tone
Muscle wasting NOT marked
No fasciculation
Hyper - reflexia
Motor Pathways

Lower motor neurone lesion
Decreased tone
Muscle wasting
Fasciculation
Diminished reflexes
Sensory pathways

Spinothalamic tracts
Pain, temperature and crude touch
Contralateral
Decussates at spinal level
Sensory pathways

Dorsal columns
Fine touch, proprioception, vibration
Ipsilateral
Decussate at medullary level
Spinal Cord Compression

Acute or Chronic

Complete or Incomplete
Acute Spinal Cord Compression

Trauma

Tumours – haemorrhage or collapse

Infection

Spontaneous haemorrhage
Chronic Spinal Cord Compression

Degenerative disease – spondylosis

Tumours

Rheumatoid Arthritis
Clinical Presentation
Acute Compression
Cord Transection

Complete Lesion – all motor and sensory modalities
affected

Sensory Level

Motor Level

Initially a flaccid arreflexic paralysis “Spinal Shock”

Upper motor neurone signs appear later
Brown-Sequard Syndrome
(Cord Hemisection)

Ipsilateral motor level

Ipsilateral Dorsal Column sensory level

Contralateral spinothalamic sensory level
Central cord syndrome

Hyperflexion or extension injury to already stenotic neck

Predominantly distal upper limb weakness

“Cape-like” spinothalamic sensory loss

Lower limb power preserved

Dorsal Columns preserved
Clinical presentation

Chronic cord compression
Chronic spinal cord compression

Same as acute except upper motor neurone
signs predominate
Causes of Spinal Cord
Compression
Trauma

High energy injury

Especially mobile segments of spine
CERVICAL
Tumour

Extradural –
usually metastasis
lung, breast, kidney,prostate

Intradural -
Extramedullary
meningioma, Schwannoma
-
Intramedullary
Astrocytoma, Ependymoma
Tumours

Can slowly compress

Can cause acute compression by collapse or
haemorrhage
Degenerative disease

Spinal canal stenosis osteophyte formation
bulging of intervertebral discs
facet joint hypertrophy
subluxation
Infection

Epidural Abscess

Surgery or Trauma
-
Bloodborne
Staph
Tuberculosis
Haemorrhage
Epidural
 Subdural
 Intramedullary

Trauma
 Bleeding diatheses
 Anticoagulants
 Arterio-venous malformations

Treatment
Trauma

Immobilise

Investigate

Decompress + stabilise - Surgery
Traction
External fixation
X-Ray/CT
MRI
Tumours - metastatic

Depends on patient status and tumour type/extent

Dexamethasone

Radiotherapy

Chemotherapy

Surgical decompression and stabilisation
Tumours - Primary

Surgical excision
Infection

Surgical Drainage

Antimicrobial therapy
Haemorrhage

Reverse anticoagulation

Surgical decompression
Degenerative disease
Surgical decompression +/stabilisation
Spinal Cord Compression

Acute compression is an EMERGENCY

Chronic compression also requires rapid treatment

Usually treatment only prevents further deterioration