Emergency - Spinal cord compression

From CambridgeNotes

  • Acute compression is when symptoms occur within 24 hours; usually include cauda equina (not actually "spinal cord")

ABC

History and Examination

  • Symptoms
    • Pain: back pain (local tissues, roots, or cord)
    • Neurology: weakness and sensory loss (a level may be found), bowel and bladder dysfunction
  • Distribution
    • Brown-Sequard: ipsilateral upper motor neurone lesion, fine touch and joint position; contralateral pain and temperature loss → complete cord lesion (bilateral loss of all)
    • Cauda equina: root pain in both legs, loss of perianal sensation, painless urinary retention

Differential Diagnosis

  • Extradural (80%): metastases (breast, lung, prostate, or kidney); extradural abscess
  • Intradural (20%)
    • Extramedullary: meningioma, schwannoma
    • Intramedullary: astrocytoma, syringomyelia
  • Cauda equina: usually central lumbar disc prolapse

Investigations

  • X-ray spine: vertebral collapse, osteolytic lesions
  • MRI (or myelogram or CT): good discs are bad news (malignancy), bad discs are good news (infection)

Definitive Treatment

  • Dexamethasone 8-16mg IV then 4mg q6h PO
  • Malignant disease usually given radiotherapy otherwise consider surgery (usually anterior approach)
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