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Spinal cord compression .pdf


Original filename: Spinal cord compression.pdf
Title: Spinal cord compression
Author: Khwaja nazim Uddin

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Compressive and non
compressive disorders of spinal
cord
Prof.Khwaja Nazim uddin

Spinal cord compression-causes

•Vertebral
•Meningial
•Spinal cord

Spinal cord
compression



More common
neurological emergency
Early stage of damage
reversible



Severely damaged
neurons donot recover



Blood supply of brain may
be zeopadised by SOLs

• Causes

• Vertebral(80%)
• Trauama
• Disk prolapse
• Metastatic
carcinoma(breast,prostate,bronch
us)
• Myeloma
• Tuberculosis

Spinal cord
compression



More common
neurological emergency
Early stage of damage
reversible



Severely damaged
neurons donot recover



Blood supply of brain may
be zeopadised by SOLs



Causes

• Meninges(intradural,extramedullary )15%

• Tumors(meningioma,neurofibroma,epe
ndymoma,metastasis,lymphoma,leuke
mias)
• Spinal cord(intradural,intramedullary)5%

• Glioma,ependymoma,metastasis

Clinical features
Usually slow(over
weeks),may be acute
with arterial lesion
Pain and sensory
symptoms occur early
Weakness and sphincter
dysfunction late

• Symptoms of spinal cord compression

•Pain :localized over the spine or in a root
distribution,which may be aggravated by
coughing,sneezing or straining

• Sensory:paresthesia,numbness or cold
sensation,specially lower limbs,which spread
proximally,often to a level on the trunk

• Motor:weakness,heaviness or stiffness of
the limbs,most commonly the leg

• Sphincter:Urgency or hesitancy of
micturition,leading eventually to retention

• Signs of spinal cord compression

Clinical features
• Sign vary with level of lesion,structure
of damage
• Tenderness to compression, local
kyphosis over the vertebral lesion
• Root lesion

Dermatomal sensory loss’

Corresponding lower motor sign
• Spinal fiber lesion

Sphincter disturbances

Sensory loss

Upper motor signs below the level


•Above C5
• Upper motor neurone signs and
sensory loss in all 4 limbs
• Diaphragm weakness

• C5-T1
• Lower motor neurone signs and
segmental sensory loss in upper
arm;upper motor signs in leg
• Respiratory muscle(intercostal)
weakness

• Signs of spinal cord compression

Clinical features
• Sign vary with level of lesion,structure
of damage
• Tenderness to compression, local
kyphosis over the vertebral lesion
• Root lesion

Dermatomal sensory loss’

Corresponding lower motor sign
• Spinal fiber lesion

Sphincter disturbances

Sensory loss

Upper motor signs below the level


•Thoracic cord
• Spastic paraplegia with sensory
level on trunk
• Weakness of legs,sacral loss of
sensation and extensor planter
responses

• Cauda equina
• Lower motor signs due to affection
of cauda equina

Brown- sequard
syndrome
Damage confined to one side of the cord

• Band like pain at the level
• Ipsilateral dorsal column
• Contraleteral spinothalamic

Clinical features

Spinal cord

Conus medullary

Cauda equina

Weakness

Symmetriac and profound Symetrical and variable

Reflexes

Increased(or
absent)ankle,knee
jerk,planter extensor

Sensory loss

Symmetrical,sensory level Symmetrical saddle
distribution

Assymetrical radicular
distribution

Sphincter

Late loss

Early loss

Often spared

Progression

Rapid

variable

variable

Asymmetrical,may be
mild

Increased,knee,decreased decreased,knee,decrease
anklejerk,planter extensor d anklejerk,planter flexor


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