Neuro and Stroke > Spinal Cord Compression > Flashcards

Spinal Cord Compression Flashcards

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1
Q

What is spinal cord compression?

A

A medical emergency where the there is compression or displacement of the arterial, venous and CSF spaces, as well as the cord itself

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2
Q

What are the possible causes of spinal cord compression?

A
  • Trauma
  • Tumours
  • Irradiation
  • Prolapsed intervertebral disc
  • Epidural or subdural haematoma
  • Inflammatory disease
  • Spinal infections
  • Cervical spondylitic myelopathy
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3
Q

What types of traumatic incident may cause spinal cord compression?

A
  • Car accidents
  • Falls
  • Sports injuries
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4
Q

How do traumatic injuries lead to spinal cord compression?

A

Vertebral fracture or facet joint dislocation

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5
Q

What types of tumours can cause spinal cord compression?

A

Benign or malignant

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6
Q

What malignancies can cause spinal cord compression?

A
  • Primary bone tumours
  • Metastatic tumours
  • Lymphomas
  • Multiple myeloma
  • Neurofibromata
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7
Q

What primary cancers most commonly metastasise to bone?

A
  • Breast
  • Prostate
  • Lung
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8
Q

When is irradiation (leading to spinal cord compression) often encountered?

A

Radiotherapy

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9
Q

Which intervertebral discs most commonly prolapse to cause spinal cord compression?

A

L4-L5 or L5-S1

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10
Q

What inflammatory disease can especially cause spinal cord compression?

A

Rheumatoid arthritis

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11
Q

What are the subtypes of infective spinal cord compression?

A

Acute and chronic

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12
Q

What is the usual type of causative organism in acute infective spinal cord compression?

A

Bacteria

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13
Q

What are the usual types of causative organism in chronic infective spinal cord compression?

A

TB or fungal

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14
Q

What is cervical spondylitic myelopathy?

A

An aging process leading to narrowing of the spinal canal due to osteophytes, herniated discs and ligamentum flavum hypertrophy

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15
Q

What are the risk factors for spinal cord compression?

A
  • Age 16-30
  • Male
  • Osteoporosis
  • Risk of trauma
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16
Q

Why is osteoporosis a risk factor for spinal cord compression?

A

It is associated with vertebral column compression fractures

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17
Q

What type of trauma related risk factors increase the risk of spinal cord compression?

A
  • High risk occupation

- High-risk recreational activities

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18
Q

Over what period do the symptoms of spinal cord compression develop?

A

Quickly or slowly depending on the cause

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19
Q

What are the common symptoms of spinal cord compression?

A
  • Pain and stiffness in neck, back or lower back
  • Burning pain that spreads to the arms, buttocks or down into the legs (sciatica)
  • Numbness, cramping or weakness in arms, hands or legs
  • Loss of foot sensation
  • ‘Foot drop’
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20
Q

What can foot drop lead to?

A

Limp (high stepping gait)

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21
Q

In addition to the common symptoms of spinal cord compression, what else can develop over time?

A

Motor, sensory, and autonomic dysfunction

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22
Q

What does the clinical features of spinal cord compression depend on?

A

Extent, rate, and site of the spinal cord compression development

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23
Q

What are the red flags suggesting spinal cord compression?

A
  • Insidious progression
  • Neurological symptoms
  • Neurological signs
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24
Q

What neurological symptoms are red flags for spinal cord compression?

A
  • Gait disturbance
  • Clumsy or weak hands
  • Loss of sexual, bladder, or bowel function
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25
What neurological signs are red flags for spinal cord compression?
- Lhermitte's sign - UMN signs in lower limbs - LMN signs in upper limbs - Sensory changes
26
What is Lhermitte's sign?
Flexion of the neck causing an electric shock-type sensation that radiates down the spine and into the limbs
27
What UMN signs can be seen in the lower limbs in spinal cord compression?
- Babinski's sign - Hyper-reflexia - Clonus - Spasticity
28
What is Babinski's sign?
Up-going plantar reflex
29
What LMN signs may be seen in the upper limbs in spinal cord compression?
- Atrophy | - Hyporeflexia
30
What sensory changes may be seen in spinal cord compression?
Loss of vibration and joint position sense
31
What investigations can be used in assessing spinal cord compression?
- MRI spine - Gadolinium-enhance MRI spine - Plain spine x-ray - CT spine
32
Which of the previously listed imaging modalities is the study of choice for assessing spinal cord compression?
MRI spine
33
What may an MRI of the spine show in spinal cord compression?
- Disc displacement - Epidural enhancement - Mass effect - T2 cord signal
34
When may a gadolinium-enhanced MRI be used in spinal cord compression?
If there is suspicion of infection (osteomyelitis) or epidural abscess
35
What may also be seen on gadolinium-enhanced MRI in spinal cord compression other than infection?
Metastatic disease
36
What can be seen on a plain spine x-ray if the underlying cause of the spinal cord compression is disc compression?
Decreased disc space height
37
What can be seen on a plain spine x-ray if the underlying cause of the spinal cord compression is a tumour?
Loss of bony detail
38
What can be seen on a plain spine x-ray if the underlying cause of the spinal cord compression is trauma?
Misalignment of vertebral elements
39
What can be seen on a plain spine x-ray if the underlying cause of the spinal cord compression is infection?
- Loss of bony detail | - Loss of end-plate definition
40
When might a CT spine be used to assess spinal cord compression?
- MRI unavailable | - Surgical planning
41
What do further investigations (beyond imaging) depend on in spinal cord compression?
The suspected underlying cause
42
What further investigations may be required in spinal cord compression?
- FBC - ESR and CRP - Blood or CSF cultures - Tumour biopsy and histopathology - Urodynamic studies - PET scan of spine
43
When may FBC be abnormal in spinal cord compression?
Raised WBC if an infection is the cause
44
When may ESR and CRP be raised in spinal cord compression?
Underlying infection or inflammation
45
When may blood or CSF cultures be positive in spinal cord compression?
- Epidural abscess - Discitis - Osteomyelitis
46
When are urodynamic studies useful in spinal cord compression?
- Evaluate degree of sphincter dysfunction | - Monitor recovery of function post-decompression surgery
47
What are the potential differentials for spinal cord compression?
- Transverse myelitis - Guillain-Barre syndrome - HIV-related myelopathy - Amyotrophic lateral sclerosis (ALS) - MS - Diabetic neuropathy - Polymyositis - Hereditary muscular dystrophy - Peripheral neuropathy
48
In what position should a patient with spinal cord compression be nursed initially and for how long?
Flat, neutral spine alignment until spinal stability and neurological stability are ensured
49
What should be given in spinal cord compression until a definitive treatment plan is made?
Dexamethasone
50
What other supportive therapy steps can be used in spinal cord compression?
- Mange postural hypotension - Insert catheter - Techniques to clear airways - VTE prophylaxis - Prevention of pressure ulcers - Pain control
51
What techniques can be used to clear the airways in spinal cord compression?
- Breathing exercises - Assisted coughing - Suction
52
How can pain be managed in spinal cord compression?
- Analgesia - Palliative radiotherapy - Spinal orthoses - Vertebroplasty - Spinal stabilisation surgery
53
When should a definitive treatment be started in spinal cord compression if one is possible?
Before the ability to walk is lost and ideally within 24 hours
54
What definitive treatment options are available for spinal cord compression?
- Surgery | - Radiotherapy
55
What types of surgery can be used to treat spinal cord compression?
- Laminectomy | - Posterior decompression
56
What should be provided to a patient post-discharge with spinal cord compression?
Community based rehab and support
57
What do complications of spinal cord compression depend on?
The site of compression and severity of dysfunction
58
What are the potential complications of spinal cord compression?
- Pressure sores - Hypothermia - Lung complications - Depression
59
What lung complications can occur as a result of spinal cord compression?
- Aspiration pneumonia - Acute respiratory distress syndrome - Atelectasis - Ventilation-perfusion mismatch - Decreased coughing with retention of secretions
60
Why is depression often a complication of spinal cord compression?
There may be restriction of ADL's
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