Spinal Cord Compression

Original article by Tom Leach | Last updated on 19/9/2016
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Physiology and anatomy

  • The spinal cord runs from C1 (junction with the medulla), to about L1, where it becomes the cauda equina.
    • Note that it terminates lower down in children – the spinal cord cannot grow as well as the rest of the body!
  • The spinal cord gets its blood supply mainly from the vertebral arteries.
 

Clinical features

  • Spastic paraparesis / tetraparesis
  • Radicular pain at the level of the compression
  • Sensory loss below the level of the compression
 

Causes

  • Degenerative disc lesions, e.g. Herniated disc
  • Degenerative vertebral lesions, e.g. Osteoporosis
  • TB
    • The most common cause of spinal cord compression in countries where TB is common
    • There is destruction of both the disc and the vertebra
    • Paralysis can occur – in which case it is called Pott’s Paraplegia
  • Epidural abscess
  • Vertebral neoplasms:
    • Myeloma
    • Metastasis - Bone, Bronchus, Prostate, Lymphoma, Thyroid
    • Menningioma
    • Neurofibroma
    • Ependymoma
    • Glioma
    • Lipoma
    • Teratoma
    •  Symptoms will occur gradually over months, perhaps even years with slow growing tumours (e.g. glioma). There will usually be root pain and an obvious sensory level.
  • Epidural haemorrhage
  • Paget’s disease
 

Example

Spinal cord compression at T4

  • Pain radiates around the thorax, typically worse on coughing
  • Spastic paraparesis develops slowly of the following hours days or weeks depending on the underlying pathology
  • Numbness from the feet to the level affected
  • Urinary Retention
  • Constipation
 

Treatment

  • It is a medical emergency
  • Can be difficult to differentiate a chronic from an acute cause, particularly if pain and sensory level are ambiguous.