Spinal Cord Compression
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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.

References

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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) FRACGP currently works as a GP and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

This Post Has One Comment

  1. Sanday alex

    Nice

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