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:
- 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.
Nice