Spinal Cord Compression
Symptoms
Back pain
Hesitancy + frequency (bladder + anal sphincter involvement is late)
Bilateral leg weakness
Painless retention
Signs
UMN signs below the level of the lesion: spastic weakness, raised plantars
Tone and reflexes are reduced in acute cord compression
LMN signs at the level of the lesion: wasting, hyporeflexia
Aetiology
Cervical disc prolapse
Intrinsic cord tumour
Infection from epidural abscess
Myeloma
Most common: secondary malignancy in spine from breast, lung, prostate, thyroid, kidney
Investigations
Arm weakness is often less severe - suggests cervical cord lesion
Biopsy if there is a mass
Chest x-ray for primary lung cancer/TB
MRI for definite diagnosis
Bloods
Do not delay imaging
Differential Diagnoses
Spinal artery thrombosis
Trauma
Cord vasculitis (PAN, syphilis)
Guillain-Barre
MS
Treatment
Radiotherapy + chemotherapy
Decompressive laminectomy
Urgent dexamethasone for malignancy
Antibiotics + surgical decompression for epidural abscess
Onset is sudden