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Spinal Cord Compression - Coggle Diagram
Spinal Cord Compression
Compression of the spinal cord resulting in upper neurone signs and specific symptoms dependent on where compression is
Risk Factors
Vertebral body neoplasms - MOST COMMON CAUSE OF ACUTE COMPRESSION:
- Secondary malignancy commonly from lung, breast, prostate, myeloma, lymphoma
Spinal Pathology
Disc Herniation
Where centre of disc (nucleus pulpous) has moved out through the annulus (outer part of disc) resulting in pressure on nerve root and pain
Disc Prolapse
When nucleus pulpous moves and presses against the annulus but it doesn't escape outside the annulus
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Clinical Presentation
There is SENSORY LOSS BELOW the level of the lesion - sensation abruptly diminishes ONE/TWO cord segments BELOW the level of the actual anatomical level of spinal cord compression
Look for a motor, reflex and sensory level with NORMAL FINDINGS ABOVE the level of the lesion
Bladder (and anal) sphincter involvement is late and manifests as hesitancy, frequency and later as painless retention
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Differential Diagnosis
Transverse myelitis, multiple sclerosis, cord vasculitis, trauma, dissecting aneurysm
Diagnosis
MRI
- GOLD STANDARD
- Identifies the cause and site of cord compression
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Screening blood tests: FBC, ESR, B12, U&E'S, syphilis serology, LFT, PSA
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Treatment
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Refer to neurosurgeons
- Epidural steroid injections - effective for leg pain
- Surgical decompression of cord - laminectomy & microdiscectomy
If malignancy then give IV dexamethasone (reduces inflammation/oedema around malignancy and improves outcome) and consider more specific therapy