1 / 30

Spinal Cord Compression

Spinal Cord Compression. Dr. Wayne Hoskins. Spinal Cord Anatomy. Medulla --> exiting nerve roots Surrounded by meninges: dura, arachnoid, pia Ends at L1/2 Protected by bony vertebral column. Spinal Cord Function. Transmits neural signals and contains neural circuits that control reflexes

huslu
Download Presentation

Spinal Cord Compression

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Spinal Cord Compression Dr. Wayne Hoskins

  2. Spinal Cord Anatomy • Medulla --> exiting nerve roots • Surrounded by meninges: dura, arachnoid, pia • Ends at L1/2 • Protected by bony vertebral column

  3. Spinal Cord Function • Transmits neural signals and contains neural circuits that control reflexes • Three major functions: • Motor • Sensory • Reflex

  4. Spinal Tracts

  5. Causes of Compressions

  6. Causes of Compressions • Trauma - vertebral fracture • Inter-vertebral disc / spinal stenosis • Tumor: Lung, breast, prostate, RCC, thyroid, lymphoma, MM • Epidural abscess

  7. UMNL vs. LMNL

  8. Case • 76 yo F - LBP & lateral R>L leg pain • Insidious onset 2/12 ago • PMHx: Colon Ca 2008 - APR • Presented to ED: DVT excluded - D/C • Represents with worsening pain • Denies weakness, numbness, parathesia, cauda equina Sx, fever

  9. Red Flags

  10. Exam & Ix • Lumbar-pelvic pain on palpation • Normal neuro exam • SLR negative • FBE, CMP, LFT NAD • CEA 3.7

  11. Lumbar-pelvic x-ray Sclerosis in left sacral alar suspicious of healing insufficiency fracture

  12. NM Bone study & SPECT Increased uptake L>R sacral alar consistent with arthritis

  13. MRI

  14. Metastatic SCC Spinal cord or cauda equina compression by direct pressure & /or induction of vertebral collapse or instability by metastatic spread or direct extension that threatens or causes neurological disability - 5-10% all Ca patients - Initial manifestation in 20% - Median survival 3-6/12

  15. Early detection • View as oncological emergency if: - neuro symptoms: radicular pain, any limb weakness, difficulty in walking, sensory loss or bowel/bladder dysfn - neuro signs of spinal cord or cauda equina compression

  16. Imaging • Whole spine MRI: <1/52 to plan definitive treatment and <24/24 if neurological symptoms • Sensitivity and specificity >90% • CT only to assess stability, plan surgery, biopsy guidance - CT myelopgraphy if MRI contra • Do not perform plain radiographs

  17. Treatment • Goals: palliative, pain control, preserve or restore ambulation,neuro & stability • Start definitive treatment ideally within 24/24 of Dx • Carefully plan surgery: consider fitness, prognosis, preferences • Urgent <24/24 RT for definitive treatment if unsuitable for surgery

  18. Treatment • Analgesia: Conventional by WHO pain relief ladder, ?specialist pain care • Bisphosphonates: myeloma or breast Ca and prostate if analgesia has failed; not for others • Corticosteroids: 16mg loading dexameth - 16mg/d, over 5-7/7 after RT or surgery - complications: sepsis, bowel perforation • Biopsy & stage (no., sites, extent)

  19. Treatment • RT: if non-mechanical pain • Vertebroplasty/kyphoplasty - consider if no MSCC or instability &: - mechanical pain resistant to analgesia - vertebral body collapse • Surgery: consider urgently if spinal instability, mechanical pain resistant to analgesia - external spinal support (halo, orthosis) if unsuitable for surgery

  20. Surgery • RT: if non-mechanical pain • Vertebroplasty/kyphoplasty - consider if no MSCC or instability &: - mechanical pain resistant to analgesia - vertebral body collapse • Surgery: consider urgently if spinal instability, mechanical pain resistant to analgesia - external spinal support (halo, orthosis) if unsuitable for surgery

  21. Radiotherapy • Urgent <24/24 if definitive treatment or unsuitable for surgery unless: - tetraplegia or paraplegia >24/24 and pain controlled; overall poor prognosis • Fractionated RT definitive Tx if no neuro impairment, pain or instability • No pre-operative RT • Post-operative RT offered when wound healed

  22. Thromboprophylaxis • All patients thigh length TEDS and/or intermittent pneumatic compression or foot impulse devices • High risk: LMWH and mechanical thromboprophylaxis

  23. CSM • Natural history: slow deterioration in stepwise fashion, with worsening symptoms of gait abnormalities, weakness, sensory changes and often pain • Dx: Hx, Exam, XR - CT/MRI to confirm

  24. Management • Minimal symptoms without hard evidence of gait disturbance or pathological reflexes warrant nonoperative treatment • Demonstrable myelopathy and spinal cord compression are candidates for operative intervention

  25. Surgery Anterior and posterior approaches

  26. ACDF

  27. Thank You

  28. Diagnosis • X-ray • Preferably MRI urgently - whole spine if cancer implicated

  29. Treatment • Dexamethasone - 16mg/d may reduce edema around lesion • Surgery - indicated in local compression and if hope of regaining functions

  30. Surgical Considerations • Speed of onset • Red flags

More Related