Spinal Cord Compression Syndrome

A syndrome that results from pressure, as a result of encroachment on the spinal canal, deformity of the spinal cord, or any other disease process.

• Origin: Medulla
• Termination: Filum terminale
• Shape: It is oval in shape
• Length: Approx. 18 inches in an adult
• Enlarged regions: It is enlarged in the cervical and lumbar regions where neurons that innervate the upper and lower extremities are located.
• Organization: It is somatotopically organized.
• Consists of 31 segments each consisting of an exiting ventral motor root and an entering dorsal sensory root.

Blood supply

It derives its blood supply at segmental levels from a single anterior and 2 posterior spinal arteries.

• Mode of onset:
  • - Acute
  • - Subacute
  • - Chronic
• Anatomic location:
  • - Cervical
  • - Thoracic
  • - Lumbosacral
• Aetiology:
  • - Infective
  • - Neoplastic
  • - Degenerative
  • - Obscure
• Site of compression:
  • - Extramedullary
  • - Intramedullary
  • * Extramedullary
  • * Intramedullary

ACUTE COMPRESSION

This requires an urgent recognition and appropriate management in order to avoid permanent damage.

• Extradural metastases especially from lung and breast ca
• Spinal epidural abscess. This presents as a clinical triad of pain, fever, and rapidly progressive weakness
• Trauma
• AV malformation
• Disc prolapse

CHRONIC COMPRESSION

• Pott’s disease
• Degenerative bone dx (spondylosis)
• Disc prolapse
• Neoplasm
  • - Primary e.g. astrocytoma, meningioma, neurofibroma, ependymoma
  • - Secondaries from lymphoma, thyroid, liver, myeloma, melanoma, nasopharynx, prostate, ovary, lungs, breast, kidneys, etc.
• Parasitic and degenerative cysts
• Hypertrophic ligaments
• Syringomyelia

Patients present with various combinations of:

• Sensory disturbance
• Motor disturbance
• Sphincteric dysfunction

The manifestations are as a result of the somatotopic organization of the SC.

Sensory disturbance

• The hallmark of SC compression is the presence of a sensory level in addition to motor weakness.
• Usual complaints include:
• - Paraesthesia
• - Numbness (unilateral or bilateral)
• - Band-like sensation around the trunk
• Examination may reveal:
• - Loss of pain and temp sensation
• - Definite sensory level
• - +/- Affectation of the posterior column
• - Dissociated sensory loss e.g. in syringomyelia

Determination of sensory level
Vertebrae	Sensory level (dermatome)
Cervical	Upper cervical - same as vertebral level Lower cervical - add 1
T1-T6	Add 2
T7-T9	Add 3
T10	L1/L2 level
T11	L3/L4 level
T12	L5

Motor disturbances

• Muscle weakness because of affectation of the descending corticospinal tract.
• Manifestations can be:
• - Quadriparesis/plegia
• - Paraparesis/plegia
• - Hypertonia
• - Hyperreflexia
• - Extensor plantar response

Sphincteric disturbance

Occurs early in intramedullary compression and later in extramedullary compression.

• Transverse myelitis
• Tropical spastic paraparesis
• HIV-associated myelopathy
• Subacute combined degeneration of the cord
• GBS (Guillain-Barré Syndrome)
• Multiple sclerosis
• Parasagittal tumor

• Spinal MRI
• CT myelogram
• Plain spinal X-rays
• Other investigations depend on the suspected cause

• Relieve obstruction via surgical means e.g. laminectomy
• Medical management e.g.:
• - Antibiotics
• - Anti-Koch’s
• - Cytotoxics
• Radiotherapy
• Physiotherapy to prevent contractures
• Management of a paraplegic / quadriplegic patient:
• - Prevent bedsore
• - Bowel and bladder care
• - DVT prophylaxis