SPINAL CORD COMPRESSION

Spinal cord compression develops when the spinal cord is compressed by

bone fragments from a vertebral fracture, a tumor, abscess,
ruptured intervertebral disc or other lesion. It is regarded as a medical
emergency independent of its cause, and requires swift diagnosis and
treatment to prevent long-term disability due to irreversible spinal cord
injury.
 ETIOLOGY
 Vertebral Fracture
 Abscess formation in disc
 Ruptured intervertebral disc
The causes of spinal cord compression include the following:
Certain degenerative diseases, such as arthritis, can lead to spinal cord
compression. A ruptured disk may lead to spinal cord compression. Injury to
the spinal cord or the area around the cord can lead to swelling, which can
cause compression.
 CLINICAL MANIFESTATIONS
 Back pain
 Paralysis of limbs below the level of compression
 Decreased sensation below the level of compression
 Urinary and fecal incontinence and urinary retention
 Most common symptoms is stiffness or pain in the back or the neck.
 Numbness or weakness in the legs, hands, and arms
 DIAGNOSIS
 Diagnosis is by x-rays but preferably MRI of the whole spin
 plain spine x-ray
 CT spine
 Blood or cerebrospinal fluid cultures
 Tumor biopsy and histopathology
 TREATMENT
 Dexamethasone (a potent glucocorticoid) in doses of 16 mg/day may
reduce edema around the lesion and protect the cord from injury. It may be
given orally or intravenously for this indication
 Anti-inflammatory medications may help decrease swelling and reduce
pain
 Physiotherapy, Exercise will strengthen the abdominal and leg muscles
 Home care, such as applying ice packs and heating pads,- can help relieve
pain.

Surgery is indicated in localized compression as long as there is some hope of
regaining function. It is also occasionally indicated in patients with little hope
of regaining function but with uncontrolled pain. Postoperative radiation is
delivered within 2–3 weeks of surgical decompression. Emergency
radiation therapy is the main treatment for malignant spinal cord
compression. It is very effective as pain control and local disease control.
SPINAL DISC HERNIATION (DISK PROLAPSE)
Herniated = from “hernia,” a part of the body that bulges out
through an abnormal opening
Disc = the disk-shaped cushions between the bones of the spine
Spinal disc herniation, also known as a slipped disc, is a
medical condition affecting the spine in which a tear in the
outer, fibrous ring of an intervertebral disc allows the soft,
central portion to bulge out beyond the damaged outer rings.
 CAUSES OF SPINAL DISC HERNIATION
 Degenerative disorder : Degenerative disk disease is when normal changes
that take place in the disks of the spine cause pain.
 Prolonged pressure on nerve ending of vertebral disc: caused by a tumor
or cyst that presses on the sciatic nerve or its roots.
 Trauma (falls, accidents, and repeated minor stresses such as heavy lifting,
prolonged sitting)
 Advancing age
 CLINICAL MANIFESTATION
 Pain : Pain can be sharp or burning

 Weakness: Feeling of instability while ambulating can also be seen in

patients with disk herniation.
 DIAGNOSTIC EVALUATION
During the physical exam, doctor will check the back for tenderness.
He or she may ask to lie flat and move the legs into various positions
to help determine the cause of pain. The doctor may also perform a
neurological exam, to check :
•Reflexes
•Muscle strength
•Walking ability
•Ability to feel light touches, pinpricks or vibration
•X-rays. Plain X-rays don't detect herniated
disks, but they may be performed to rule out
other causes of back pain, such as an infection,
tumor, spinal alignment issues or a broken
bone.
• Computerized tomography (CT scan). A CT
scanner takes a series of X-rays from many
different directions and then combines them to
•Magnetic resonance imaging (MRI). Radio waves and a
strong magnetic field are used to create images of body's
internal structures. This test can be used to confirm the
location of the herniated disk and to see which nerves are
affected.
•Myelogram. A dye is injected into the spinal fluid, and
then X-rays are taken. This test can show pressure on the
spinal cord or nerves due to multiple herniated disks or
other conditions.
 Medical management
•Over-the-counter pain medications. If pain is mild to
moderate, doctor may tell to take an over-the-counter
pain medication, such as ibuprofen (Advil, Motrin IB,
others) or naproxen (Aleve, others).
•Narcotics. If the pain doesn't improve with over-the-
counter medications, doctor might prescribe narcotics,
such as codeine or an oxycodone-acetaminophen
combination (Percocet, OxyContin, others), for a short
time. Sedation, nausea, confusion and constipation are
•Anticonvulsants. Drugs originally designed to control
seizures also may be helpful in the treatment of the
radiating nerve pain often associated with a herniated
disk.
•Muscle relaxers. Muscle relaxants may be prescribed if
the patient have muscle spasms. Sedation and dizziness
are common side effects of these medications.
•Cortisone injections. Inflammation-suppressing
corticosteroids may be given by injection directly into the
area around the spinal nerves. Spinal imaging can help
guide the needle more safely. Occasionally a course of
oral steroids may be tried to reduce swelling and
inflammation.
• Physiotherapy may be decrease or minimize the pain
• Hot or cold application to affected area
• Cervical collar or cervical traction is widely used
 Surgery for herniated disk
Laminotomy/laminectomy
In a laminotomy, a surgeon makes an opening in the vertebral arch (lamina)
to relieve pressure on the nerve roots. This procedure is performed through a
small incision, sometimes with the aid of a microscope. If necessary, the
lamina can be removed. This is called a laminectomy.
Diskectomy/microdiskectomy
Diskectomy is the most common surgery used for herniated disk in the lumbar
region. In this procedure, the portion of the disk that is causing the pressure on
the nerve root is removed. In some cases, the entire disk is removed.
The surgeon will access the disk through an incision in the back (or neck).
When possible, the surgeon will use a smaller incision and special instruments
to achieve the same results. This newer, less invasive procedure is called
microdiscectomy
 COMPLICATION

 Permanent neurological dysfunction

 Chronic pain with associated psychological issue
 Cauda equina syndrome