A condition that results from processes causing compression or displacement of the arterial, venous, and cerebrospinal fluid spaces, as well as the spinal cord itself

Aetiology

Acute spinal cord compression

• Trauma
  • High energy injury
  • Particularly affects the mobile segments of the spine i.e. cervical
• Malignancy - haemorrhage or collapse
  • Extradural - usually metastasis e.g. lung, breast, prostate
  • Intradural - extramedulary meningioma, schwannoma
  • Intramedullary - astrocytoma, ependymoma
• Infection
  • Epidural abscess - bloodborne staph, TB
  • Post surgery/trauma
• Spontaneous haemorrhage
  • Epidural, subdural, intramedullary
  • Trauma, bleeding diathesis, anticoagulants, aterio-venous malformations
• Prolapsed intervertebral disc
  • L4-L5 and L5-S1 are the most common levels for disc prolapse - both will cause sciatica
  • Large disc herniations can cause cauda equina syndrome

Chronic spinal cord compression

• Degenerative disease, mainly spinal canal stenosis
  • Osteophyte formation, bulging of intervertebral discs, facet joint hypertrophy, subluxation
• Malignancy
• Rheumatoid arthritis

Clinical features

Symptoms

• Motor, sensory and autonomic dysfunction can occur
• Cervical spine lesions can produce quadriplegia
• Thoracic spine lesions produce paraplegia
• Lumbar spine lesions can affect L4, L5 and sacral nerve roots
• Sensory symptoms can include sensory loss and paraesthesia; light touch, proprioception and joint position sense are reduced
  • The sensory level is usually 2-3 dermatome levels below the level of anatomical compression

Signs