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{{Spinal cord compression}}
{{Spinal cord compression}}
{{CMG}}
{{CMG}}
==Overview==
==[[Spinal cord compression overview|Overview]]==
'''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]].


Symptoms suggestive of cord compression are [[back pain]], a [[dermatome]] of increased sensation, [[paralysis]] of limbs below the level of compression, decreased sensation below the level of compression, [[urinary incontinence|urinary]] and [[fecal incontinence]] and/or [[urinary retention]]. [[Lhermitte's sign]] (intermittent shooting electrical sensation) and [[hyperreflexia]] may be present.
==[[Spinal cord compression pathophysiology|Pathophysiology]]==


Diagnosis is by [[X-ray]]s but preferably [[magnetic resonance imaging]] (MRI) of the whole spine. The most common causes of cord compression are tumors, but [[abscess]]es and [[granuloma]]s (e.g. in [[tuberculosis]]) are equally capable if producing the syndrome. Tumors that commonly cause cord compression are [[lung cancer]] (non-small cell type), [[breast cancer]], [[prostate cancer]], [[renal cell carcinoma]], [[thyroid cancer]], [[lymphoma]] and [[multiple myeloma]].
==[[Spinal cord compression causes|Causes]]==


[[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 [[intravenous]]ly for this indication.
==[[Spinal cord compression differential diagnosis|Differentiating Spinal cord compression from other Diseases]]==


[[Surgery]] is indicated in localised 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. Emergency [[radiation therapy]] (usually 20 Gray in 5 fractions) is the mainstay of treatment for malignant spinal cord compression. It is very effective as pain control and local disease control. Some tumors are highly sensitive to chemotherapy (e.g. lymphomas, small-cell lung cancer) and may be treated with chemotherapy alone.
==[[Spinal cord compression epidemiology and demographics|Epidemiology and Demographics]]==
 
==[[Spinal cord compression risk factors|Risk Factors]]==
 
==[[Spinal cord compression natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
==Diagnosis==
[[Spinal cord compression history and symptoms| History and Symptoms]] | [[Spinal cord compression physical examination | Physical Examination]] | [[Spinal cord compression laboratory findings|Laboratory Findings]] | [[Spinal cord compression x ray|X Ray]] | [[Spinal cord compression MRI|MRI]] | [[Spinal cord compression other imaging findings|Other Imaging Findings]] | [[Spinal cord compression other diagnostic studies|Other Diagnostic Studies]]
==Treatment==
[[Spinal cord compression medical therapy|Medical Therapy]] | [[Spinal cord compression primary prevention|Primary Prevention]] | [[Spinal cord compression secondary prevention|Secondary Prevention]]
==Case Studies==
[[Spinal cord compression case study one|Case #1]]


Once complete paralysis has been present for more than about 24 hours before treatment, the chances of useful recovery are greatly diminished, although slow recovery, sometimes months after radiotherapy, is well recognised.


The median survival of patients with metastatic spinal cord compression is about 12 weeks, reflecting the generally advanced nature of the underlying malignant disease.


==Source==
* Loblaw DA, Perry J, Chambers A, Laperriere NJ. Systematic review of the diagnosis and management of malignant extradural spinal cord compression: the Cancer Care Ontario Practice Guidelines Initiative's Neuro-Oncology Disease Site Group. ''J Clin Oncol'' 2005;23:2028-37. PMID 15774794.


{{CNS diseases of the nervous system}}
{{CNS diseases of the nervous system}}

Revision as of 18:24, 30 January 2013

Spinal Cord Compression Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Pathophysiology

Causes

Differentiating Spinal cord compression from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | X Ray | MRI | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Primary Prevention | Secondary Prevention

Case Studies

Case #1



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