Choose a single article, issue, or full-access subscription. Once the diagnosis is established, treatment is instituted with steroids, decompressive surgery and postoperative irradiation or external irradiation alone depending upon the emergent nature of the clinical situation. The intervertebral disc absorbs shock, provides resistance to compression and allows flexibility of the vertebral column.7 A compromised (degenerated or anatomically abnormal) disc lends itself to abnormal motion and herniation of the nucleus pulposus, with potential radiculopathy and pain. Contact 64/No. Anteroposterior and lateral radiographs of the thoracic or lumbar regions are indicated in patients with localized tenderness or a suspicious mechanism of injury. Spinal cord compression is an emergency. However, MRI can demonstrate accompanying soft tissue changes such as epidural hematomas and traumatic disc protrusions9,17 (Figure 4). There are many causes of acute myelopathy including multiple sclerosis, systemic disease, and acute spinal cord compression (SCC). Gouliamos AD, Topper R, MRI is the modality of choice for identifying cervical disc herniation (Figure 5). Metastatic epidural spinal cord compression. It can also develop if a tumour puts pressure on the spinal cord. They may require anything from supportive care to emergency surgery. Klug N. Lanfermann H, /
Thron A. Muscle weakness, if progressive, must be evaluated urgently. The manifestations of spinal cord compression are difficult to diagnose at an early phase, particularly in the youngest patients. 2 It is possible for the cord to be compressed in both the front and back. It can occur as a first presentation of malignancy, or during treatment (representing disease progression or relapse). of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, 1994; AHCPR publication no. NLM Don't miss a single issue. Importantly, a delay in diagnosis may lead to permanent disability. Paleologos TS, Selden NR, Neuroblastoma with spinal cord compression: is there an emergency treatment of choice? Spinal cord compression Spinal cord compression occurs in 3-5% of patients with advanced cancer. 95-0642, Information from Glick TH, Workman TP, Gaufberg SV. Clin Sports Med. 15. The spine is divided into four sections: the cervical, thoracic, lumbar and sacrococcygeal vertebrae. If the spinal roots below the conus medullaris are involved, it is termed cauda equina syndrome. spinal cord compression SPINAL CORD COMPRESSION (SCC) is a life-threatening complication of pri-mary and metastatic cancer that can significantly impact a patient’s quality of life. However, these studies are costly and have a high false-positive rate.8. Acute spinal cord and cauda equina compression (SCC) has the potential to cause devastating neurologic impairment; therefore, timely and accurate diagnosis in the emergency department (ED) setting is paramount. Spinal cord emergencies: false reassurance from reflexes. Van der Reis W. Wakhloo AK, Kourousis DD. Suspect spinal cord compression if any of the following features are present: Neurological symptoms (including radicular pain, any limb weakness, difficulty in walking, sensory loss, or bladder or bowel dysfunction). Quint DJ, Spinal cord compression is a surgical emergency and if unrecognised or untreated, can result in irreversible neurological damage and disability. Rockville, Md. The history is key to the evaluation of spinal lesions. Spinal stenosis is usually a degenerative condition resulting from hypertrophy of the facet joints (osteoarthritis), hypertrophy of the ligamentum flavum and vertebral degeneration with bulging of the intervertebral disc. corrected] Lumbar spinal stenosis may result in neurogenic claudication. Regardless of the initial treatment, patients with spinal cord compression require management in a multi-disciplinary fashion. An important differential diagnosis in spinal emergencies. Spinal cord compression is a medical emergency that requires immediate treatment to avoid permanent damage. Spinal cord compression is caused by a condition that puts pressure on your spinal cord. Contact your doctor straight away if you have any symptoms of spinal cord compression. Physicians must look for “red flags”—key historical and clinical clues that increase the likelihood of a serious underlying disorder. Spinal cord compression (also called cord compression) is a problem that occurs when something, such as a tumour, puts pressure on the spinal cord. In addition, patients with myelopathy and spinal cord compression are likely at increased risk of acute spinal cord injury following trauma. Swenson R. Yim JW, Wagner R, extension may lead to spinal cord compression and cause acute neurological symptoms as well as long-term neurological sequelae with signiﬁcant impact on daily activities and health-related quality of life.1 Early decompression of the spinal cord may prevent irreversible neurological deﬁcits and is a neuro-oncological emergency. A clinical practice improvement project was carried out to review and fine tune the clinical pathway for the acute management of patients with metastatic spinal cord compression. 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