Spinal Cord Syndrome

Aka: Spinal Cord Syndrome, Epidural Spinal Cord Compression, Acute Spinal Cord Compression, Spinal Cord Compression

II. Symptoms

  1. Acute neck or back pain
  2. Extremity weakness or paralysis
  3. Sensory deficits with broader distribution than individual Dermatomes
  4. Changes in bowel or Bladder function (e.g. acute urinary or stool retention or Incontinence)

III. History

  1. Acute Spinal Trauma
    1. Cervical Spine Injury is most common level of cord injury
  2. Epidural Neoplasm
    1. Thoracic Spine involvement is more common
    2. Review malignancy risk factors
  3. Epidural Abscess Risks
    1. Thoracic Spine involvement is more common
    2. Fever
    3. Immunosuppression
    4. Intravenous Drug Abuse
  4. Spinal Epidural Hematoma Risks
    1. Anticoagulation
    2. Spinal Procedures (e.g. spine surgery)

IV. Exam: Distinguishing Upper from Lower Motor Neuron Injury

  1. Upper Motor Neuron Lesion (lesion proximal to the spinal cord anterior horn cells)
    1. Hyperreflexia
    2. Clonus
    3. Motor Spasticity
    4. Increased muscle tone
    5. Babinski Sign positive
    6. Muscles without atrophy (normal muscle mass)
  2. Lower Motor Neuron Lesion (lesion distal to the spinal cord anterior horn cells)
    1. Motor Weakness to Flaccid Paralysis
    2. Muscle Atrophy
    3. Muscle Fasciculations
    4. Deep Tendon Reflexes decreased or lost

V. Types: Spinal Cord Syndrome

  1. Trauma - Complete transection of the spinal cord
    1. Complete Cord Syndrome
  2. Trauma - Partial spinal cord injuries
    1. Anterior Cord Syndrome
    2. Central Cord Syndrome
    3. Spinal Cord Hemisection (Brown-Sequard Syndrome, rare)
    4. Neuropraxia (Stinger, Burner)
  3. Other cord syndromes
    1. Spinal Shock
    2. Cauda Equina Syndrome
    3. Conus Medullaris Syndrome
      1. Similar to Cauda Equina, but with compression at L1-L2 and sensory deficits at Lumbosacral Spine
  4. Images
    1. CordSyndrome.jpg

VI. Causes

  1. Traumatic Spinal Injury
  2. Epidural Neoplasm
  3. Spinal Epidural Abscess
  4. Spinal Epidural Hematoma

VII. Differential Diagnosis

  1. See Peripheral Neuropathy
  2. See Cervical Spinal Stenosis
  3. See Lumbar Spinal Stenosis
  4. See Claudication

VIII. Imaging

  1. CT Spine
    1. First-Line study in Spine Trauma
  2. MRI Spine
    1. Indicated in suspected Epidural Neoplasm, Spinal Epidural Abscess, Epidural Abscess or cord syndrome

IX. Management

  1. See Spinal Trauma
  2. See Epidural Neoplasm
  3. See Spinal Epidural Abscess
  4. See Spinal Epidural Hematoma

X. References

  1. Dasburg (2020) Crit Dec Emerg Med 34(6): 28-9
  2. Decker in Chorley and Bachur (2014) Overview of Cervical Spinal Cord Injuries..., UpToDate, Wolters-Kluwer
  3. Wagner (1997) Emerg Med Clin North Am 15:699-711 [PubMed]

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Related Studies

Ontology: Compression of spinal cord (C0037926)

Definition (MSHCZE) Soubor příznaků rozvíjejících se při útlaku míchy z různých příčin (nádory, traumata, aj.), nejč. příčinou je však mediální nebo paramediální protruze a herniace ploténky krční páteře. Komprese míchy je přímá a též v důsledku alterace krevního oběhu postižené oblasti. Při alteraci kortikospinálních drah se rozvíjí slabá centrální paraparéza dolních končetin, při lézi předních rohů míšních dojde k periferní obrně příslušných svalových skupin horních končetin. V klinickém obraze často dominují vegetativní a vazomotorické poruchy (např. edémy akrálních částí končetin s lividním zabarvením kůže). Prognóza a průběh závisejí na vyvolávající příčině. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (MSH) Acute and chronic conditions characterized by external mechanical compression of the SPINAL CORD due to extramedullary neoplasm; EPIDURAL ABSCESS; SPINAL FRACTURES; bony deformities of the vertebral bodies; and other conditions. Clinical manifestations vary with the anatomic site of the lesion and may include localized pain, weakness, sensory loss, incontinence, and impotence.
Concepts Disease or Syndrome (T047)
MSH D013117
ICD10 G95.2 , G95.20
SnomedCT 71286001, 282807009, 192913003, 193080004, 230140007, 230141006
English Compressions, Spinal Cord, Spinal Cord Compression, Spinal Cord Compressions, Compression, Spinal Cord, SPINAL CORD COMPRESSION, Cord compression, Spinal cord compression NOS, Cord compression, unspecified, Compression of spinal cord, Cord compression, NOS, spinal cord compression (diagnosis), spinal cord compression, Extramedullary Spinal Cord Compression, Spinal Cord Compression, Extramedullary, Compressive Myelopathy, Myelopathy, Compressive, Unspecified cord compression, Spinal Cord Compression [Disease/Finding], cord compression, Compression;spinal cord, spinal cord compressions, compression spinal cord, compressive myelopathy, compression cord spinal, compression of spinal cord, (Cord compression) or (spinal cord compression) (disorder), Spinal cord compression NOS (disorder), Cord compression NOS (disorder), (Cord compression) or (spinal cord compression), Spinal cord compression, SCC - Spinal cord compression, Spinal cord compression (disorder), compression; spinal cord, spinal cord; compression, Spinal cord compression, NOS, Cord compression NOS
French COMPRESSION MOELLE EPINIERE, Compression de la moelle épinière SAI, Compression de la moelle épinière, Compression de la moëlle épinière, Compression médullaire, Syndrome de compression médullaire
Dutch ruggenmergcompressie NAO, compressie; ruggenmerg, ruggenmerg; compressie, Compressie van ruggenmerg, niet gespecificeerd, ruggenmerg compressie, Compressie, ruggenmerg-, Myelopathie, compressieve, Ruggenmergcompressie
German Rueckenmarkskompression NNB, Rueckenmarkkompression, nicht naeher bezeichnet, Rueckenmarkskompression, Myelopathie, kompressive, Kompression, Rückenmark-, Rückenmarkkompression
Italian Compressione del midollo spinale NAS, Compressione del midollo spinale da causa extramidollare, Mielopatia compressiva, Compressione del midollo spinale
Portuguese Compressão da medula spinal NE, Compressão da Medula Espinal, COMPRESSAO MEDULAR, Compressão da Medula Espinhal, Compressão da espinal-medula, Mielopatia Compressiva
Spanish Compresión de la médula espinal NEOM, compresión medular, SAI (trastorno), compresión medular, SAI, compresión de la médula espinal, SAI, compresión de la médula espinal, SAI (trastorno), compresión de la médula espinal (trastorno), compresión de la médula espinal, Compresión de la médula espinal, Compresión de la Médula Espinal, Mielopatía Compresiva
Japanese 脊髄圧迫ＮＯＳ, ｾｷｽﾞｲｱｯﾊﾟｸ, ｾｷｽﾞｲｱｯﾊﾟｸNOS, 脊髄圧迫
Swedish Ryggmärgskompression
Finnish Selkäytimen puristustila
Russian MOZGA SPINNOGO SDAVLENIE, МОЗГА СПИННОГО СДАВЛЕНИЕ
Czech Komprese míchy NOS, Komprese míchy, kompresivní myelopatie, komprese míchy, mícha - komprese, syndrom komprese míchy
Korean 상세불명의 척수압박
Polish Ucisk rdzenia kręgowego, Ciasnota kanału kręgowego
Hungarian Gerincvelő compressio k.m.n., Gerincvelő compressio
Norwegian Kompresjonsmyelopati, Ryggmargskompresjon, Ekstramedullær ryggmargskompresjon
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Spinal cord syndrome (C0560648)

Concepts Injury or Poisoning (T037)
SnomedCT 282784007
English spinal cord syndrome, cord spinal syndrome, cord spinal syndromes, Spinal cord syndrome, spinal cord syndrome (diagnosis), Spinal cord syndrome (disorder)
Spanish síndrome de médula espinal (trastorno), síndrome de médula espinal
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Cervical Spine Disorders

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