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Spinal cord compression

 

 
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Spinal cord compression
 
 
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Spinal cord compression develops when the spinal cord
Spinal cord

The spinal cord is a long, thin, tubular bundle of neuron and glia that extends from the brain. The brain and spinal cord together make up the central nervous system....
 is compressed by bone fragments from a vertebral fracture, a tumor
Tumor

A tumor or tumour is the name for a swelling or lesion formed by an abnormal growth of cells . Tumor is not synonymous with cancer. A tumor can be Benign neoplasm, Carcinoma in situ or malignant, whereas cancer is by definition malignant....
, abscess
Abscess

An abscess is a collection of pus that has accumulated in a cavity formed by the tissue on the basis of an infection process or other foreign materials ....
, ruptured intervertebral disc
Intervertebral disc

Intervertebral discs lie between adjacent vertebra in the vertebral column. Each disc forms a cartilaginous joint to allow slight movement of the vertebrae, and acts as a ligament to hold the vertebrae together....
 or other lesion. It is regarded as a medical emergency
Medical emergency

A medical emergency is an injury or illness that is Acute and poses an immediate risk to a person's life or long term health. These emergencies may require assistance from another person, who should ideally be suitably qualified to do so, although some of these emergencies can be dealt with by the victim themselves....
 independent of its cause, and requires swift diagnosis
Diagnosis

Diagnosis is the identification of the nature of anything, either by process of elimination or other analytical methods. Diagnosis is used in many different disciplines, with slightly different implementations on the application of logic and experience to determine the cause and effect relationships....
 and treatment to prevent long-term disability due to irreversible spinal cord injury
Spinal cord injury

Spinal cord injury causes myelopathy or damage to white matter or myelinated fiber tracts that carry sensation and motor signals to and from the brain....
.

toms suggestive of cord compression are back pain
Back pain

Back pain is pain felt in the Human back that usually originates from the muscles, nerves, bones, joints or other structures in the Vertebral column....
, a dermatome
Dermatome

Dermatome may refer to:*Dermatome , a surgical instrument used to produce thin slices of skin*Dermatome , an area of skin that is supplied by a single pair of dorsal roots...
 of increased sensation, paralysis
Paralysis

Paralysis is the complete loss of muscle function for one or more muscle groups. Paralysis can cause loss of feeling or loss of mobility in the affected area....
 of limbs below the level of compression, decreased sensation below the level of compression, urinary
Urinary incontinence

Urinary incontinence is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life....
 and fecal incontinence
Fecal incontinence

Fecal incontinence is the loss of regular control of the bowels. Involuntary excretion and leaking are common occurrences for those affected.Subjects relating to defecation are often socially unacceptable, thus those affected are often beset by feelings of shame and humiliation....
 and/or urinary retention
Urinary retention

Urinary retention also known as ischuria is a lack of ability to urinate. It is a common complication of Benign prostatic hyperplasia , although anticholinergics may also play a role, and requires a catheter or Prostatic stent....
.






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Spinal cord compression develops when the spinal cord
Spinal cord

The spinal cord is a long, thin, tubular bundle of neuron and glia that extends from the brain. The brain and spinal cord together make up the central nervous system....
 is compressed by bone fragments from a vertebral fracture, a tumor
Tumor

A tumor or tumour is the name for a swelling or lesion formed by an abnormal growth of cells . Tumor is not synonymous with cancer. A tumor can be Benign neoplasm, Carcinoma in situ or malignant, whereas cancer is by definition malignant....
, abscess
Abscess

An abscess is a collection of pus that has accumulated in a cavity formed by the tissue on the basis of an infection process or other foreign materials ....
, ruptured intervertebral disc
Intervertebral disc

Intervertebral discs lie between adjacent vertebra in the vertebral column. Each disc forms a cartilaginous joint to allow slight movement of the vertebrae, and acts as a ligament to hold the vertebrae together....
 or other lesion. It is regarded as a medical emergency
Medical emergency

A medical emergency is an injury or illness that is Acute and poses an immediate risk to a person's life or long term health. These emergencies may require assistance from another person, who should ideally be suitably qualified to do so, although some of these emergencies can be dealt with by the victim themselves....
 independent of its cause, and requires swift diagnosis
Diagnosis

Diagnosis is the identification of the nature of anything, either by process of elimination or other analytical methods. Diagnosis is used in many different disciplines, with slightly different implementations on the application of logic and experience to determine the cause and effect relationships....
 and treatment to prevent long-term disability due to irreversible spinal cord injury
Spinal cord injury

Spinal cord injury causes myelopathy or damage to white matter or myelinated fiber tracts that carry sensation and motor signals to and from the brain....
.

Symptoms

Symptoms suggestive of cord compression are back pain
Back pain

Back pain is pain felt in the Human back that usually originates from the muscles, nerves, bones, joints or other structures in the Vertebral column....
, a dermatome
Dermatome

Dermatome may refer to:*Dermatome , a surgical instrument used to produce thin slices of skin*Dermatome , an area of skin that is supplied by a single pair of dorsal roots...
 of increased sensation, paralysis
Paralysis

Paralysis is the complete loss of muscle function for one or more muscle groups. Paralysis can cause loss of feeling or loss of mobility in the affected area....
 of limbs below the level of compression, decreased sensation below the level of compression, urinary
Urinary incontinence

Urinary incontinence is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life....
 and fecal incontinence
Fecal incontinence

Fecal incontinence is the loss of regular control of the bowels. Involuntary excretion and leaking are common occurrences for those affected.Subjects relating to defecation are often socially unacceptable, thus those affected are often beset by feelings of shame and humiliation....
 and/or urinary retention
Urinary retention

Urinary retention also known as ischuria is a lack of ability to urinate. It is a common complication of Benign prostatic hyperplasia , although anticholinergics may also play a role, and requires a catheter or Prostatic stent....
. Lhermitte's sign
Lhermitte's sign

Lhermitte's Sign, sometimes called the Barber Chair phenomenon, is an electrical sensation that runs down the back and into the limbs, and is produced by bending the neck forward....
 (intermittent shooting electrical sensation) and hyperreflexia
Hyperreflexia

Hyperreflexia is defined as overactive or overresponsive reflexes. Examples of this can include Muscle contraction or spastic tendencies, which are indicative of upper motor neuron disease as well as the lessening or loss of control ordinarily exerted by higher brain centers of lower neural pathways ....
 may be present.

Diagnosis

Diagnosis is by X-ray
X-ray

X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 10 to 0.01 nanometers, corresponding to frequency in the range 30 Hertz to 30 Hertz and energies in the range 120 Electron volt to 120 keV....
s but preferably magnetic resonance imaging
Magnetic resonance imaging

GaneshMagnetic resonance imaging , or nuclear magnetic resonance imaging , is primarily a medical imaging technique most commonly used in radiology to visualize the structure and function of the body....
 (MRI) of the whole spine. The most common causes of cord compression are tumors, but abscess
Abscess

An abscess is a collection of pus that has accumulated in a cavity formed by the tissue on the basis of an infection process or other foreign materials ....
es and granuloma
Granuloma

A granuloma is a medical term for a ball-like collection of immune cells trying to destroy a foreign substance. It represents a special type of inflammatory reaction common to a wide variety of diseases, both infectious and non-infectious....
s (e.g. in tuberculosis
Tuberculosis

Tuberculosis is a common and often deadly infectious disease caused by mycobacterium, mainly Mycobacterium tuberculosis . Tuberculosis usually attacks the lungs but can also affect the central nervous system, the lymphatic system, the circulatory system, the genitourinary system, the gastrointestinal system, bones, joints, and even the...
) are equally capable of producing the syndrome. Tumors that commonly cause cord compression are lung cancer
Lung cancer

Lung cancer is a disease of uncontrolled cell growth in tissue of the lung. This growth may lead to metastasis, which is the invasion of adjacent tissue and infiltration beyond the lungs....
 (non-small cell type), breast cancer
Breast cancer

Breast cancer is a cancer that starts in the Cell of the breast in women and men. Worldwide, breast cancer is the second most common type of cancer after lung cancer and the fifth most common cause of cancer death....
, prostate cancer
Prostate cancer

Prostate cancer is a disease in which cancer develops in the prostate, a gland in the male reproductive system. It occurs when cell s of the prostate Mutation and begin to multiply out of control....
, renal cell carcinoma
Renal cell carcinoma

Renal cell carcinoma is a kidney cancer that originates in the lining of the proximal renal tubule, the very small tubes in the kidney that filter the blood and remove waste products....
, thyroid cancer
Thyroid cancer

Thyroid cancer refers to any of four kinds of cancer tumors of the thyroid gland: papillary thyroid cancer, follicular thyroid cancer, medullary thyroid cancer or anaplastic thyroid cancer....
, lymphoma
Lymphoma

Lymphoma is a type of cancer that originates in lymphocytes of the immune system. They often originate in lymph nodes, presenting as an enlargement of the node ....
 and multiple myeloma
Multiple myeloma

Multiple myeloma is a cancer of plasma cells. These immune system cells are formed in bone marrow, are numerous in lymphatics and produce antibody....
.

Treatment and prognosis

Dexamethasone
Dexamethasone

Dexamethasone is a potent synthetic member of the glucocorticoid class of steroid hormones. It acts as an anti-inflammatory and immunosuppressive drug....
 (a potent glucocorticoid
Glucocorticoid

Glucocorticoids are a class of steroid hormones which bind to the glucocorticoid receptor , which is present in almost every animal cell.GCs are part of the feedback mechanism in the immune system which turns immune activity down....
) in doses of 16 mg/day may reduce edema
Edema

File:Oedema.jpgEdema or Oedema , formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin, or in one or more cavities of the body....
 around the lesion and protect the cord from injury. It may be given orally
Mouth

The mouth, buccal cavity, or oral cavity is the first portion of the alimentary canal that receives food and begins digestion by mechanically breaking up the solid food particles into smaller pieces and mixing them with saliva....
 or intravenously for this indication.

Surgery
Surgery

Surgery is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, to help improve bodily function or appearance, or sometimes for some other reason....
 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. Postoperative radiation is delivered within 2-3 weeks of surgical decompression. Emergency radiation therapy
Radiation therapy

Radiation therapy is the medicine use of ionizing radiation as part of cancer oncology to control malignant cell s . Radiotherapy may be used for curative or Adjuvant chemotherapy cancer treatment....
 (usually 20 Gray in 5 fractions or 30Gy in 10 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.

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.

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