![]() Acute compression of the cauda equina by lesions in the lumbar spine causes flaccid paraparesis and early incontinence, findings that are similar to those in patients with the syndrome of spinal shock. The spinal cord ends near the L1–L2 level, where it transitions to spinal roots that make up the cauda equina. Variations and partial presentations of the typical syndromes are common ( Table 1). Localized back or neck pain is an additional characteristic of most acute types of cord compression. ![]() The limbs may instead be flaccid and areflexic, accompanied by systemic hypotension - a combination of findings that constitutes the syndrome of spinal shock. Hyperreflexia and Babinski signs, which are characteristic of intrinsic diseases of the spinal cord, may not be evident in cases of acute and severe cord compression, particularly if the cause is trauma. The cardinal features of acute spinal cord compression are relatively symmetric paralysis of the limbs, urinary retention or incontinence, and a circumferential boundary below which there is loss of sensation, referred to as the “ sensory level” (see the interactive graphic, available with the full text of this article at ). Clinical Syndromes of Acute Spinal Cord Compression. Clinical Features of Acute Spinal Cord Compression Instability that poses a risk of cord damage generally requires surgical fixation of the spine, and bony fusion of adjacent vertebrae ( spinal fusion) may be necessary for durable stabilization. This biomechanical concept is essential to an understanding of cord compression, because spinal instability (see the Glossary) permits subluxation of vertebrae ( spondylolisthesis), which narrows the spinal canal. Stability is defined by the retention of normal spinal alignment under physiologic conditions (loads) such as standing, walking, bending, or lifting. The disorders discussed here also damage vertebrae, intervertebral disks, ligaments, and facet joints, leading to instability of the spinal column. Cord compression in patients with cancer is generally due to metastasis to the spinal column, cord compression in patients with sepsis or in patients who are intravenous drug users suggests epidural abscess, and cord compression associated with anticoagulant therapy, antiplatelet therapy, or coagulopathy is likely to be caused by epidural hematoma. Traumatic cord compression is often self-evident. The medical context of spinal cord compression determines the diagnosis and directs treatment. The pathophysiological features and management of these disorders are similar to those of other acute and serious spinal conditions. This review addresses the disorders that account for most instances of acute spinal cord compression: trauma, tumor, epidural abscess, and epidural hematoma. Diseases that cause acute spinal cord compression constitute a special category because they originate in the spinal column and narrow the spinal canal. Neoplastic Epidural Spinal Cord CompressionĪcute compression of the spinal cord is a devastating but treatable disorder. The most trusted, influential source of new medical knowledge and clinical best practices in the world. Information and tools for librarians about site license offerings. ![]() Valuable tools for building a rewarding career in health care. The authorized source of trusted medical research and education for the Chinese-language medical community. The most advanced way to teach, practice, and assess clinical reasoning skills. Information, resources, and support needed to approach rotations - and life as a resident. The most effective and engaging way for clinicians to learn, improve their practice, and prepare for board exams. NEW! Peer-reviewed journal featuring in-depth articles to accelerate the transformation of health care delivery.Ĭoncise summaries and expert physician commentary that busy clinicians need to enhance patient care. NEW! A digital journal for innovative original research and fresh, bold ideas in clinical trial design and clinical decision-making.
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