Spinal Cord COMPRESSION/PARAPLEGIA

Clinical Description

• Lower limbs weakness

Signs and Symptoms

• Deep, local spinal pain
• Stabbing, radicular pain in a dermatomal distribution and LMN weakness at lesion level
• Progressive UMN weakness and sensory loss below lesion
• Bladder hesitancy, frequency → painless retention
• Faecal incontinence or constipation
• Look for motor, reflex and sensory level
• Shooting, radicular pain at level, anaesthesia below
• LMN signs at level, UMN signs below level
• Tone and reflexes are usually reduced in acute cord compression

Causes

Compressive

• Spinal cord tuberculosis (Pott‘s disease)
• Spinal cord metastases and neoplasms
• Degenerative spinal disease (e.g. slipped disc)
• Schistosomiasis
• Bacterial abscesses

Non-Compressive

• Autoimmune transverse myelitis
• HIV-associated vacuolar myelopathy
• Neuroschistosomiasis
• Neurocysticercosis
• Syphilis (meningomyelitis, meningovascular myelitis, Tabes dorsalis)
• Vitamin B12 deficiency (subacute combined cord degeneration)
• Viral (Herpes, Varicella)

Investigations

• HIV test, VDRL (Syphilis test), FBC, Blood sugar, ESR (erythrocyte sedimentation rate), Ova of Schistosoma in urine and stool; If available, serology
• X-ray: spine (level depending on clinical findings) and chest (signs of TB?)
• Ultrasound abdomen (signs of TB?), Lumbar Puncture
• CT-guided percutaneous vertebral or paravertebral biopsy and aspiration would be the gold standard for spinal TB, Neuroimaging: MRI (level depending on clinical findings)
• MRI is definitive modality
• CXR for primaries

Treatment

This is a neurosurgical emergency