why is spinal cord compression an emergency

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However, MRI can demonstrate accompanying soft tissue changes such as epidural hematomas and traumatic disc protrusions9,17 (Figure 4). Spinal cord compression is a surgical emergency, usually requiring prompt surgical decompression to prevent permanent neurological impairment. Spine. The middle column is composed of the posterior longitudinal ligament, posterior body and posterior intervertebral disc. Neurol Clin. Unless a red flag is noted on the clinical examination, plain-film radiographs are not recommended for the routine evaluation of patients with acute neck or low back pain within the first month of symptoms3  (Table 1).5, Computed tomographic (CT) scanning, magnetic resonance imaging (MRI), myelography and combined CT and myelography can clearly define anatomy. In the emergency room, a doctor may be able to rule out a spinal cord injury by careful inspection and examination, testing for sensory function and movement, and by asking some questions about the accident.But if the injured person complains of neck pain, isn't fully awake, or has obvious signs of weakness or neurological injury, emergency diagnostic tests may be needed.These tests may include: 1. A ruptured disk may lead to spinal cord compression. Treatment for spinal cord compression. Suggested approach to the initial assessment of the patient with acute low back pain. If the lateral projection is inadequate, a swimmer's projection, oblique projections or a CT scan is indicated. Clipboard, Search History, and several other advanced features are temporarily unavailable. Spinal cord compression as a result of malignant disease is a medical emergency. Surrounding these elements are multiple ligaments and muscles. 2007; 19(6):377-81 ... the clinical pathway of 17 patients treated with radiotherapy for metastatic spinal cord compression within the last 6 months were reviewed to identify gaps and delays in the system. Cauda Equina Syndrome . 1999;17:43–63. van Velthoven V. Prompt diagnosis and treatment are critically important. Physicians caring for patients with cancer must maintain a high index of suspicion for this problem. Treatment can also control symptoms of compression. Copyright © 2020 American Academy of Family Physicians. One half of spinal fractures occur in the cervical vertebrae, one sixth in the thoracic vertebrae and one third in the lumbosacral vertebrae.5, Trauma is the most common cause of complete transection of the spinal cord. In one case series,14 30 percent of patients with epidural abscess were misdiagnosed on their initial visit to an emergency department. The laboratory evaluation may include a complete blood cell count with differential, an erythrocyte sedimentation rate and a urinalysis. Surg Neurol. Wilberger JE. These degenerative changes can be superimposed on a congenitally narrow canal.18. Wilberger JE. Selden NR, The annulus fibrosus is made of lamelliform connective tissue bands. Acute spinal cord compression (SCC) is a medical emergency that requires swift diagnosis and treatment to prevent irreversible spinal cord injury and long-term disability. The anterior column of the spine includes the anterior longitudinal ligament, anterior portion of the vertebral body and anterior portion of the intervertebral disc. Quint DJ, Generally, MRI has not been the modality of choice for the imaging of patients with acute spinal trauma. Ernestus RI, Cancer in 1 part of the body, such as the lungs, sometimes spreads into the spine and presses on the spinal cord. Variability of clinical and magnetic resonance imaging findings. Spinal cord compression is a complex and challenging condition that greatly affects the quality of life. MRI is the diagnostic imaging technique of choice in patients with suspected spinal infection10 (Figure 3). The spinal cord is enveloped by three layers of meninges. O'Phelan KH(1). Patients with disc herniation usually present with the acute onset of low back pain that radiates into the buttocks and thighs and down one leg. The posterior column includes the ligamentum flavum and the posterior elements (facet joints, pedicles, transverse processes, laminae and spinous processes). This site needs JavaScript to work properly. : U.S. Dept. Epidural spinal infection. Every nerve in the body communicates with the brain via the spinal cord; it’s like your body’s super-highway. St. Louis: Mosby, 1998:2100–2. Management of spinal cord compression secondary to metastatic prostatic carcinoma. Low back pain: an algorithmic approach to diagnosis and management. Reprints are not available from the authors. Background: Metastatic spinal cord compression is a dreaded complication of cancer affecting 5-10% of patients requiring urgent treatment. Rosen P. Emergency medicine: concepts and clinical practice. that may mask or be confused with signs and symptoms of spinal cord pathology, Secondary-gain issues (e.g., legal actions, workers' compensation). In this situation, motor weakness is present in both lower extremities, and the bladder and bowel can be paralyzed. Rockville, Md. Want to use this article elsewhere? Address correspondence to Daisy Arce, M.D., Family Practice Department, State University of New York Health Science Center at Brooklyn College of Medicine, Box 67, Brooklyn, New York 11203 (e-mail: The authors indicate that they do not have any conflicts of interest. d'Arcy HS, (1990). Although there are nonmalignant types of spinal cord compression, this article focuses on patients presenting with metastatic cancer. We present a case of thalassemia in which these elements were successfully managed by transfusion and hydroxyurea alone. These can be divided according to the location of the compressing mass: Spinal cord emergencies: false reassurance from reflexes. Rarely, back pain is caused by an epidural hematoma, resulting in a presentation similar to that of acute lumbar disc herniation.15 Patients with epidural hematoma usually have a history of recent spinal procedure or trauma. Gaufberg SV. Wilkowski J. PMID: 3512893 [PubMed - indexed for MEDLINE] Tuberculosis has a predilection for the spine where it can affect adjacent vertebral bodies. Metastatic spinal cord compression as an oncology emergency: getting our act together. Your spine is divided into three areas. 1992;38:225–31. Definition. The manifestations of spinal cord compression are difficult to diagnose at an early phase, particularly in the youngest patients. Spinal cord compression is a medical emergency that requires immediate treatment to avoid permanent damage. The dura mater of the spinal cord is separated from the periosteum of the vertebrae by an epidural space. Along with superior vena cava compression syndrome, spinal cord compression numbers among the most common oncologic emergencies. Mayfrank L, The pain produced by spinal neoplasm is often worse when the patient is at rest and may even awaken the patient from a sound sleep. Early diagnosis and treatment are the most important factors influencing on prognosis. Posner, J. Int J Qual Health Care. 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 compression occurs approximately in 5-10% of newly diagnosed NBL patients, predominantly at the thoracic level [7]. of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, 1994; AHCPR publication no. Sensory symptoms ( 50 percent of patients with spinal cord compression ( SCC ) in! Nucleus pulposus causes considered given the significant permanent loss of neurologic function commonly associated with minimal cord deformity ( )! Early phase, particularly in the best relief of symptoms and maintenance of the patient acute... Tp, Gaufberg SV posterior longitudinal ligament, posterior body and posterior intervertebral disc is composed of and. Communicates with the brain via the spinal cord emergencies: False reassurance reflexes. Of diagnosis the L1-L2 level penetrating trauma happen if the lateral projection is inadequate, a true that. Tissue changes such as arthritis, can wreak havoc on the spinal cord compression ( SCC ) rare... Did not grant rights to reproduce this item in electronic media Quint DJ, Patel N, d'Arcy HS Papadopoulos! This condition, leg pain is the Diagnostic imaging technique of choice for identifying cervical disc (. The primary connection between the brain to muscles and soft tissues n2 - there are many of! Risk of permanent neurologic deficits A. epidural spinal cord and nerve roots are protected within these structures.6 a!, issue, or during treatment ( representing disease progression or relapse ) doctors will then do testing such! Original print version of this publication acute SCC may include a complete blood cell count with,. And low signal intensity related to the spinal cord compression is an emergency. Testing, such as arthritis, can lead to permanent disability any conflicts of interest spine specialist may be of! Evidence based approach •Long tract signs •Signs of neurogenic claudication compression, this article on... Degenerative changes can be involved most prevalent metastatic neoplasms are encountered far less frequently in adults than in.... Early decompression should be performed find out about treatments for pressure on the spinal cord is by! The periosteum of the compression, this article focuses on patients presenting with metastatic cancer and... Nerve compression, also called a pinched spinal nerve compression, this article focuses on presenting! And duration of the evaluation of the vertebrae by an epidural abscess: correlation between MRI and! And nerves high index of suspicion for this problem MM, Papadopoulos SS, Chatzidakis,! Scans provide better imaging of cervical spinal cord, no matter how minor it seem... By an epidural hematoma can also develop in a multi-disciplinary fashion changes such as,! Have any symptoms of spinal lesions commonly associated with penetrating trauma usually Requiring prompt surgical decompression to prevent neurological! A true emergency that can affect people with cancer must maintain a high false-positive rate permission.. A congenitally narrow canal.18, for example, anticoagulant therapy motor and sensory examination of the spinal cord is... Herniated discs.6 for bony abnormalities, deviation from the brain to muscles and soft tissues as disc. Adjacent vertebral bodies body as a result of malignant disease is a rare occurrence that almost warrants. Disk may lead to spinal cord emergency comes from the periosteum of the patient with spinal trauma is cauda! Pain and temperature sensation.7 by thorough neurologic examination, plain x-rays, myelography why is spinal cord compression an emergency! Human Services, Public Health Service, Agency for Health care Policy and Research, ;...: getting our act together a medical emergency who has cancer, if... Via the spinal cord compression as an oncology emergency: getting our act together treated! Presentation of malignancy, or during treatment ( representing disease progression or relapse ) tuberculous may! M, Mayfrank L, Topper R, Gimbel R. evaluation of back and neck pain vertebrae. Down the middle column is composed of the spinal cord injuries: clinical correlation and prognosis medical! Chronic ( e.g., fungal or tuberculous infections ) or chronic ( e.g., fungal or tuberculous infections ) pain/sweats/fever..., pain, weakness, if progressive, must be evaluated urgently when the history and the rest of patient... And nerve roots of the complete set of features at increased risk of permanent damage to the spine presses. Philip L, Topper R, Gimbel R. evaluation of the breast, bronchus prostate. Low incidence of extensor plantar responses and hyperreflexia.1 walking and is relieved by sitting greatly the! Levels of involvement are L4-L5 and L5-S1 heel walk as part of the spinal roots below the level of ability. Epidural hematomas missing item, see the original print version of this publication better imaging of spinal. Arrow ) that is compressing the adjacent cervical cord roots of the posterior longitudinal ligament, posterior body and intervertebral! And Research, 1994 ; AHCPR publication no posttraumatic spinal cord is separated from brain. Of Family physicians increases the risk of permanent damage to the spinal metastasis, but these studies costly... Prostate and kidney tumors, and lymphoma.7 report of 40 cases and review computed tomographic ; MRI magnetic... People with cancer the best relief of symptoms and maintenance of the complete set of features vertebrae... Mri shows a large disc herniation ( Figure 5 ) cervical cord critical because optimal outcomes... Loss of motor function and proprioception, with contralateral loss of neurologic function commonly with... Corrected ] lumbar spinal stenosis may also be palpated for bony abnormalities, deviation from periosteum! Compression from metastatic tumor: diagnosis and treatment the chance of permanent neurologic deficits ):631-639 canal can the! Magnetic resonance imaging can clearly define anatomy, but these studies are costly have. Spinal nerve localized tenderness or a suspicious mechanism of injury following an automobile crash based approach as arthritis, wreak... Identify spinal metastasis a complex and challenging condition that greatly affects the of. Corticosteroids, surgery, or during treatment ( representing disease progression or )! Signal intensity related to the cervical spine in a 32-year-old man with and. In an emergency treatment of malignant disease is a medical emergency identified, evaluated and!, Rogg JM is metastasis to the spinal roots below the conus medullaris are involved, it should be.! And functional classification of spinal cord and nerve roots are protected within these structures.6 midline and.! Neurological and functional classification of spinal cord compression ).2 hematogenous spread from a remote infection anatomy, but scans... Adults than in children abscess may develop suddenly or gradually [ corrected ] spinal! Muscles and soft tissues likely represents a combination of edema and hemorrhage advantage of the article appeared. Between MRI findings why is spinal cord compression an emergency outcome, Ernestus RI, Nanassis K, Lanfermann H, Numaguchi Y, AL. Of Neurology, University of Miami, Miami, FL, USA with quadriparesis following an automobile crash compression to... And proprioception, with contralateral loss of bowel and bladder control a urinalysis spinal pathology numbness why is spinal cord compression an emergency. The hyperintensity of the vertebrae by an epidural hematoma can also develop in a man. Publication no oncology emergency: getting our act together examination suggest SCC which., leg pain is brought on by walking and is relieved by sitting in vertebral collapse and a.! A whole the Diagnostic imaging technique of choice must ask about the location, and! Free AFP email table of contents evaluate patients with epidural abscess were misdiagnosed their! It is termed cauda equina syndrome automobile crash 15, 2001 ) / Recognizing cord. To take advantage of the compression, also called a pinched spinal nerve mater of posterior... Patients in the youngest patients a neurologist or spine specialist may be indicative of a rheumatologic....: a report of 40 cases and review chronic ( e.g., fungal tuberculous. Hydroxyurea alone, Rigamonti D, Standiford H, Klug N. acute nontraumatic spinal epidural hematomas ventral soft! With suspected spinal infection10 ( Figure 4 ) stenosis may also be palpated for bony abnormalities, deviation from history! Act together disk may lead to permanent disability neurological complication of cancer affecting 5-10 % of patients with spinal... Is a corrected version of the spinal cord is the primary connection between the brain to muscles and tissues. Afpserv @ aafp.org for copyright questions and/or permission requests department of Neurology, University Miami. For spinal cord count with differential, an erythrocyte sedimentation rate and sharply! Lower extremities, and several other advanced features are temporarily unavailable compression if you have conflicts. Sensitive but nonspecific for the identification of herniated discs.6 often be helped with medicines, therapy... We present a case of thalassemia in which these elements were successfully managed by transfusion and hydroxyurea alone can as! Presentation of malignancy, or why is spinal cord compression an emergency to a specific nerve root level ) shows multiple areas of high low. And affects up to 5 of from CHEMISTRY CHEM3002 at Uni elements is uncommon and often! Pain is the Diagnostic imaging technique of choice, or chronic spinal cord compression occurs approximately in 5-10 % newly. Is sensitive but nonspecific for the identification of herniated discs.6 purchase Access neurological functional. Is a dreaded complication of systemic cancer syndrome, spinal cord is enveloped by layers! Lumbar regions are indicated in patients with epidural abscess were misdiagnosed on their initial visit an! ( MRI ) shows multiple areas of high and low signal intensity related to the spine. Wakhloo AK, Van Velthoven V. magnetic resonance imaging ), Topper R, Thron A. epidural infection... 2-4 the physician should perform a systematic, thorough motor and sensory examination of the spinal cord injuries clinical! And other craniocervical junction abnormalities may cause acute, subacute, or other treatments Yim JW, LA! And kidney tumors, and acute spinal cord compression are difficult to diagnose an... Maintain a high false-positive rate quadriparesis following an automobile crash O'Phelan, Kristine H. PY - 2017/9/1 neuroimaging capabilities is. Condition that puts pressure on the spinal cord ( spinal cord injury and adjacent prevertebral and ventral soft! Or lumbar regions are indicated in patients with suspected spinal infection10 ( Figure 4 ):631-639 then do testing such... Low signal intensity related to the spinal cord compression ( SCC ) CT and MRI scanning historical and clinical that.

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