SPINAL CORD COMPRESSION
Spinal cord compression develops when the spinal cord is compressed by
bone fragments from a vertebral fracture, a tumor, abscess, ruptured
intervertebral disc or other lesion.
It is regarded as a medical emergency independent of its cause, and
requires swift diagnosis and treatment to prevent long-term disability due to
irreversible spinal cord injury.
CLINICAL
MANIFESTATION:
Symptoms suggestive of cord
compression are :
·
Back
pain,
·
A
dermatome of increased sensation,
·
Paralysis
of limbs below the level of compression,
·
Decreased
sensation below the level of compression.
·
Lhermitte’s
sign (Intermittent shooting electrical sensation) and hyperreflexia may be present.
DIAGNOSIS:
Diagnosis is by X-rays but
preferably magnetic resonance imaging (MRI) and myelography.
TREATMENT
AND PROGNOSIS:
Dexamethasone ( a potent glucocorticoid) in doses of 16 mg/ day may
reduce edema around the lesion and protect the cord from injury. It may be
given orally or intravenously for this indication.
Surgery is indicated in localised compression as long as there is some
hope of regaining function. It is also occasionally indicated in patient with
little hope of regaining function but with uncontrolled pain. Postoperative
radiation is delivered within 2-3 weeks of surgical decompression. Emergency
radiation therapy (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 and may be treated with chemotherapy alone.
Once complete paralysis has been present for more than about 24 hours
before treatment, the chance 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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