Malignant Spinal Cord Compression-- Dealing the most common --Mets
Central Cord Compression 11
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Transcript of Central Cord Compression 11
8/3/2019 Central Cord Compression 11
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Central Cord Compression
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What is it?
It is an acute cervical spinal cord injury affecting thecentral spinal cord or grey matter
It is an incomplete spinal cord injury where there is
greater weakness or outright paralysis of the upperextremities, as compared with the lower extremities.
This is due to the fact that the outer (peripheral) areasof the cervical spinal cord are spared, informationgoing to and from the brain and the lower extremitiesis not as severely affected.
It is also commonly known as Central Cord Syndrome(C.C.S).
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Pathology
Typically occurs in older patients with long
standing cervical spondylosis as this reduces
the space in spinal canal and increases risk of
pressure on the cord due to varying factors.
Unlike a complete lesion, that causes loss of
all sensation and movement below the level of
the injury, an incomplete lesion causes only a
partial loss of sensation and movement.
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This syndrome is associated with damage tothe large nerve fibres that carry information
directly from the cerebral cortex to the spinalcord and control hand and arm function.
The overall amount and type of functional lossis dependent upon the severity of nervedamage.
It is generally associated with hyperextensioninjury in older pts hence the spinal cord is
pinched by the ligamentum flavum(posteriorly) or compression by osteophytes(anteriorly).
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Causes
Trauma most commonly resulting fromfalls
Cervical Spondylosis (particularly in olderadults)
In younger individuals, Central CordCompression results from major trauma,
e.g., Cervical Fractures/Subluxations Bleeding into the central part of the cord
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Incidence
In 2007 it was estimated that the annualincidence of Spinal Cord Injury (SCI) wasapproximately 40 per million in the UnitedStates, with over 11 000 new cases each year.
Central Cord Compression is considered tobe the most common SCI, accounting for 9% of
all traumatic SCIs. Affects more men than women with a ratioof 3:1
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Signs and Symptoms
Numbness, weakness or difficulty using your arms or legs
Impairment in the upper extremities is usually greater than in the
lower extremities and is especially prevalent in the muscles of thehand.
Sensory loss is variable, although sacral sensation is usually present.
Anal wink, anal sphincter tone, and Babinski reflexes should be tested.
Muscle stretch reflexes may initially be absent but will eventually
return along with variable degrees of spasticity in affected muscles.
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Pain or tenderness in the middle or top of your back
or neck
Severe pain in your lower back that gets worse or
doesnt go away
Pain in your back that is worse when you cough,
sneeze or go to the toilet
Bladder or bowel difficulties
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Signs on Subjective Assessment
MAIN PROBLEM
- Numbness and tingling in arms and hands
- Sensory loss
24 HOUR PATTERN
- Problems with ADL esp. lifting and carrying things as reduced sensationin arms
- Problems with fine motor control in hands e.g. buttoning shirts
- problems withwalking as muscle weakness in legs
HPC / PMH- trauma esp. In a younger person causing a hyperextension injury
- fall in an older person with a history of spondylosis
MANDATORYQUESTIONS
- will have bladder dysfunction
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Signs on Objective Assessment
May present with one sidedweakness or weakness inthe upper extremitiesgreater than in the lowerextremities noticeable onobservation
Injury noticeable onneurological tests
- muscle power reduced esp.in arms
- sensory loss below site of injury
- reflexes absent below siteof injury
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Prognosis
The patient who receive early treatment, are the oneswho usually recover better.
Walking will improve over time, however patients areusually left with some disability.
Improvement usually starts in the lower limbs, movingnext to the bladder and lastly the upper limbs will start toshow improvement.
A recent study by Lenehana et al. researched the clinicaloutcomes of 50patients with central cord compression. It
showed that patients over the age of 70 tended to have asignificantly poorer clinical outcome than youngerpatients with the same condition.
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Rx.
There is no real cure for central cord compression, nor is therea standard course of treatment, although drug therapy,surgery, physiotherapy treatment and rest are often part of the program.
Magnetic resonance imaging (MRI) is often used to indicatethe degree of spinal cord compression and vertebralinstability. Recent studies suggest that surgery can bebeneficial in individuals with persistent compression of thespinal cord and ongoing neurological deterioration. However
the need for surgical treatment has to be individualised. If you become aware of signs of central cord compression
refer on for orthopaedic/neurology appointment, if caudasigns then treat as an emergency
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