Epidural compression syndromes: Difference between revisions
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==Management== | ==Management== | ||
#[[Dexamethasone]]: at least 16 mg IV as soon as possible after assessment<ref>Metastatic spinal cord compression: Diagnosis and management of | |||
patients at risk of or with metastatic spinal cord compression. Full Guideline. November 2008. Developed for NICE by the National Collaborating Centre for Cancer. ©2008 National Collaborating Centre for Cancer</ref> | patients at risk of or with metastatic spinal cord compression. Full Guideline. November 2008. Developed for NICE by the National Collaborating Centre for Cancer. ©2008 National Collaborating Centre for Cancer</ref> | ||
#Consider foley for bladder decompression | |||
#Radiation therapy (if due to neoplasm) | |||
#Consult spine service (neurosurgery or ortho; institution dependent) | |||
==See Also== | ==See Also== | ||
Revision as of 03:22, 7 April 2015
Background
- Includes spinal cord compression, cauda equina syndrome, conus medullaris syndrome
- Presentation and initial management are similar; difference is level of neuro deficit
- The cauda equina (Latin for "horse's tail") begins at the 2nd Lumbar space extending down to the beginning of the sacral nerves. It is distal to the tapered end of the spinal cord, or conus medularis.[1]
Etiology
- Epidural abscess
- Malignancy
- Massive mid-line disk herniation
- Spinal canal hemorrhage
Clinical Features
- Back pain with neuro deficits
- Weakness in lower extremities, paresthesias/sensory deficits, gait difficultly
- Deficits usually affect both legs but are often asymmetric
- Bladder and rectal sphincter paralysis usually reflect involvement of S3-S5 nerve roots
- Conus medullaris syndrome
- Lesions at vertebral level L2
- early and prominent sphincter dysfunction with flaccid paralysis of the bladder and rectum, impotence, and saddle (S3-S5) anesthesia
- Cauda equina syndrome
- Low Back Pain
- Urinary retention with or without overflow incontinence (Sn 90%, Sp 95%)
- Rectal incontinence
- Bilateral sciatica
- Saddle anesthesia (75% pts)
- Decreased anal sphincter tone (60-80% pts)
- Difficulty ambulating and/or wew foot-drop
- Symptoms worsened by coughing (increases intraspinal pressure)
Differential Diagnosis
Lower Back Pain
- Spine related
- Acute ligamentous injury
- Acute muscle strain
- Disk herniation (Sciatica)
- Degenerative joint disease
- Spondylolithesis
- Epidural compression syndromes
- Thoracic and lumbar fractures and dislocations
- Cancer metastasis
- Spinal stenosis
- Transverse myelitis
- Vertebral osteomyelitis
- Ankylosing spondylitis
- Spondylolisthesis
- Discitis
- Spinal Infarct
- Renal disease
- Intra-abdominal
- Abdominal aortic aneurysm
- Ulcer perforation
- Retrocecal appendicitis
- Large bowel obstruction
- Pancreatitis
- Pelvic disease
- Other
Spinal Cord Syndromes
- Complete spinal cord transection syndrome
- Anterior cord syndrome
- Central cord syndrome
- Brown-Séquard syndrome
- Epidural compression syndromes
Diagnosis
- Emergent MRI
- If considering compression due to neoplasm obtain scan of entire spine
- Consider Bladder scan/ultrasound for bladder volume
Management
- Dexamethasone: at least 16 mg IV as soon as possible after assessment[2]
- Consider foley for bladder decompression
- Radiation therapy (if due to neoplasm)
- Consult spine service (neurosurgery or ortho; institution dependent)
See Also
References
- ↑ Cohen MS, Wall EJ, Kerber CW, et al. The Anatomy of the Cauda Equina on CT Scans and MRI. J Bone Joint Surg Br 1991; 73 (3): 381-84.
- ↑ Metastatic spinal cord compression: Diagnosis and management of patients at risk of or with metastatic spinal cord compression. Full Guideline. November 2008. Developed for NICE by the National Collaborating Centre for Cancer. ©2008 National Collaborating Centre for Cancer