Epidural compression syndromes

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Background

  • Includes spinal cord compression, cauda equina syndrome, conus medullaris syndrome
    • Presentation and initial management are similar; difference is level of neuro deficit

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
  • Cauda equina syndrome
    • Urinary retention with or without overflow incontinence (Sn 90%, Sp 95%)
    • Rectal incontinence
    • Bilateral sciatica
    • Saddle anesthesia
    • Decreased anal sphincter tone (60-80% pts)

Management

  • Dexamethasone 10mg IV (give before obtaining any confirmatory tests)
  • MRI
    • If considering compression due to neoplasm obtain scan of entire spine

Source

  • Tintinalli
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