1- Highlights:
* Spinal cord compression is a neurosurgical emergency
* Absence of neurological signs supralésionnels
* There is a syndrome in spinal vertebral causes
* The lesion syndrome often precedes sub-lesional syndrome; must make the diagnosis at this stage
* Sign of the Bell: provocation of sciatic pain by pressing in the paraspinal region next disc (slipped disc).
* Brown-Sequard syndrome is pathognomonic for spinal cord injury.
* An earlier compression mainly provides motor disorders and can mimic an array of ALS.
* The study of CSF often shows albuminocytologique dissociation (increased CSF protein without hypercytose).
* Lhermitte sign: electric shock sensation browsing the spine and lower limbs during neck flexion (MS, combined degeneration of the cord; CM).
* The vertebral fracture osteoporosis respect the posterior vertebral wall and gives no spinal cord compression.
* In intramedullary causes, there is an infringement of dissociated sensitivity (damage of thermo-algesic sensitivity only) and suspended topography.
* In intramedullary causes, there is no spinal and radicular syndrome-lar.
2- Etiology:
A- brutal spinal cord compression:
* Spinal epidural hematoma
* Herniated disc: Cervical most often (syn-drome of the lumbar QDC).
* Collapsed vertebra: vertebra metastatic, myeloma or spondylitis. -> + Spinal radicular syndrome syndrome
B- slow medullary compression:
* Causes intradural extramedullary:
– Neuroma (man of 40; hourglass tumor recreated)
– Meningioma (woman after 40 years; sub-lesional syndrome predominates (syndrome Brown Sequard)
* Causes intramedullary:
– Tumours: ependymoma; astrocytoma; hemangioblastoma (Hippel-Lindau) metastasis
– Angioma marrow.
* Other causes:
– Narrow spinal canal (osteoarthritis)
– Medullary vascular malformation
3- Clinic:
A- lesional syndrome:
– Very important locator Value
– Radicular topography of Pain:
* Augmented by effort
* Uni or bilateral
* Night Paroxysm
– With hypothyroidism or anesthesia for all modes in the same territory
– Motor disorders: radi-lar peripheral paralysis and muscular atrophy with corresponding abolition of tendon reflexes.
B- Syndrome sub-lesional:
– Motor disorders:
* Driving force (painless claudication -> spastic paraparesis).
* ROT alive the lower limbs
* Cutaneous abdominal reflexes abolished and Babinski sign
* Reflex defense with triple removal of the lower limbs in advanced forms.
– Sensation Disorders: subjective (pain, paresthesia); targets (tactile sensibility, proprioception, and / or thermo-algesic)
– Sphincter disorders: urinary urgency and urinary frequency and urinary retention and overflow incontinence or incontinence.
C- spinal syndrome:
– Spinal stiffness
– Spontaneous spinal pain or caused by tapping thorns
– It is especially clear in cases vertebral
4- Topography:
A- Cervical high (C1-C4):
quadriplegia; occipital neuralgia (C1-C2); phrenic reached (C3-C4): diaphragm paralysis or hiccups; achievement of XI (SCM, trapezius); trap reached the thermoalgique sensitivity of the face (descending root of the V which stops at C2).
B- Cervical low (C5-D1):
radicular syndrome in the upper limbs (trigeminal cervicobachiale) and paraplegia
C- Dorsal:
thoraco-abdominal pain associated with a waist band anesthesia (D4: nipple D6: xiphoïde; D10: umbilicus);paraplegia.
D- Lumbosacral:
Paralysis of the quadriceps; abolished patellar; achilles alive; bilateral Babinski; sphincter disorders
E- Cone terminal:
Lesional syndrome is projected lower limbs can hide the central characters (value Babinski sign); severe sphincter disorders; reaching the L1 (psoas paralysis and sensory disturbances of the groin fold); abolition of the abdominal cutaneous reflexes and lower cremasteric reflex.
F- posterior compression:
Lesion predominantly posterior cordonale (proprioceptive ataxia) + Lhermitte’s sign
G- Side Compression:
Hémimoelle syndrome (Brown Sequard): pyramidal syndrome and cordonal rear on the same side of the cord and spinothalamic syndrome opposite side of the compression.
4- Differential Diagnosis:
– Before any medullary syndrome, eliminate spinal compression before discussing: transverse myelitis, September 1, ALS …;
A- September with medullary form:
Notions of outbreaks; values of cerebral hyperintensities on MRI T2; HyperGamma-globulinorrachie oligoclonal
B- amyotrophic lateral sclerosis:
Achievement of 2 motor neurons (sup and inf); absence of sensory disorders; importance of fasciculation; Possible bulbar signs.
C- Syringomyelia:
intramedullary cavity; dissociated sensory disturbances (thermal algesic) and dissociated; hypointense on T1
D- sclerosis combined marrow:
Associates a pyramidal syndrome and posterior cord syndrome. Imaging is normal; pernicious anemia
E- Syndrome-tail horse:
Sensorimotor impairment of lower limb peripheral type; importance of sphincter disorders; abolition of the Achilles and patellar reflexes.
F- Meningiomas of falx:
Can give a spastic paraparesis compression of 2 central lobules +++
Syndrome-tail horse:
– It is a violation of roots L2 to S5, responsible for motor and sensory innervation of the lower limbs, perineum and external genitalia and the sphincter control.
– The terminal cone of the cord ends at the lower edge of the L1 vertebra.
– It is a lesion syndrome pluriradiculaire.
– The diagnosis is clinical but additional tests are needed to etiological research (IRM +++)
– Lower back pain radiating to the legs with a plain topography or pluriradiculaire and may be unilateral or bilateral.
– Motor deficit from simple fatigue to walk to the peripheral flange type lower limb paralysis with hypotonia and atrophy
– Abolition of tendon ankle reflexes in the reach of the S1 root; patella (L4 root) and anal reflex (S3 root).
– Sensation Disorders of the perineal area (saddle anesthesia), EMB and sometimes the buttocks and legs.
– Genitourinary sphincter disorders early and constant. urinary incontinence and retention in the beginning and overflow incontinence; incapacity ; anal incontinence and constipation early.
– Negative signs: absence of central or spinal signs (no Babinski, cutaneous abdominal reflexes preserved,
– Differential diagnosis: cone reaching the terminal:
* Achievement of the iliopsoas (flexion of the thigh on the pelvis)
* Sensation Disorders in the groin folds
* Pyramidal signs (Babinski sign)
– Etiology: disc herniation (neurosurgical emergency); spinal stenosis; spinal hematoma ear or subdural
