Spinal cord disorders can be devastating, but many are treatable if recognized early ( Table 200-1). Knowledge of relevant spinal cord anatomy is often the key to correct diagnosis (Fig. 200-1).
TABLE 200-1TREATABLE SPINAL CORD DISORDERS |Favorite Table|Download (.pdf) TABLE 200-1TREATABLE SPINAL CORD DISORDERS
|Epidural, intradural, or intramedullary neoplasm |
|Epidural abscess |
|Epidural hemorrhage |
|Cervical spondylosis |
|Herniated disk |
|Posttraumatic compression by fractured or displaced vertebra or hemorrhage |
|Arteriovenous malformation |
|Antiphospholipid syndrome and other hypercoagulable states |
|Multiple sclerosis |
|Neuromyelitis optica |
|Transverse myelitis |
|Sjögren's syndrome myelopathy |
|Systemic lupus erythematosus |
|Viral: VZV, HSV-1 and -2, CMV, HIV, HTLV-I, others |
|Bacterial and mycobacterial: Borrelia, Listeria, syphilis, others |
|Mycoplasma pneumoniae |
|Parasitic: schistosomiasis, toxoplasmosis |
|Tethered cord syndrome |
|Vitamin B12 deficiency (subacute combined degeneration) |
|Copper deficiency |
Transverse section through the spinal cord, composite representation, illustrating the principal ascending (left) and descending (right) pathways. The lateral and ventral spinothalamic tracts ascend contralateral to the side of the body that is innervated. C, cervical; D, distal; E, extensors; F, flexors; L, lumbar; P, proximal; S, sacral; T, thoracic.
Sensory symptoms often include paresthesias; may begin in one or both feet and ascend. Sensory level to pin sensation or vibration often correlates well with location of transverse lesions. May have isolated pain/temperature sensation loss over the shoulders ("cape" or "syringomyelic" pattern) or loss of sensation to vibration/position on one side of the body and pain/temperature loss on the other (Brown-Séquard hemicord syndrome).
Motor symptoms are caused by disruption of corticospinal tracts that leads to quadriplegia or paraplegia with increased muscle tone, hyperactive deep tendon reflexes, and extensor plantar responses. With acute severe lesions there may be initial flaccidity and areflexia (spinal shock).
Autonomic dysfunction includes primarily urinary retention; should raise suspicion of spinal cord disease when associated with back or neck pain, weakness, and/or a sensory level.
Pain may be present. Midline back pain is of localizing value; interscapular pain may be first sign of midthoracic cord compression; radicular pain may mark site of more laterally placed spinal lesion; pain from lower cord (conus medullaris) lesion may be referred to low back.
SPECIFIC SIGNS BY SPINAL CORD LEVEL
Approximate indicators of level of lesion include the location of a sensory level, a band of hyperalgesia/hyperpathia at the upper end of the sensory disturbance, identification of isolated atrophy or fasciculations, or lost tendon reflex at a specific spinal cord segment.
Lesions Near the Foramen Magnum