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Introduction
SPINAL CORD DISORDERS• AETIO-PATHOGENESIS & CLINICAL FEATURES
PRESENTED BY DR. AGHO E. JMBBS (AAU)
Outline• Epidemiology• Classification of spinal cord disorders• Pathophysiology
Epidemiology• Epidemiology of spinal cord disorders is perculiar to
specific diseases entity, for example Low back Pain of spinal origin is a common presentation in young Americans below the age of 45yr.
ctn• Cervical spondylotic changes occur naturally with aging, it
appears radiologically in about 90% of the population aged 65 or older.
• Cauda equina syndrome acct for 1-2% of patients with intervertebral disc herniation and occur in 7/100000 per/yr
classification
• Compressive Vs Non Compressive• Acute Vs sub-acute and chronic • Etiology
Classification
Spinal cord disordersMyelopathy due to degenerative and Structural spine Diseases
a) Cervical spondylotic myelopathiesb) Thoracic and lumbar spondylosisc) Syringomyeliad) Hirayama Disease
ctn Vascular myelopathiesa. Spinal cord infarctionb. Spinal dural arteriovenous fistulac. Intramedullary arteriovenous malformationd. Cavernous angiomae. Vasculitisf. Epidural hematomas
ctn
Metabolic and Toxic causes of myelopathy
a. Nutrient deficiency myelopathies•Vitamin B12 •Folic acid•Copper•Vitamin E
ctnb. Toxic myelopathies• Nitrous oxide• Heroin• Konzo (cassava)• Neurolathyrism• Radiation
Myelopathy associated with micro-organismsa. Viruses• HIV 1• Herpes 1&2• VZV• EBV• CMV• Rubella• Mump
a. Bacteria• M. tuberculosis• Treponema pallidum• Listeria monocytogenes• Brucella species
a. Fungi• Aspergillus fumigatum• Cryptococcus neoforma• Candida species• Coccidioides immitis• Blastomyces dermatitidis
a. Parasites• Taenia solium• Toxoplasma gondii• Trypanosoma cruzi• Echinococcus granulosis
Immune-mediated myelopathiesa. Transverse myelitis• Due toMultiple sclerosis (MS)Neuromyelitis optica
Mixed connective tissue disordersSarcoidosisAcute demyelinating encephalomyelitisparaneoplastic
Neoplastic myelopathiesa. Direct involvement of the spinal cord by neoplasm• Intradural intramedullary (parenchymal)i. Primary spinal cord tumorsEpendymomaAstrocytomahemagioblastoma
ctn
ii. Metastatic • Intradural extramedullaryPeripheral nerve sheath tumorMeningiomaSchwannomaneurofibromasLeptomeningeal metastasis
Extradural Extramedullary• metastasis Breast CA, Lung CA, MM• hematoma• TB spine
ctnb. Indirect involvementRadiation injuryChemotherapy injuryParaneoplastic
ctn
Disorders of cauda Equina.Diskogenic Cauda Equina Compression
Cauda equina syndrome
CTN
Nondiskogenic Cauda Equina Disorders
Traumatic Neoplastic
Ctn
Infectious Iatrogenic.Other structural etiologya. Dural arteriovenous fistulab. Dutal ectasiac. Epidural lipomatosis
Pathophysiology• Cervical spondylotic myelopathy; • The development of cervical spondylotic myelopathy is
due to a combination of factors which include external compression from spondylotic canal stenosis, biomechanical stretch and vascular factors.
• Spondylosis refers to age related degenerative changes of the spine
ctn• It begins with dessication of the intervertebral discs,
bulging or herniation of the disc material, • Osteophyte formation along the vertebral endplates, this
combine with the degenerative disc to form osteophytic bars which impinge on the spinal cord.
• Calcification of the posterior longitudinal ligament may also compress the cord ventrally, while ligamentum flava pathology may compromise cord .
Clinical features of spinal cord disorders
• Cervical spondylotic myelopathy Presents with;Progressive gait dysfunctionNeck stiffnessVague sensory changes in lower extremetiesDifficulty performing fine motor functionsProximal limb weakness
ctnParaesthesia of the hands, shoulder, subscapular regionsBladder disturbance; incontinence,retention, Spastic gaitIncreased tone, ankle clonus, hoffman and babinski sign
positive, hyperreflexiaLarge fibre sensory loss if posterior column is affected
with reduced stability
Anterior horn cell involvement manifest as segmental lower motor n. finding
Location Sign and symptoms
Cervical spine
Headache or neck, shoulder, or arm painBreathing difficultiesLoss of sensation in the armsMuscle weakness in the neck, trunk, arms, and handsParalysis involving the neck, trunk, arms, and hands.Lhermites sign
Thoracicspine
Pain in the chest and/or backLoss of sensation below the level of the tumorIncreased sensation above the level of the tumorMuscle weaknessParalysisPositive Babinski reflexBladder and bowel problemsSexual dysfunction
Lumbosacralspine
Low back pain that may radiate down the legs and/or perineal areaWeakness in the legs and feetParalysis in the legs and feetLoss of sensation in the legs and feetBladder and bowel problemsSexual dysfunctionFoot dropDecreased or absent reflexes in the legs
C/FCONUS MEDULLARIS CAUDA EQUINA
Sudden and bilateral onset Gradual and unilateral onset
Radicular pain less prominent
Radicular pain more prominent
More low back pain Less low back pain
Symmetric, distal, hyperreflexicparesis
Asymmetric, areflexic paraplegia
Symmetric, bilateral, typicallyperianal area sensory loss,sensory dissociation occurs
Asymmetric, typically saddlearea, no sensory dissociation
Early sphincteric signs Late sphincteric signs
Management• Investigations• Diagnosis• Treatment.