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Identifying Spinal Cord Compression - Key Red Flags

Identifying Spinal Cord Compression - Key Red Flags. Including a Summary of a Recent Presentation by Sue Greenhalgh & Colleagues, Bolton Orthopaedic CATS Dr Nick Pendleton. Significant Event Reviews.

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Identifying Spinal Cord Compression - Key Red Flags

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  1. Identifying Spinal Cord Compression - Key Red Flags Including a Summary of a Recent Presentation by Sue Greenhalgh & Colleagues, Bolton Orthopaedic CATS Dr Nick Pendleton

  2. Significant Event Reviews • Case reviews of the consultation histories of patients diagnosed at a late stage with sinister back pain have shown that Red Flags were present at an early stage • Wider knowledge of Key Red Flags for sinister back pain could lead to earlier diagnosis and a better outcome for the patient • Sinister causes of back pain include Metastatic Disease and Spinal Abscesses

  3. Spinal Cord Anatomy

  4. The Cauda Equina • The cauda equina is formed by nerve roots distal to the level of spinal cord termination (Usually L1/L2). Cauda equina syndrome is caused by compression of these nerves • Compression can occur by trauma, vertebral fracture or displacement, disc herniation, a tumour or metastatic deposit or an abscess • Because permanent neurological damage can occur early identification and urgent treatment is critical

  5. Cauda Equina Syndrome Low back pain and: • Bladder dysfunction, usually retention. • Sphincter disturbance • Saddle anaesthesia • Lower limb weakness • Gait disturbance • Urgent referral is mandatory

  6. Metastatic Spinal Cord Compression (MSCC)

  7. Metastatic Spinal Cord Compression (MSCC) • Can happen at any level of the spinal cord • A search of the literature has shown that 163 Red Flags for sinister back pain have been identified! • ‘Which of these are most useful for identifying MSCC at an early stage?’

  8. Early Warning Signs ofMetastatic Spinal Cord Compression • Referred pain that is segmental or band-like • Escalating pain which is poorly responsive to treatment (including medication) • Different character or site to previous symptoms • Funny feelings, odd sensations or heavy legs (multi-segmental) • Lying flat increases pain • Agonising pain causing anguish & despair • Gait disturbance, unsteadiness, especially on stairs (not just a limp) • Sleep grossly disturbed due to pain being worse at night Greenhalgh & Selfe 2009

  9. Metastatic SpinalCord Compression • NB- Established motor/sensory/bladder/bowel disturbances are late signs • Past Medical History of Cancer (but note 25% of patients do not have a diagnosed primary) • Early Diagnosis is Essential as the prognosis is much worse once paralysis occurs • A Combination of Red Flags increases suspicion (the greater number of red flags the higher the risk and the greater the urgency) • To access the MSCC guidelines go to www.gmccn.nhs.uk • NHS Greater Manchester and Cheshire Cancer Network Greenhalgh & Selfe 2009

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