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Spinal Cord Compression

Spinal Cord Compression. Surgical Students ’ Society of Melbourne Presentation Felicity Victoria Connon. Spinal Cord Compression Cervico -medullary junction  Conus medullaris +/- cauda equinae. Lesions are: Extradural (80%) Intradural , extramedullary (15%) Intramedullary (5%).

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Spinal Cord Compression

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  1. Spinal Cord Compression Surgical Students’ Society of Melbourne Presentation Felicity Victoria Connon

  2. Spinal Cord Compression Cervico-medullary junction  Conusmedullaris +/- caudaequinae Lesions are: Extradural (80%) Intradural, extramedullary (15%) Intramedullary (5%) http://myradnotes.wordpress.com/category/tumor/ http://indyspinemd.com/Images/normalAnat/coloredSpine.jpg

  3. Causes of Spinal Cord Compression

  4. Presentation - Pain • Subacute Chronic • Pain • Muscles • Bone • Segment/central • Nerve root http://www.dheerajbojwani.com/images/spinal-nerve.jpg http://www.patient.co.uk/images/OM1314b.jpg

  5. Presentation – Altered Sensation and Power

  6. Presentation – Altered Sensation and Power http://rezidentiat.3x.ro/eng/lombalgiaeng.files/image010.gif

  7. http://www.ortho.pe.kr/upload/ank_spond02.jpg Investigations • MRI • Definitive Ix • Spinal X-rays • Erosion, destruction, collapse • Scalloping,  IV space • Myelography • CT (intrathecal contrast) http://www.urmc.rochester.edu/smd/Rad/neurocases/Case34/Fig3.jpg

  8. Management – Neurosurgical Emergency Conservative Specific Malignancy Extramedullary/Vertebral Laminectomy (post.) Vertebrectomy + fusion (ant.) XRT, chemo Intramedullary: Macroscopic excision XRT + Dexamethasone • Rest • Weight loss • Epidural steroid injections • Analgesia, anti-inflammatories • Muscle relaxants • Physiotherapy

  9. Management • Spinal canal stenosis • Laminectomy • Discectomy • Foramenectomy • ACDF • Abscess • Drainage +/- decompression • Antibiotics • AVM • Dural: nidus excision or venous obliteration • Intradural http://img.springerimages.com/Images/Springer/PUB=Springer-Verlag-Berlin-Heidelberg/JOU=00586/VOL=2009.18/ISU=S2/ART=2009_895/MediaObjects/WATER_586_2009_895_Fig2_HTML.jpg

  10. References • Essential Neurosurgery, Kaye, 3rd ed.,2005, Blackwell Publishing • Neurology and Neurosurgery Illustrated, Lindsay & Bone, 4th ed., 2004, Churchill Livingstone • www.uptodate.com • Treatment and prognosis of neoplastic epidural spinal cord compression, including caudaequinae. Schiff et al, 2010 • Anatomy and localisation of spinal cord disorders, Eisen et al, 2010

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