Spinal Emergencies

Department of the Navy
Bureau of Medicine and Surgery

Non-traumatic neurosurgical emergencies of the spine frequently are caused by masses. These masses more often than not are benign. However, because of their location, and due to pressure (usually chronic) upon the spinal cord, these lesions can be extremely foreboding. Specifically outlined here are nontraumatic spinal cord emergencies.

Spinal cord compression due to tumors

Many patients with spinal cord compression due to tumors will give a long-standing history of pain. Tumors of the spinal canal are divided conveniently by their radiologic appearance: intramedullary, intradural-extramedullary, and extradural. Again considering the radiologic capabilities of most ships, the radiologic abnormalities noted in these lesions are least likely in intramedullary lesions and most likely in extradural lesions when examined with plain radiographs. Since intradural-extramedullary lesions are usually benign (meningioma or neural sheath tumors), x-ray changes show chronic changes: scalloping of the vertebral bodies, enlargement of neural foramina, or chronic erosive changes of the vertebral pedicals. X-ray changes with intramedullary tumors are rare.

Vascular abnormalities of the spine may present with the acute onset of severe pain, and loss of neurologic function. Injury to the spinal cord occurs directly upon the spinal cord or indirectly due to mass effect from hematomas.

Cauda Equina Syndrome

Another not uncommon cause for spinal dysfunction may be an acute cauda equina syndrome, caused by a huge extruded disk fragment which may entirely fill the canal. Many times these patients give a history of stretching or bending which is followed by excruciating pain. Loss of bowel and bladder function is an ominous sign and dictates emergency evaluation and therapy. Frequently a sensory or motor function level can be established.

Therapy for these lesions is the same. Rapid transfer to a medical facility is of the utmost importance. With tumors, initial boluses with megadose steroids (Decadron, 100 mg initially followed by 25 mg q 6 hrs) may be beneficial. In addition, if plain films reveal instability, stabilization on a spine board or collar should be accomplished before transfer. Catheterization should be performed to avoid bladder distension. Serial examinations and recording should be performed to determine whether progression has occurred.