Spinal Emergencies
Introduction
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
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.
-
Neurologic exam must include
careful scrutiny for a segmental level of loss of neurologic function. Loss
of function may be solely present on the sensory exam. However, all
modalities, motor, sensory, cerebellar, and reflexes (including rectal exam)
must be performed. Prognostically those patients with sacral sparing have
the potential for better outcome. Because of loss of bowel and bladder
function which often, if not always, follows spinal cord dysfunction,
catheterization may be necessary.
DispositionTherapy 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.
Reviewed and revised by CDR Robert Heim,
MC, USN, Neurosurgery Specialty Leader and Staff Neurosurgeon, National Naval
Medical Center, Bethesda, MD. (1999).
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Preface
· Administrative Section
· Clinical Section
The
General Medical Officer Manual , NAVMEDPUB 5134, January 1, 2000
Bureau
of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C.,
20372-5300
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