1. spinal cord
Disease
Dr. Kifah Alubaidy

2. Relevant anatomy

3. spinal cord level relative to vertebral bodies
Upper cervical same level
lower cervical level higher
Upper thoracic level higher
Lower thoracic level higher
Lumber T10 –T12
Sacral T12 – L1
Coccygeal L1

4. Relevant anatomy

5. Relevant anatomy

6. Relevant anatomy

7. Relevant anatomy

8. Relevant anatomy

9. Relevant anatomy

10. Intramedullary syndrome

11. Relevant anatomy

12. Brown- Sequard hemicord syndrome

13. Anterior two-third syndrome
Preserve position vibration touch

16. Relevant anatomy Patterns of spinal cord disease
Brown- Sequard hemicord syndrome
Central cord syndrome
Anterior two-third syndrome
Intramedullary and extramedullary syndrome

18. Relevant anatomy Level of the lesion
A level below which the sensory, motor, and autonomic function were disturbed.

19. Relevant anatomy Level of the lesion
The upper most level is localized by segmental signs
Hyperalgesia or hyperpathia
Fasciculation, atrophy and weakness of the muscle innervated by the segment and diminished or absent deep tendon reflex

20. Relevant anatomy

21. Signs below the lesion
Autonomic ( urinary retention, constipation, ileus, hypothermia, hypotension, bradycardia)
Upper motor neuron sign ( hemiplegia and/or hemiparesis sparing the face, paraplegia and/or paraparesis, tetraplegia and/or tetraparesis)
Sensory ( lack of sensation at a certain level, hemisensory loss) symptoms.

22. Relevant anatomy Specific localizing signs
Near junction with medulla oblongata
Extensive : Quadriplegia + Vasomotor and respiratory collapse (Involvement of medullary centers)
partial : Crural paresis
Compression near the foramen magnum clockwise or anti – clockwise paresis of limbs

23. Relevant anatomy Specific localizing signs Higher cervical
Quadriplegia
Respiratory paralysis

24. Relevant anatomy Specific localizing signs C4-C5 Quadriplegia
Normal respiratory function

25. Relevant anatomy
Specific localizing signs C5-C6 Relative sparing of shoulder muscles loss of Biceps and Brachioradialis reflexes Lower limbs weakness (paraplegia)

26. Relevant anatomy Specific localizing signs C7
Weakness of the finger and wrist extensors
absent Triceps reflex

27. Relevant anatomy Specific localizing signs C8
Weakness of the finger and wrist flexion
loss of finger flexor reflex
Paraplegia
At any cervical level (may occur)
Ipsilateral Horner`s syndrome
Lhermitte sign

28. Relevant anatomy Specific localizing signs Thoracic cord Sensory level
Beevor`s sign
Medline back pain
Paraplegia

29. Relevant anatomy Specific localizing signs L2-L4
Weakness of flexion and adduction of the thigh and knee extension
Absent patellar reflex
Absent cremastric reflex (L1-L2)
Babnisky extensor planter

30. Relevant anatomy Specific localizing signs L5-S1
Weakness of thigh extension and paralyze foot & ankle
Absent ankle reflex

31. Relevant anatomy Specific localizing signs
Sacral cord & conus medullaris
Bladder & bowel dysfunction
impotence
Saddle anesthesia
Absent balbocavernosus(S2-S4)
Absent anal(S4-S5) reflexes

32. Relevant anatomy Specific localizing signs Cauda equina
Sever low back or radicular pain
Asymmetric leg weakness & sensory loss
Variable areflexia
Relative sparing of Bladder & bowel function

33. Causes Compressive Epidural, intradural, or intramedullary neoplasm
Epidural abscess
Epidural hemorrhage
Cervical spondylosis
Herniated disc
Trauma

34. Causes Vascular Ischemia AVM Inflammatory Transverse myelitis
Multiple sclerosis
vasculitis

35. Causes Infections H simplex 2 Bacterial Parasitic Developmental
Syringomyelia

36. Causes
Metabolic
Subacute combined degeneration
Degenerative

37. Investigations
Spine x-ray & CXR
MRI
CSF
S. B12

38. Investigations

39. Investigations MRI

40. Investigations
MRI

41. Compression of the spinal cord
Commonest spinal cord emergency
It is reversible in the early stage
Clinically presented as a cute – chronic extramedullary or Brown – sequard syndrome

42. Compression of the spinal cord
Vertebral (80%)
Trauma
Intervertebral disc metastasis
(breast, prostate, bronchus)
Myeloma TB

43. Compression of the spinal cord
Meninges (15%)
Tumor
(Meningioma, neurofibroma ependymoma, metastasis, lymphoma leukemia)
Epidural abscess

44. Compression of the spinal cord
Tumours
(Glioma, ependymoma, metastasis)

45. Compression of the spinal cord
MRI

46. Compression of the spinal cord

47. Compression of the spinal cord
Management
Surgical decompression
Radiotherapy

48. spondylosis
Cervical
Degeneration of the Intervertebral disc & secondary osteoarthrosis
Mainly C6, C7, &C5 radiculopathy
Myelopathy (compression or ant. spinal artery occlusion)

49. spondylosis Cervical Myelopathy

50. spondylosis Lumber Lumbago ( recurrent low back pain)
Mainly S1, L5, & L4 radiculopathy

51. spondylosis Management Bed rest Back strengthening exercises
Local anesthesia or steroid injection

52. spondylosis Management Surgical decompression conservative failure
progressive
central disc prolepses
sphincter disturbance

53. Spinal canal stenosis Congenital narrowing Old age Exercise induced
weakness & paraesthesia in the legs
(cauda equina claudication)
Extensive lumber laminectomy

54. syringomyelia
Fluid –filled cavity near the centre of spinal cord due to CSF flow obstruction
Congenital (Chiari type I malformation)
Basal arachnoiditis
trauma

55. syringomyelia Age 20 – 40 Slowly progressive neck & shoulder pain
Central cord syndrome
Pain & temperature sensory loss in the upper limbs as hemicape
Atrophic lesions (painless ulcers) in the UL
LMN signs in the UL & UMN in the LL

56. syringomyelia Associated anomalies Kyphoscoliosis Pes cavus
Spina bifida
syringobulbia

57. syringomyelia
Management
Surgical decompression

58. Transverse myelitis
Acute or subacute monophasic inflammation of the spinal cord
40% antecedent infection or vaccination
No causative microorganism
An autoimmune reaction is the cause
Demylination (Multiple sclerosis)
vasculitis

59. Transverse myelitis Clinical features local neck or back pain
variable asymmetric
parasthesia
Sensory loss
Motor weakness

60. Transverse myelitis
MRI

61. Transverse myelitis CSF
Lymphocytic pleocytosis several hundred / MicroL
Protein normal or elevated
Oligoclonal band (Multiple sclerosis)

62. Transverse myelitis
Treatment
Methylprednisolone
prednisolone