Presentation

all common all less common

♦ Bone involvement from cancer—breast

—thyroid —kidney —bladder —bowel —melanoma

♦ Initial presentation of malignancy—prostate, breast, myeloma.

♦ Crush fracture or tumour extension common.

♦ Occasional direct extension from retroperitoneal, mediastinal tumours e.g. lymphoma.

♦ Occasional extra-dural compression in absence of bone involvement.

♦ Occasional intra-medullary metastases.

♦ 66% of cases occur in the thoracic cord.

Table 32.1 Spinal cord compression syndromes Complete compression

Sensory level just below level of lesion Loss of all sensory modalities — may be variable at onset Bilateral upper motor neurone weakness below lesion Bladder and bowel dysfunction

Anterior compression

Partial loss of pain and temperature below lesion Bilateral upper motor neurone weakness below lesion Bladder and bowel dysfunction

Posterior compression

Loss of vibration and position below lesion Relative sparing of pain,temperature,and touch Band of dysthaesia at level of lesion

Lateral compression (Brown-Sequard syndrome)

Contralateral loss of pain and temperature (touch relatively spared) Ipsilateral loss of vibration and position Ipsilateral upper motor neurone weakness

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